Neurospine.  2023 Jun;20(2):498-506. 10.14245/ns.2244910.455.

Intra-articular Distraction Versus Decompression to Treat Basilar Invagination Without Atlantoaxial Dislocation: A Retrospective Cohort Study of 54 Patients

• Zhang B
• Qi M
• Xin Z
• Du Y
• Zhang C
• Liu Z
• Guan J
• Wang Z
• Jian F
• Duan W
• Chen Z

• KMID: 2543549
• DOI: http://doi.org/10.14245/ns.2244910.455

Abstract

Objective
The surgical management of basilar invagination without atlantoaxial dislocation (type B basilar invagination) remains controversial. Hence, we have reported the use of posterior intra-articular C1–2 facet distraction, fixation, and cantilever technique versus foramen magnum decompression in treating type B basilar invagination as well as the results and surgical indications for this procedure.
Methods
This was a single-center retrospective cohort study. Fifty-four patients who underwent intra-articular distraction, fixation, and cantilever reduction (experimental group) and foramen magnum decompression (control group) were enrolled in this study. Distance from odontoid tip to Chamberlain’s line, clivus-canal angle, cervicomedullary angle, craniovertebral junction (CVJ) triangle area, width of subarachnoid space and syrinx were used for radiographic assessment. Japanese Orthopedic Association (JOA) scores and 12-item Short Form health survey (SF-12) scores were used for clinical assessment.
Results
All patients in the experimental group had a better reduction of basilar invagination and better relief of pressure on nerves. JOA scores and SF-12 scores also had better improvements in the experimental group postoperation. SF-12 score improvement was associated with preoperative CVJ triangle area (Pearson index, 0.515; p = 0.004), cutoff value of 2.00 cm² indicating the surgical indication of our technique. No severe complications or infections occurred.
Conclusion
Posterior intra-articular C1–2 facet distraction, fixation, and cantilever reduction technique is an effective treatment for type B basilar invagination. As various factors involved, other treatment strategies should also be investigated.

Keyword

Basilar invagination; Reduction; Posterior approach; Fixation; Syringomyelia