Türk Nöroşirürji Dergisi 2009 , Vol 19 , Num 1
Long Term Implications of Craniovertebral Junction Surgery
Haseki Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye OBJECTIVE: Trauma, degenerative disease, tumor and infections are the major causes of instability in the craniovertebral Junction (CVJ). Several surgical methods have been defined to treat pathologies of this region. Various internal fixation systems are being developed for CVJ stabilization. However, there is no totally agreed upon method for CVJ fixation systems. We present the results of a series of 25 CVJ instability cases, all of which were applied fusion via plate-screw or rod instrumentation.

METHODS: We have examined retrospectively all our surgical applications for CVJ pathologies performed in our clinic from 1998 to 2008. Craniovertebral fusion was the major means for all the cases with rigid posterior screw or plate, and rods were used otherwise. There were a total of 25 patients; of which 13 were female and 12 male. The patients' age had a range of 3 – 75 years (avg. 44.4). Average follow up duration was 48.2 months. 5 out of 25 patients had trauma (25%), 5 patients had basilar invagination (25%), 8 patients had infection – Pott Disease (32%), 4 patients had rheumatoid arthritis (16%) and 3 patients had tumor etiology (12%). 3 of the patients had unsuccessful halo application history. Postoperative follow up was performed routinely at the 1st week, 1st, 3rd, 6th months and every year.

RESULTS: Craniovertebral dislocations were corrected in all patients. There was no mortality due to surgical operations. 2 (8%) of the patients had a slight skin-deep infection. Another 2 (8%) patients who had been applied dens resection died due to late period infection. Symptoms and neurological findings improved significantly in 90% of the patients, while 10% of the total remained unchanged. Fusion level changed between occiput and C3-C4. Autograft iliac wing was used in all except 6 patients, with autograft costa used for 3 of the remaining patients and an allograft for the other 3. There was a lack of fusion instance and implant fracture in one of the patients.

CONCLUSION: Rigid internal fixation of the complex craniovertebral region has become a trustworthy technique thanks to continuous developments and analysis of occipital bone, cervical pedicule and lateral mass anatomy. In the postoperative period, cervical stiffness and postoperative cervical pain are the disadvantages, while elimination of the need for Halo application is an advantage. Fusion rate is very high. Anahtar Kelimeler : Surgery, Instability, Craniovertebral junction