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. 2018 Jun;160(6):1243-1250.
doi: 10.1007/s00701-018-3523-y. Epub 2018 Mar 26.

Predictive factors of neurological recovery after chronic craniovertebral brainstem compression

Aymeric Amelot  1   2 , Louis-Marie Terrier  3 , Guillaume Lot  4
Affiliations

Predictive factors of neurological recovery after chronic craniovertebral brainstem compression

Aymeric Amelot et al. Acta Neurochir (Wien). 2018 Jun.

Abstract

Background: Neurologic manifestations of craniovertebral junction (CVJ) disease may generate dramatic brainstem damage, which could evolve to paralysis. In most cases, patients are referred with advanced neurological symptoms such as tetraplegia/paresis. The aim of this study was to identify predictive factors of favorable neurological evolution after non-traumatic brainstem compression.

Methods: A prospective study evaluated 143 consecutive patients who had undergone CVJ anterior brainstem decompression. The mean age was 45.1 ± 19.1 years. The study analyzed clinical, surgical, and imagery characters to determine predictive factors of neurological improvement.

Results: The mean follow-up of our series was 10.2 years (range 0.5-23.9). Seventy-one (49.6%) presented initial tetrapalsies resulting from spinal cord compression. Multivariable analysis revealed that Frankel score [odds ratio (OR) 5.7, CI 95% 1.01-31.8; p < 0.04] and preoperative symptoms < 6 months [OR 0.33, CI 95% 0.125-0.9; p < 0.025] were independently associated with partial neurological improvement, while the only independent factor associated with total neurologic recovery was the preoperative symptom evolution <6 months [odd ratio (OR) 4.3, CI 95% 1.6-11.4; p < 0.003]. None of the following were identified as predictive factors: demographic characteristics, medical history, the etiology of compression, or initial spinal cord MRI.

Conclusion: The earlier the decompression is performed, the better the neurological improvement. Whatever the initial Frankel score, if neurological palsy or disorders evolved for less than 6 months, complete recovery is possible.

Keywords: Craniocervical junction; Franckel score; Neurological recovery; Palsy; Predictive factors; Surgery.

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