Surgical, Clinical, and Radiological Outcomes Analysis of Craniovertebral Junction Anomalies Cases: An Institutional Experience

Hanuman Prasad Prajapati; Ansari Mohd Ahmad; Faheem Mohd; Deepak Kumar Singh; Raj Kumar

doi:10.1055/s-0042-1758843

Surgical, Clinical, and Radiological Outcomes Analysis of Craniovertebral Junction Anomalies Cases: An Institutional Experience

Asian J Neurosurg. 2022 Dec 14;17(4):568-576. doi: 10.1055/s-0042-1758843. eCollection 2022 Dec.

Authors

Hanuman Prasad Prajapati¹, Ansari Mohd Ahmad¹, Faheem Mohd¹, Deepak Kumar Singh², Raj Kumar¹

Affiliations

¹ Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Uttar Pradesh, India.
² Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences (RMLIMS), Lucknow, Uttar Pradesh, India.

Abstract

Objective The aim of this study was to evaluate the clinical and radiological outcomes analysis of craniovertebral junction (CVJ) anomalies cases. Materials and Methods Retrospective analysis of 43 CVJ anomalies cases, which were surgically managed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India, from period between June 2015 and June 2019. They were analyzed for age, sex, clinical characteristics, radiological diagnosis, and treatment given. Patient's clinical and radiological status was assessed pre- and postoperatively during time of discharge and at 6 months of follow-up. For clinical assessment we used visual analogue scale (VAS) and Nurick grading system. Radiological assessment was done by atlantodental interval (ADI), craniobasal angle, and craniometric lines. Overall outcomes were depicted as favorable, stabilized, and mortality at 6 to 18 months (mean 12.69 ± 3.77) of follow-up. Results The age range of our cases was 7 to 71 years (mean 29.93 ± 17.39). Male-to-female ratio was 2.91:1. Majority of the cases were presented with neck pain ( n = 38; 88.37%), motor weakness ( n = 35; 81.40%), and sensory deficits ( n = 25; 58.14%). Congenital atlantoaxial dislocation ( n = 31; 72.09) was the most common CVJ anomaly. Clinically, there were significant improvements in VAS ( p = 0.001) and Nurick grade ( p = 0.007) postoperatively. Radiologically, ADI ( p = 0.003) had decreased, clivus canal angle ( p = 0.005) become less acute, and odontoid process ( p = 0.003 for McRae's line) goes downwards in postoperative period. Bony fusion was achieved in 41 (95.35%) cases. Out of 43, 73% cases had favorable outcomes, 21% were stabilized, and mortality was seen in 2.33% cases at 6 months (mean ± standard deviation = 12.69 ± 3.77) of follow-up. Conclusion Proper preoperative evaluation and selection of individualized surgical technique was the key for excellent clinical and radiological outcomes with minimal complications.

Keywords: clinical; craniovertebral junction; radiological and outcomes; surgical.

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