Song Gyo-Chang, Cho Kyoung-Suok, Yoo Do-Sung, Huh Pil-Woo, Lee Sang-Bok
Department of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea.
J Korean Neurosurg Soc. 2010 Jul;48(1):37-45. doi: 10.3340/jkns.2010.48.1.37. Epub 2010 Jul 31.
Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability.
Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score.
Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability.
The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.
颅颈交界区（CVJ）由围绕枕骨大孔的枕骨、寰椎和枢椎组成。对于伴有颈髓压迫的不可复位CVJ病变，其死亡率和发病率较高。在一项临床回顾性研究中，作者回顾了32例CVJ不稳定患者采用多种方法进行枕颈融合的临床和影像学结果。
我科在12年中治疗了32例CVJ病变（男性18例，女性14例）。不稳定的原因包括创伤（14例）、类风湿性关节炎（8例）、寰椎融合（4例）、肿瘤（2例）、基底凹陷（2例）及其他（2例）。32例患者接受了7例前路和后路减压并枕颈融合内固定、15例后路减压并钢丝棒枕颈融合、5例C1-2经关节螺钉固定和5例C1侧块-C2椎弓根螺钉固定。结果（平均随访期38个月）基于临床和影像学检查。临床结果采用日本骨科协会（JOA）评分进行评估。
9例神经功能正常的患者术后情况保持不变。在23例颈椎病患者中，18例（78.3%）临床症状有改善。1例患者术后2个月因肺炎和败血症死亡。在最后一次随访时，27例患者（93%）实现了融合。没有患者出现新的、复发的或进行性不稳定的迹象。
作者得出结论，对于可复位的CVJ病变，建议早期进行枕颈融合；对于不可复位的颅颈交界区病变，建议进行适当的减压和枕颈融合。
