Posterior Reduction and Fixation of Atlantoaxial Dislocation by Distraction, Compression, and Extension Reduction (DCER) Technique: Clinical and Radiological Outcome

Background: In the past two decades, the surgical management of the anterior atlantoaxial dislocation (AAD) was shifted from the two-stage operation of transoral decompression and posterior fixation to the single-stage posterior approaches. This study evaluates the clinical and radiological outcomes of the distraction, extension, compression, and reduction (DCER) technique in AAD patients, aiming to reduce, realign, and alleviate craniocervical compression through a single-stage posterior approach. Methods: This retrospective observational study included 14 patients with post-traumatic and developmental AAD, operated on by the DCER technique between January 2017 and January 2024, and followed up for at least 12 months after surgery. The neurological outcome was evaluated using the VAS score for neck pain and Nurick grading for myelopathy. The extent of reduction, screws’ position, and bone fusion were assessed by plain X-rays and CT scans with thin-slice axial cuts and reconstructed views at the same visits, while decompression was evaluated by an MRI examination performed three months after surgery. Results: The mean Nurick score at one year after surgery was 1.29 ± 0.47 (1–2), representing a significant improvement from the mean preoperative Nurick score of 3.57 ± 0.65 (3–5) (P value < 0.05). The mean VAS score for neck pain at one year after surgery was 2.2 ± 1.1 (1–3), representing a significant improvement from the mean preoperative VAS score for neck pain of 8.3 ± 1.2 (7–10) (P value < 0.05). Neither neurological deterioration nor mortality was observed in the postoperative period. The anterior displacement was successfully reduced in 14 cases (100%). Conclusion: For the reduction of AAD, DCER is a posterior-only, one-stage, effective, and safe approach. The DCER technique reduces the atlantoaxial dislocation, while also ensuring firm long-term stability provided by the rod-screws system dorsally and the spacers within the facet joints.