Indirect Ventral Brainstem Decompression by Posterior C1-C2 Distraction and Fixation for Basilar Invagination

Abstract

Objective: Basilar invagination usually shows a decrease of clivus axis angle (CAA), which could give rise to progressive neural compression. Exploring a safe and effective fixation technique to achieve atlantoaxial stability and neural decompression remains necessary. In this study, we introduce a modified posterior C1-C2 distraction and fixation technique by which we obtained indirect ventral neural decompression and atlantoaxial stability in a series of patients with decreased CAA.

Methods: Thirty patients of basilar invagination were enrolled in our series. All patients underwent thin-slice computed tomography (CT) scan, magnetic resonance imaging, and dynamic plain radiography examinations before surgery, at discharge and during the follow-ups. Posterior C1-C2 facet joint release and intraoperative reduction by fastening rods were performed in all patients. The CAA was measured on midsagittal CT scans. Patients' neurologic status was evaluated by the Japanese Orthopaedic Association score.

Results: No neurovascular injury and serious postoperative complication occurred in all patients. Complete ventral brainstem decompression was achieved in 20 patients and partial in 10 patients. The mean postoperative CAA significantly improved to 132.6 degrees compared with the preoperative 123.6 degrees (P < 0.01). The bone fusion was confirmed in all patients on the basis of the last follow-up spine CT scans.

Conclusions: Indirect ventral brainstem decompression by posterior C1-C2 distraction and fixation is a safe and effective technique for treatment of basilar invagination.

Keywords: Atlantoaxial dislocation; Basilar invagination; C1-C2 distraction and fixation; Craniocervical junction malformation; Ventral brainstem decompression.