Siroya Hardik Lalit, Bhat Dhananjaya Ishwar, Devi Bhagavatula Indira, Shukla Dhaval P, Sathyaprabha Talakad Narasappa, Alekhya Thota Sai Laxmi
Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India.
Department of Consultant Neurosurgeon, ASTER Hospital, Bengaluru, Karnataka, India.
J Craniovertebr Junction Spine. 2022 Oct-Dec;13(4):439-453. doi: 10.4103/jcvjs.jcvjs_117_22. Epub 2022 Dec 7.
Craniovertebral junction (CVJ) anomalies involve mosaic interaction of multifaceted neurovascular and bony elements. Most of them present late in the course of illness usually as acute presentations following trivial trauma. Knowing subclinical autonomic dysfunction in such anomalies when managed medically can not only indicate progression but also provide en route to early intervention for better outcomes, especially in relatively asymptomatic patients.
We conducted a 6-year longitudinal prospective study including 40 consecutive patients of CVJ anomalies with clinical, radiological, and heart rate variability (HRV) parameters and found their correlation in preoperative and follow-up period.
Twenty-eight patients were male and the rest were female. The mean age was 32 years with the least age being 8 years and maximum age being 75 years old. Mean Nurick's grade and Barthel's index were 1.8 and 83.75, respectively. 38% had severe-to-moderate compression. The mean follow-up was 17.4 months. Both sympathetic and parasympathetic oscillator HRV indices were significantly affected in the preoperative period ( ≤ 0.001) with no association with Nurick's grade or degree of compression although there was association with grade of Barthel's index. Poincare plots showed "fan," "complex," or "torpedo" patterns in 36 patients. Forty patients had both preoperative and follow-up clinical grade whereas 22 patients HRV tests in the above periods. None of the HRV indices showed significant improvement at follow-up. Nonetheless both sympathetic and parasympathetic did improve at follow-up with sympathetic tone registering better scores. Poincare plots showed improvement toward "comet" patterns in all patients.
HRV indices not only help in prognosticating but may also help in predicting outcomes.
颅颈交界区（CVJ）异常涉及多方面神经血管和骨质成分的复杂相互作用。它们大多在病程后期出现，通常表现为轻微创伤后的急性症状。在对这类异常进行药物治疗时，了解其中的亚临床自主神经功能障碍不仅可以指示病情进展，还能为早期干预提供途径以获得更好的治疗效果，尤其是对于相对无症状的患者。
我们进行了一项为期6年的纵向前瞻性研究，纳入了40例连续的CVJ异常患者，记录其临床、放射学和心率变异性（HRV）参数，并分析术前和随访期间这些参数之间的相关性。
28例患者为男性，其余为女性。平均年龄为32岁，最小年龄为8岁，最大年龄为75岁。平均Nurick分级和Barthel指数分别为1.8和83.75。38%的患者存在重度至中度压迫。平均随访时间为17.4个月。术前交感神经和副交感神经振荡器HRV指标均受到显著影响（≤0.001），与Nurick分级或压迫程度无关，但与Barthel指数分级有关。庞加莱图显示36例患者呈现“扇形”“复杂型”或“鱼雷型”模式。40例患者有术前和随访时的临床分级，22例患者在上述时期进行了HRV测试。随访时，HRV指标均未显示出显著改善。尽管如此，交感神经和副交感神经在随访时均有改善，交感神经张力得分更高。庞加莱图显示所有患者均向“彗星型”模式改善。
HRV指标不仅有助于预后评估，还可能有助于预测治疗结果。
