Goel Atul, Sharma Praveen
Department of Neurosurgery, King Edward Memorial Hospital, Parel, Mumbai, India.
Neurol Med Chir (Tokyo). 2005 Oct;45(10):512-7; discussion 518. doi: 10.2176/nmc.45.512.
Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. The mean duration of symptoms was 11 months. The atlantoaxial dislocation and basilar invagination were reduced by manual distraction of the facets of the atlas and axis, stabilization by placement of bone graft and metal spacers within the joint, and direct atlantoaxial fixation using an inter-articular plate and screw method technique. Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment.
2002年10月至2004年3月期间，对12例选定患者进行了寰枢关节手法治疗及颅颈区域对线恢复，这些患者年龄在14至50岁之间，包括8名男性和4名女性，患有与先天性颅颈骨异常相关的脊髓空洞症，这些异常包括基底凹陷和固定性寰枢椎脱位，其中8例还伴有Chiari I畸形。3例患者在症状出现前有外伤史。痉挛性四肢瘫和共济失调是最突出的症状。症状的平均持续时间为11个月。通过对寰椎和枢椎小关节进行手动牵引来减轻寰枢椎脱位和基底凹陷，通过在关节内植入骨 graft 和金属 spacer 来实现稳定，并采用关节间钢板和螺钉方法技术进行直接寰枢椎固定。术后所有患者在3至20个月（平均7个月）的随访期间均表现出症状改善和颅颈对线恢复。由于使用不锈钢金属板、螺钉和 spacer 进行固定，无法评估脊髓空洞症的影像学改善情况。在选定的脊髓空洞症病例中，对寰枢关节进行手法治疗并恢复解剖学上的颅颈对线可导致显著且持续的临床恢复，这可能是最佳的手术治疗方法。
