Basilar invagination without atlantoaxial dislocation: treatment by correction of clivus canal angle with interfacet distraction and fixation

BMC Musculoskeletal Disorders

Research

Zhe Hou¹  Wayne Fan²  Qiang Jian³  Tao Fan³  Yinqian Wang³ 

[1] Department of Neurosurgery, Beijing Luhe Hospital, Capital Medica University, Beijing, People’s Republic of China;Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China;Faculty of Science, The University of British Columbia, Vancouver, BC, Canada;Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China;

关键词: Clivus canal angle;    Basilar invagination;    Distraction;    Fixation;   

DOI  :  10.1186/s12891-022-06102-1

 received in 2022-08-12, accepted in 2022-12-19,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThis study reports on the surgical technique used and clinical outcomes obtained during the treatment of basilar invagination (BI) without atlantoaxial dislocation (AAD) through the correction of the clivus canal angle (CCA) using interfacet distraction and fixation.MethodsNineteen cases with BI without AAD treated by the correction of the clivus canal angle were retrospectively analyzed. Pre- and postoperative computed tomography scans and three-dimensional reconstruction views were obtained to measure the size of the CCA, pB-C2 distance, and degree of BI. Chiari malformation and syringomyelia were evaluated by magnetic resonance imaging (MRI). The clinical outcomes for all patients were measured using the Japanese Orthopedic Association (JOA) scale. The CCA was corrected by using interfacet distraction and fixation techniques. The Wilcoxon test was used to compare pre- and postoperative measurements.ResultsAll the patients were followed up for 24.95 ± 5.22 months (range 12-36 months); no patient suffered intraoperative nerve or vascular injury. Clinical symptoms improved in 17 patients (89.5%). The mean JOA score increased from 12.32 ± 1.89 to 14.37 ± 1.30 (Z = -3.655, P < 0.001). The mean CCA improved from 129.34 ± 8.52° preoperatively to 139.75 ± 8.86° postoperatively (Z = -3.824, P < 0.001). The mean pB-C2 decreased from 7.47 ± 2.21 to 5.68 ± 3.13 (Z = -3.060, P = 0.002). Syringomyelia was significantly reduced in 10 out of 13 patients by the first follow-up year. All patients achieved bony fusion.ConclusionPosterior interfacet distraction and fixation to correct the CCA is a feasible and effective method for treating BI without AAD.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 9

Fig. 9