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. 2020 Nov 27:13:127-133.
doi: 10.1016/j.jcot.2020.11.016. eCollection 2021 Feb.

Surgical outcomes of posterior occipito-cervical decompression and fusion for basilar invagination: A prospective study

Ruchir Patel  1 , Anil M Solanki  1 , Apurv Acharya  1
Affiliations

Surgical outcomes of posterior occipito-cervical decompression and fusion for basilar invagination: A prospective study

Ruchir Patel et al. J Clin Orthop Trauma. .

Abstract

Study design: A Prospective Study.

Objective: To assess results of posterior occipito-cervical decompression and fusion operated with intra-operative traction/manipulation and instrumented reduction in cases of Basilar Invagination(BI).

Methods: Total 22 patients of 8-65 years with diagnosed BI were operated for posterior occipito-cervical fusion by intra-operative traction/manipulation and instrumented reduction. Fusion was done using autologous bone graft taken from iliac crest. Immediate post-operative, first month and then every 3 months' follow-up examination were done for minimum period of 2 years.

Results: 22 patients (10 males,12 females) with mean age of 23.9 years having BI were included. 11 patients had C1 occipitalization, 4 had platybasia and 9 had atlanto-axial dislocation (AAD). 1 patient with os odontoideum with kyphotic deformity expired on 4th postoperative day due to respiratory insufficiency (mortality rate 4.54%). Neurological improvement by at least by one grade according to RANAWAT's and/or NURICK'S scale was observed in 17/21 patients (80.95%). 3 patients remained static and 1 had neuro-worsening. Mean mJOA score of 13.14 improved to 16.24. All had reduction of dens below foramen magnum according to McRae, chamberlain line and Ranawat index. Bone graft fused in all patients as confirmed with CT scan and dynamic X-rays. 1 wound dehiscence and 1 asymptomatic implant loosening were seen on follow-up.

Conclusion: Surgical treatment of BI with intra-operative traction/manipulation, instrumented reduction and posterior occipito-cervical fusion can achieve good correction of radiology, functional performance and clinical neurology as well as excellent fusion rates without adverse effects of trans-oral surgery.

Keywords: Basilar invagination; Decompression and fusion; Occipito-cervical; Posterior.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Case example showing excellent outcome with our surgical procedure.
Fig. 2
Fig. 2
Clinical image showing post-op wound dehiscence and exposed implant.
Fig. 3
Fig. 3
Follow-up X-ray of patient with loosening of the implant from occiput bone (asymptomatic).
See this image and copyright information in PMC

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