Clinico-Radiological Outcome Analysis in Craniovertebral Junction Diseases: An Institutional Experience of 38 Patients in a Tertiary Care Centre.

Abstract

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.