Faheem Mohd, Jaiswal Manish, Ojha Bal K, Chandra Anil, Singh Sunil K, Srivastava Chhitij
Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Etawah, India.
Department of Neurosurgery, King George's Medical University, Lucknow, India.
World Neurosurg. 2018 Sep;117:e612-e630. doi: 10.1016/j.wneu.2018.06.099. Epub 2018 Jun 21.
Craniovertebral junction diseases, although considered rare, are common in northern parts of India. This study was conducted to evaluate the clinico-radiologic and surgical outcome of patients with a minimum follow-up of 1 year. Our study also compared bony fusion among various techniques of posterior fusion.
This retrospective study was performed with 38 patients who met the inclusion criteria for analysis. These patients were contacted by telephone and letters, and their clinical examination and radiologic investigations were performed at a follow-up visit. The preoperative, postoperative, and follow-up clinical evaluations of the patients were done using the Nurick grading system.
The age range was 4-60 years with an average of 20.5 years. There were 31 male and 7 female patients, with a male:female ratio of 4.43:1. There were 13 cases of fixed atlantoaxial dislocation (AAD), 17 cases of mobile AAD, 6 cases of traumatic AAD, and 2 cases of postinfective AAD. The majority of these patients (n = 29; 76.31%) had neck pain and cerebellovestibular disturbances (n = 27; 71.1%). Sphincter disturbances were observed in 9 patients. An increase in craniovertebral angle was observed in postoperative period in all patients. Initially, 84% of the patients had a poor Nurick grade; this was reduced to 28% after the surgical intervention. One hundred percent bony fusion was attained in patients who underwent rigid fixation technique, and 80% was attained using a semirigid fixation technique.
The key to successful management of craniovertebral junction disease is individualized selection of judicious surgical intervention from various available techniques.
颅颈交界区疾病虽被认为罕见，但在印度北部却很常见。本研究旨在评估随访至少1年的患者的临床放射学及手术结果。我们的研究还比较了各种后路融合技术的骨融合情况。
本回顾性研究纳入了38例符合分析纳入标准的患者。通过电话和信件联系这些患者，并在随访时进行临床检查和放射学检查。采用Nurick分级系统对患者进行术前、术后及随访临床评估。
年龄范围为4至60岁，平均20.5岁。男性31例，女性7例，男女比例为4.43:1。固定性寰枢椎脱位（AAD）13例，可动性AAD 17例，创伤性AAD 6例，感染后AAD 2例。这些患者中大多数（n = 29；76.31%）有颈部疼痛和小脑前庭功能障碍（n = 27；71.1%）。9例患者出现括约肌功能障碍。所有患者术后颅颈角均增大。最初，84%的患者Nurick分级较差；手术干预后这一比例降至28%。采用刚性固定技术的患者实现了100%的骨融合，采用半刚性固定技术的患者实现了80%的骨融合。
成功治疗颅颈交界区疾病的关键是从各种可用技术中明智地选择个体化手术干预。
