Functional outcome following surgery for craniovertebral junction pathologies

Introduction: In the past 15 years, the authors have treated 168 cases of craniovertebral junction bony lesions - 12 tuberculous lesions of C1-2, 10 traumatic dislocations of dens (3 malunited), 3 rheumatoid lesions and the rest (143) congenital bony anomalies. Methods: The results of surgical interventions performed on these 168 cases have been analysed retrospectively with emphasis on functional outcome. There was no selection bias used for this purpose. Results: All the tuberculous C1-2 cases made good recovery and returned to premorbid functional status. 7 unstable traumatic A.A.D., fixed by posterior route also returned to premorbid functional level with no residual deficit. The 3 malunited but stable A.A.D. had relief in pain but continued with their preoperative neurological deficit. The remaining 143 congenital craniovertebral junction anomalies had various types of surgeries - transoral odontoidectomy with posterior decompression and fixation (52 cases) and posterior fixation and decompression (91 cases). There were two perioperative deaths in the first group and 4 in the second group. Good functional recovery was noted in 18 of the first group and 23 of the second group. Discussion and Conclusions: In congenital craniovertebral junction bony lesions that show anterior compression, anterior decompression provides a better functional outcome. Pre-operative skeletal traction helps in reducing neurological deficit in majority of patients. Posterior decompression with fixation alone in patients with basilar invagination gives poorer functional results unless combined with anterior decompression.