The Validity of Artificial Tiger Bone in the Treatment of Atlantoaxial Dislocation with Osteoporosis
Authors: Shen Qingfeng , Xia Yingpeng , Fu Yuang , Ma Shibo , Li Lingbo , Jin Jinzhe 
Published: January 2022

Abstract
Objective: To evaluate the clinical efficacy and safety of the medicine, Jintiange capsule, in the treatment of atlantoaxial dislocation with osteoporosis. Methods: Between February 2017 and February 2018, a total of 58 patients diagnosed with atlantoaxial dislocation were treated by spine surgery in our hospital, Tianjin Union Medical Center. In total, 43 patients were specifically diagnosed with atlantoaxial dislocation with osteoporosis based on BMD < - 2.5SD. All 43 patients were treated with C1-2 pedicle screw rod system reduction and internal fixation via posterior cervical approach, and bilateral C1-2 inter-facet fusion combined with C1-2 inter-lamina autogenous iliac bone graft. Further, 43 patients were followed up for 16 months and enrolled in this study. Before the operation, 22 patients were randomly divided into the study group. Then from the 2nd day after the operation, these patients were treated with Jintiange capsule and calcium for 16 months, while the other 21 patients were only treated with calcium as control for 16 months. Before operation, all patients were examined with two-photon bone mineral density. Cervical CT and MRI were used to determine the compression of spinal cord. Additionally, the JOA score was used to evaluate the neurological function 2 weeks after operation and at the last follow-up. Notably, bone mineral density was used to determine the status of osteoporosis. At the last follow-up, X-ray plain film and CT were used to determine the status of bone graft fusion and whether the internal fixation was successful. VAS (visual analog scale) was also measured by one researcher, who blinded to the patients’ clinical and neurological status, to evaluate the feel of all patients before and after operation. The measurement results of all indices were analyzed by SPSS13.0. All figures were made by Prism 8.0. Results: After 16 months of follow-up, no death or reoperation case was occurred in both groups. The final BMD of the study group increased in 14 cases compared to that of cases before operation (63.6%); the control group was only 2 cases (9.5%) (P＜0.05). The JOA score was improved from 3.1±1.2 points preoperatively to 8.1±2.1 points (P＜0.0001) postoperatively and 11.9±2.1 points (P＜0.0001 ) at the final of all patients (P). The average change in JOA score was significantly greater in study group than those in control group (P＜0.01) . In the control group, 1 case had loosening of internal fixation, bone graft absorption, without deterioration of neurological symptoms. In comparison of fusion rate among the groups, there was a significant difference between the 2 groups (P＜0.01). The rate of fusion in the control group was 81.0% (17/21), while the rate of fusion was 100% in the study group (22/22). The VAS was significantly improved in both groups respectively after operation (P＜0.0001).Conclusion: Jintiange capsule combined with calcium could partly prevent the occurrence of osteoporosis after operation of atlantoaxial internal fixation. At the same time, it significantly improve the fusion rate of bone graft, and the success rate of the high difficulty operation of atlantoaxial dislocation as well as reduces the possibility of internal fixation loosening.