Structural features and diagnostics of axis maldevelopments, a differentiated choice of surgical tactics

Abstract

Purpose. To study X-ray anatomy of craniovertebral zone considering structural features of the second cervical vertebra for differential diagnosis of pathology and its variable anatomy in the clinical aspect.Materials and methods. In the period from 2004 to 2014 in the clinic 43 patients were examined, maldevelopments of the dens of the second cervical vertebra (CII) were revealed. Clinical and radiological examinations were conducted, with functional tests, CT, MRI.Results. We used differentiated approach to: fixation of CI–CII vertebrae; craniovertebral fixation involving CI–CII vertebrae; decompression of CI–CII vertebrae; decompression on craniovertebral level involving CI–CII vertebrae. After spinal cord compression riddance it’s necessary to perform locking operations. Regression of symptoms in average was 1.8 points on ASCIA scale. Long-term results were studied in terms up to 10 years, in average 3.2 years.Conclusions. Variants of axis dens development were revealed in 20% cases; in some of them there were individual development options, in others — anomalies and maldevelopments. Anomalies and maldevelopments with craniovertebral disorders or secondary pathological conditions with danger of severe neurological disorders are indications for surgical stabilization of craniovertebral, zone, suboccipital decompression and laminectomy. Features of axis dens anatomy are often misinterpreted that causes difficulty in decision about indications for use of different methods of surgical treatment and rehabilitation, prognosis and expert diagnostics.