Evaluation of Different Techniques in the Management of Craniocervical Instability El-Ghandour Nasser M.F.1, Abdalraheem Yasser Ahmed2,*, Ahmed Hany Mohamed2, Nazim Wael Mohamed2, Zein-Elabedin Mostafa1 1Neurosurgery Department Faculty of Medicine, Cairo University, Cairo, Egypt 2Neurosurgery Department Faculty of Medicine, Beni-suef University, Egypt *Corresponding Author: Dr. Yasser Ahmed Abdalraheem Lecturer at Neurosurgery Department, Faculty of Medicine, Beni-suef University, Egypt, Email: yasserneuro2020@gmail.com
Online published on 4 April, 2020. Abstract Objectives Evaluation of clinical picture and results of occipitocervical and atlanto-axial fusion with craniocervical instabilities Patients and Method The investigation included 22 patients, 14 males (63.6%) and 8 females (36.4%). Ages ranged (10 to 70) years. Instability resulted fromfracture of the odontoid process in 8 cases(36.4%), transverse atlantal ligament injury with C1 C2 sub laxation in 6 cases(27.3%), osodontodium in 4 cases(18.2%), Morquio's syndrome in 2 cases(9%), C2 Hangman's fracture type III one case(4.5%), and transverse atlantal ligament injury associated with sub axial sublaxation in one case(4.5%). Trauma was the most common cause of instability (73%). Single hollow titanium anterior odontoid screw was done in 4 cases (18, 2%), posterior atlanto-axial fixation in 12 patients(54.5%) three of them (25%) needed trans oral odontoidectomy prior to fixation, fixation was performed from C1to C4 in one patient(4.5%), and occipitocervical fixation in 5 patients(22.7%). Postoperative Philadelphia neck collar was applied for 8–12 weeks. Results Postoperative clinical evaluation revealed good outcome of neurological ASIA grading. 10 patients improved (45.5%), while 11 patients (50%) remained at the same ASIA score as pre-operative, and only one patient (4.5%) deteriorated from ASIA score D to A. Pain and neck disability scores reduced postoperatively compared to preoperative. Fusion was achieved in 18 cases (81.8%) at last follow-up. Instrumentation failure occurred in only 2 cases (9%). Three mortality cases due to respiratory problems (2cases died in the first week after surgery and the third case died one month after the surgery). Top Keywords Craniocervicalinstability, Occipitocervical fusion, Odontoidscrew, Trauma. Top |