Surgical management of adult reducible atlantoaxial dislocation, basilar invagination and chiari malformation with syringomyelia

Abstract

ABSTRACTand nervous elements within this region, any congenital malformation of one tissue may cause a wide spectrum of neurological deficit, especially the compression of medulla oblongata, which may lead to serious consequences.Appropriate and timely diagnosis and treatment of these malformations are of great significance. However, there is still lack of an ideal method to cure all of these malformations. Anterior transoral decompression at the CVJ can occur in many types of pathology, including malformation (e.g., basilar invagination, atlas assimilation, os odontoideum, atlantoaxial █ INTRODUCTIONCraniovertebral junction (CVJ) malformations include bone, soft tissue, and neural structure malformations. AAD, BI and AOL are the most commonly encountered bone malformations, and CHM is the most common of the nervous structure malformations. The CVJ is an anatomical complex formed by the basis of the occipital bone, clivus, foramen magnum, and upper cervical vertebrae, their ligaments, and the vascular and nervous tissues passing through these bony structures (9). Because of the special relation of the bony, vascular AIM: To analyze retrospectively the surgical management of reducible atlantoaxial dislocation (AAD), basilar invagination (BI) and Chiari malformation (CHM) with syringomyelia through a single-stage posterior approach. MATERIAL and METHODS:Forty-three patients with reducible AAD, BI and CHM with syringomyelia underwent surgery from January 2009 to January 2013. Intraoperative restoration followed by posterior decompression and plate-rod placement with occipital cortical screws and C2/C3 lateral mass cortical screws fixation devices were used in all patients. Results were recorded both pre-and postoperatively and these outcome measures included Nurick grading (NG) and radiology findings (atlantodental interval (ADI), space available for the spinal cord (SAC), interval between odontoid and Chamberlain's line (IOC), and the cervicomedullary angle (CMA)). RESULTS:Forty (93%) of the 43 patients were followed up. Thirty-six (90%) patients' symptoms improved and four (10%) stabilized. No patients became progressively worse. The difference between preoperative and postoperative Nurick grades was statistically significant. All patients achieved restoration, including thirty (75%) patients had full restoration and ten (25%) had part restoration. The size of syringomyelia was obviously decreased in 32 (80%) patients and stable in 8 (20%) patients. All radiology findings (ADI, IOC, SAC, CMA) showed significant changes from pre-to postoperative (p < 0.01). CONCLUSION:Intraoperative distraction, extension combined posterior decompression with use of plate-rod-screws occipitocervical fusion device is an effective method to treat AAD, BI and CHM with syringomyelia.

Surgery for basilar invagination with and without Chiari I malformation

“…Although pediatric neurosurgeons tend to favor bony decompression for Chiari I malformations, leaving the dura intact to avoid CSF-related complications, the rates for postoperative syrinx decreases are lower with this technique compared with those involving duraplasty. 32 In basilar invagination, the rates for postoperative syrinx reductions achieved with posterior realignment and fusion alone are disappointing, with reported rates of 28.1% 9 and 31.6%, 33 whereas rates of 71.4%, 28 80%, 34 and 92.3% 35 have been obtained with additional foramen magnum decompressions including duraplasty. In the present study, syringomyelia was either reduced or stabilized in 93.3% of patients with this technique.…”

Treatment of Chiari malformations with craniovertebral junction anomalies: Where do we stand today?

“…Occipital/neck pain was reported in seven articles: 192 of 328 patients (58.5%) had symptoms of occipital/neck pain. 4 , 5 , 7 , 12 , 15 , 19 , 20 In the six articles that reported paresthesias, 221 of 307 patients (72.0%) were affected. 4 , 5 , 7 , 12 , 15 , 19 Five articles reported weakness.…”

“… 10 , 11 Studies have reported success with anterior decompression and transoral approaches, posterior decompression with or without instrumentation, craniocervical fusion, and C1/C2 joint distraction and fixation. 12 , 13 , 14 , 15 , 16 The literature on the treatment for CM-CVJA is heterogeneous; varying populations, interventions, and measured outcomes render it difficult to claim an ideal method. We therefore sought to systematically review the literature to evaluate the trends and outcomes of surgical interventions for patients with CM-CVJA abnormalities.…”

Comparative characteristic of anterior and posterior stabilization of the cervical spine during surgical interventions

“…Следует отметить, что в литературе, посвященной анализу методик фиксации, не расставляются подобные акценты (по протяженности, локализации и нозологии) [8,9,17], что подтверждает оригинальность полученных данных. Реализация этих преимуществ осуществляется только посредством непременного использования винтовой фиксации [17], которая является относительно более безопасной, даже при наличии мальпозиций элементов металлоконструкции [14,15]. Следует отметить, что, по нашим данным, задняя стабилизация имеет более низкое соотношение осложнений, в том числе имплантатозави-симых, с необходимостью ревизионных вмешательств для их устранения [18,19].…”