Introduction: craniovertbral Junction anomalies present unique challenges especially in pediatric population. Many new theories about anomalies like instability of lateral mass and Prof Atul Goel’s recent proposition that Atlanto Axial instability being cause of Chiari malformation have provided new insights into this complex problems. We hypothesise that in view of multiple anatomical substrates involved and also growing bones may present dynamic progressing problems
Methods: Thirty five pediatric cases were studied, 21 had Irreducible AAD with 10 having basilar invagination. 5 had reducible AAD and 4 traumatic AAD. One of the Traumatic AAD child had congenital Anomaly which was uncovered by trauma. About 12 patients had significant disabling myelopathy. Eight patients had cord changes and 4 had syrinx complicating the problem. Eleven presented with quadriparesis. Eleven patients needed distraction realignment with spacers and fixation surgery. Two had tranoral odontoidectomy and Occipitocervical fixation surgery.
Results: Out of these, 5 patients who had C1C2 fixation surgery needed resurgery. 2 needed additional occipital fixation and 3 Occipital and subaxial fixation surgery. Both patients who had transoral surgery done needed revision realignment surgery with spacers and occipitocervical fixation. One patient who had foramen magnum decompression for chiari with syrinx had worsening of syrinx after 3 years. She was treated by atlanto axial fixation. She had complete resolution of syrinx after fixation. In all 8/35 patients needed resurgery.
Conclusions: Inclusion of occiput for fixation may provide additional stability and prevent telescoping of dens. In patients with recurrent syrinx possibility of sub clinical Instability should be evaluated. Surgeon and patient should be open to the fact that these patients may more than one surgery regardless of type.
Patient Care: To recognise and thereby prevent possible complications
Learning Objectives: To learn about unique features of Pediatric Cranivertebral Junction Pathologies
Learn to tackle different Challenges