ArticleJournal of orthopaedic surgery and research2025
A novel image-based classification system for atlantoaxial deformity caused by mucopolysaccharidosis type IVA: an efficacy evaluation.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
STUDY
designRetrospective Study.
objectiveType IVA mucopolysaccharidosis (MPS) is often associated with atlantoaxial deformity, and lacks a unified surgical treatment standard or classification system. We examined the value and clinical applicability of a new classification system for atlantoaxial deformities caused by type IVA MPS.
methodsIn this single-center retrospective clinical study, we analyzed 85 patients with type IVA MPS admitted between 2018 and 2022. Using the new classification system, the patients were classified as MPS A, B, C, and D according to pathological and imaging characteristics. Intra- and interobserver consistency tests were conducted by 10 independent observers. Subsequent clinical treatment was guided by the new classification system. Demographic, surgical, and clinical data were collected.
resultsThirty-nine patients with MPS A, fifteen with MPS B, seven with MPS C, and twenty-four with MPS D were included. The inter- and intra-observer k-values were 0.773 and 0.792, respectively. During the study period, seven patients with MPS A converted to MPS D, and five underwent subsequent surgery. Two patients with MPS B converted to MPS D and underwent surgery. Two patients with MPS C underwent atlantoaxial reduction and fusion fixation, and one underwent simple posterior arch resection of the atlas. Among 33 patients who underwent posterior atlantoaxial reduction and fusion fixation, 32 achieved bone fusion. Short-term complications comprised 1 case of mortality, 1 case of postoperative airway obstruction, 1 case of pain at the iliac bone graft donor site, and 2 cases of delayed wound healing. During the long-term follow-up period, no serious surgical complications have been observed to date, and the mADI value and ASIA scores of all patients improved to varying degrees.
conclusionThe new classification system has a high reliability and clinical guidance value for diagnosis and treatment planning. The surgical plans adopted based on this diagnostic classification were effective and safe.
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