ArticleBMC musculoskeletal disorders2026
Graft position versus material in posterior atlantoaxial fusion: establishing a clinical decision hierarchy.
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal bone grafting strategy for posterior atlantoaxial fusion remains controversial, with the interplay between graft position (interlaminar vs. intra-articular) and material (allograft vs. autograft) poorly understood. We aimed to evaluate their interactive effects on clinical and radiographic outcomes.
methodsIn this single-center retrospective cohort study, 52 patients with atlantoaxial instability were categorized into three groups: Group A (n = 18, interlaminar allograft), Group B (n = 19, intra-articular allograft), and Group C (n = 15, intra-articular autograft). Primary outcomes included the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain, fusion time, and lateral mass joint space height. Analysis of covariance (ANCOVA) was used to compare final clinical scores, adjusting for baseline values.
resultsANCOVA revealed a significant main effect of group on final JOA (P < 0.001) and NDI (P = 0.003). Both intra-articular groups (B and C) demonstrated significantly better functional outcomes than the interlaminar group (A), with no difference between B and C. VAS improvement was comparable across groups (P = 0.925). Fusion time was shortest in Group C (6.34 ± 0.97 months) versus both Group A (8.83 ± 1.76, P < 0.001) and Group B (8.22 ± 1.27, P = 0.001). Intra-articular allograft achieved greater immediate joint distraction, while autograft better maintained joint height long-term.
conclusionsIn this retrospective cohort study, our findings identify a clear clinical decision hierarchy for posterior atlantoaxial fusion: graft position is the primary determinant of functional outcomes, with intra-articular grafting associated with superior neurological and functional recovery compared to interlaminar grafting. Within the intra-articular space, a material-specific clinical trade-off exists: autograft facilitates faster fusion and better joint height maintenance, while allograft provides comparable mid-term functional outcomes without harvest-site morbidity. These findings suggest that surgical strategy should prioritize intra-articular graft placement when anatomically feasible, with graft material selection individualized to patient factors and surgical priorities.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.