Analysis on the therapeutic effect of different neurosurgical approaches for cranio-cervical malformation

HUANG Gang; ZHNAG Wei; SUN Gangfeng; WANG Zhengjun; JI Xituan

Abstract：Objective The clinical effect of three approaches to cranio-cervical malformation surgery was discussed.Methods Six hundreds and ninety patients with cranio-cervical malformation who accepted operations were included in the study.Pre-operative Japanese Orthopedic Association (JOA) score evaluation of the patients was 3～13 (average value was 8.20 ±4.34).Posterior internal fixation using occipital screws combined with axis pedicle screws was performed in 390 patients,posterior atlanto-axial pedicle screw reduction and internal fixation was completed in 210 patients.In addition,90 patients were only treated with surgical removal of arcus posterior atlantis and foramen magnum posterior margin.The therapeutic effect was assessed by post-operative clinical symptoms,JOA score and imaging.Follow-up was obtained for all the patients for a period of 1 ～ 14 months.Results Clinical symptoms of all the patients were significantly improved after surgery.Post-operative JOA score was 7 ～ 16 (average value was 12.13±3.38),which was significantly increased compared to pre-operation (t =-5.976,P =0.002).Moreover,cervical CT scanning showed all the screws were well in position including 485 patients with atlanto-axial luxations totally restored,and MRI showed the spinal cord shape was improved at 3 d after operation.Three dimensional CT scanning showed that the result of occipital/interbody fusion was satisfactory and MRI suggested that 512 syringomyelia cases disappeared or were evidently ameliorated at 3 months following surgery.Conclusion The stability of cranio-cervical malformation should be considered as a key factor for the neurosurgical approach choice for a better therapeutic effect.