Outcome analysis of surgeries around craniovertebral junction

Abstract

Background: The craniovertebral junction (CVJ) is mainly affected by various bony developmental anomalies. Other causes of compression include trauma, tumors, atlantoaxial instability, and infection (tubercular/pyogenic). We have surgically treated 38 patients of CVJ utilizing different procedures over a span of 4 years and done retrospective study. The purpose of this paper is to analyze the outcome of surgeries around CVJ. Materials and Methods: In our institution, from September 2015 to August 2019, 38 patients underwent surgeries by different methods around CVJ and a retrospective analysis was done. Clinico-radiological evaluation was done to assess the results. The neurologic recovery rate was calculated by Japanese Orthopaedic Association (JOA) score. Results: There were 31 male and 7 female patients in our study with a mean age of 49.8 years (2–86 years). Three (3) anterior surgeries, one (1) combined anterior-posterior 360o fusion, and 34 posterior surgeries including 22 atlantoaxial fixations were done. Average JOA pre-op was 11.6 (range 4–16), at last follow-up average JOA is 14.1 (range 6–16). Radiologically, fusion was achieved in all except two cases. Conclusion: We conclude that CVJ procedures are safe and effective, posterior-only surgery gives promising results with high fusion rate and neurological improvement in most of the patients.