Clinical and radiological outcomes after surgical stabilization of craniovertebral junction – A single-center experience

Abstract

Background and Objectives: Craniovertebral instability and its surgical management require a thorough knowledge of the anatomy and dynamics of the craniovertebral junction (CVJ). Due to the wide range of mobility and proximity of vital neurovascular structures, these surgeries demand high technical skill and precision. It is very difficult to suggest a single good technique for CVJ stabilization as each procedure has got its own indications and benefits. Novel techniques and gadgets like neuro navigation and robotic arms help surgeons to minimize complications, thereby improving the overall functional outcome. In this study, we are analyzing the retrospective data of CVJ instabilities surgically managed by freehand technique in our institute. Materials and Methods: We did a retrospective analysis of 33 patients operated on for craniocervical junction instability for 7 years from January 1, 2015, to December 31, 2021. We analyzed the clinical and radiological presentations and postoperative outcomes at 3 weeks, 6 months, and after 1 year. The distribution of clinical presentation in terms of neck pain, myelopathy, restricted neck movements, and lower cranial nerve palsy was evaluated and correlated with the demographic parameters. The paired “t”-test was used to correlate the clinical and radiological outcomes after surgery. Results: The paired “t” value of the clinical improvement assessed with the preoperative and postoperative Japanese Orthopedic Association (JOA) myelopathic scores was − 4.376 with P < 0.001, which indicates a significant clinical improvement 6 months after surgery. Among the 33 patients evaluated, only three patients developed a slight reduction in the JOA score after surgery, which was improved within 1 year. All the patients achieved satisfactory trabecular bone formation at the graft site and decorticated joint facets without any clinical or radiological evidence of implant failure. Among the C2 pedicle screws, 3 (7.5%) were having vertebral foraminal impingement, and 2 (5%) were having medial cortical violation and spinal canal impingement. All the patients with radiological evidence of implant malposition were clinically intact and did not show any deterioration of the studied myelopathic score (JOA). Conclusions: As the bony anatomy and the vascular course of the CVJ vary from patient to patient, thorough preoperative planning is mandatory for the surgical management of CVJ instability. In our study, the clinical and radiological improvement after surgical stabilization of craniovertebral instability by freehand technique is comparable with the available data. The overall risk of screw malposition and associated lethal complications may be minimized by adding modern technologies such as neuronavigation, robotic arms, and three-dimensional C-arm in the armamentarium.

Keywords

• c1-c2 fixation
• craniovertebral junction instability
• craniovertebral junction stabilization