Treatment of craniocervical instability using a posterior-only approach: report of 3 cases.
The object of this study was to demonstrate that a posterior-only approach for craniocervical junction pathology is feasible with intraoperative reduction. The authors reviewed 3 cases of craniocervical instability. All patients had craniocervical instability according to radiological imaging and various methods of measurement, with results outside the normal range. Posterior instrumentation aided the intraoperative reduction techniques while maintaining structural integrity and the desired fusion construct. No anterior approach was necessary in any of the patients. Neurological symptoms resolved in two patients and significantly improved in another. Follow-up imaging demonstrated stable constructs. There are many approaches to anterior cervical pathology at the craniocervical junction. Posterior instrumented reduction and stabilization of the occipitocervical spine can be safely achieved, obviating the need for a transoral approach in the setting of craniocervical junction settling.
Departments of 1 Neurological Surgery and.
Richard M
RM
Young
Jonathan H
JH
Sherman
Joshua J
JJ
Wind
Zachary
Z
Litvack
Joseph
J
O'Brien
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications; D001268:Atlanto-Axial Joint / Q000503:physiopathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
OC = occipitocervical; RA = rheumatoid arthritis; SSEP = somatosensory evoked potential; basilar invagination; cervical fusion; cranial settling; craniocervical instability