Single-Stage Posterior Decompression and Occipitocervical Fusion Using a Screw-Rod-Plate System for Basilar Invagination with Anterior Spinal Cord Compression and Craniocervical InstabilityRamazan Alper Kaya1*, Kenan Kibici2, and Ali Önder Atça2
- *Corresponding Author:
- Ramazan Alper Kaya, MD
Istanbul Cad. Telekom sok
No:4 Saban Residence A Blok D7
Eyüp Göktürk 34077 Istanbul, Turkey
Tel: +90 532 3162516
Fax: +90 212 2244990
E-mail: [email protected]
Received date: May 09, 2016; Accepted date: May 16, 2016; Published date: May 18, 2016
Citation: Kaya RA, Kibici K, Atça AO (2016) Single-Stage Posterior Decompression and Occipitocervical Fusion Using a Screw-Rod-Plate System for Basilar Invagination with Anterior Spinal Cord Compression and Craniocervical Instability. J Spine 5:305. doi:10.4172/2165-7939.1000305
Copyright: © 2016 Kaya RA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Purpose: To review our experience with surgical management of basilar invagination causing foramen magnum compression, focusing on selection of the surgical approach.
Methods: Twelve consecutive patients underwent posterior foramen magnum decompression with occipitocervical fixation and fusion for treatment of basilar invagination causing brain stem compression and instability. Gentle traction and reduction during positioning of the patients also were performed. Ventral decompression (odontoid resection) was performed in none of the patients. Pre- and postoperative neurologic status was graded according to JOA and Nurick scales.
Results: All patients had anterior spinal cord compression due to cranial settling of the cervical spinal column as well as instability at the craniocervical junction. The average follow-up period was 31 months (range, 24–42 months). All patients’ JOA and Nurick scores improved after surgery, but postoperative neurologic improvement and odontoid reduction were better in patients with atlas assimilation compared with patients with other pathologies.
Conclusion: Odontoid reduction using an occipitocervical fixation system and decompression of the foramen magnum through a single-stage posterior approach is an effective treatment for basilar invagination, particularly in patients with atlas assimilation. Since odontoid reduction and foramen magnum decompression can be achieved through a single-stage posterior approach in most patients, odontoid resection should remain as a secondary procedure when these decompression efforts are insufficient.