alexa Abstract | Single-Stage Posterior Decompression and Occipitocervical Fusion Using a Screw-Rod-Plate System for Basilar Invagination with Anterior Spinal Cord Compression and Craniocervical Instability
ISSN: 2165-7939

Journal of Spine
Open Access

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Research Article Open Access

Abstract

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.

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Author(s): Ramazan Alper Kaya, Kenan Kibici, and Ali Önder Atça

Keywords

Occipitocervical fixation, Instability, Basilar invagination, Craniocervical junction anomaly, Odontoid resection, Transoral approach, Spinal Canal,Spinal Diseases,Spinal arteriovenous malformations

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