The Study Of Classification And Posterior Cervical Surgery Approach Treatment Of Cranio-cervical Junction Malformations

BackgroundThe disease progression of cranio-cervical junction malformations is not only caused by the congenitial abnormities of embryonic development,but also is affected by posterior changes in pathophysiology and biomechanics.It has many forms and multiple malformations coexist in most cases.Surgical treatment is still the first choice for most types of cranio-cervical junction malformations with corresponding typical clinical symptoms.Posterior decompression and reset orthopedic fixation technology now gradually become the mainstream of the surgical procedures.ObjectiveThe classification and surgical management of cranio-cervical junction malformations is still controversial.Our study aims to discuss the new classification and individualized surgical treatment of this disease by reviewing large numbers of clinical cases.MethodsThe clinical data of 110 cases with cranio-cervical junction malformations underwent surgical treatment were collected by neurosurgery department of Shandong Provincial Hospital from March 18,2012 to December 24,2016.Among them 31 are male and 79 female.The age ranges from 12 to 67 years.We attempt to divide the cranio-cervical junction malformations into four types according to the clinical presentation and definite imaging diagnosis.A type:Chiari malformation type;B type:atlantoaxid dislocation;C:basilar impression.In addition,some cases have coexisted malformations combined with syringomyelia.The surgical techniques include decompression technology,orthopedic reduction technology,internal fixation technology,simple posterior fossa decompression and joint orthopedic reduction and internal fixation surgical procedure.The patients were followed up for 3-48 months to observe their symptom alleviates,the preoperative and postoperative clinical symptoms and complications and all cases were assessed on Lavender and Symon clinical standard and Japanese Orthopaedic Association Score for Cervical.We used statistical methods to analyze the clinical data and then discussed the curative effect of posterior cervical surgery approach.ResultsAmong all the cases,patients with surgical treatment were 102;simple posterior decompression were 50;including 31 cases of epidural decompression in patients and 19 patients with subdural decompression;44 patients with posterior decompression and occipitocervical fusion;patients with occipital cervical fusion by posterior decompression in 8 patients.According to the Lavender and Symon clinical standard;within 3 months after operation,the total efficiency is 86.27%,after more than 6 months the total efficiency is 92.16%;based on Japanese Orthopaedic Association Score for Cervica:after 3 months of treatment in the improvement rate is 83.17%,after more than 6 months the improvement rate is 84.04%.The postoperative clinical standard and Japanese Orthopaedic Association Score for Cervical was significantly improved and the preoperative and they had significant correlation.Posterior cervical surgery approach treatment could improve the postoperative clinical standard and Japanese Orthopaedic Association Score for Cervical of patients who suffered cranio-cervical junction malformations with a significant statistical value(P<0.005).ConclusionsThe plexy craniocervical junction malformations may be fully assessed based on different clinical manifestations and thorough imaging studies.Then personalized operative plans are to be designed.It can significantly improve the prognosis of patients,reduce postoperative complications and improve the quality of life of patients.Posterior cervical approach decompression surgery is an effective and reasonable treatment for cranio-cervical junction malformations.Decompression technique and principle of fixation and fusion are still controversial,We need more clinical data to demonstrate..The reduction,fixation and fusion of the posterior approach can solve most of the orthopedic problems of cranio-cervical junction deformity.It is safe and effective and can be considered as the first choice.SignificanceBased on the clinical presentation and definite imaging examination of cranio-cervical junction malformations,the new clinical classification method in cranio-cervical junction malformations and individualized posterior cervical surgery approach strategy may have some significance in the selection of and may improve the prognosis of patients.