Introduction: Craniocervical fixation is a surgical challenge due to proximity of neurovascular structures and the wide range of motion of this region, hampering bone fusion.Craniocervical instability can originate from congenital causes,in adults,it is primarily seen in the setting of acute trauma or degenerative changes.Also,neoplasm & infection have been found to be an additional cause of instability.A variety of techniques have been described to reduce anatomic risk and improve results
Methods: Prospective study conducted on 20 cases underwent craniocervical posterior fixation using screw-rod technique admitted in Alexandria hospital. All cases underwent clinical evaluation pre & postop.;For myelopathic cases the mJOA score was used.Age ranged from 16 to 63yrs with a mean of 40.25yrs including 12(60%) males and 8(40%) females.The etiology included trauma in 12 cases(60%),tumor in 3 cases(15%),Rh.A in 3 cases(15%)and Down syndrome in 2 cases(10%)
Results: All cases presented with neck pain(100%), 13 cases with myelopathy and a neurological deficit(65%).3 cases were mJOA grade III(15%),7 cases were grade II(35%),6 cases were grade I(30%) & 4 cases were normal(20%).The mean follow up period was 14.1 mths.By the end of follow up period, 2 cases were mJOA grade III(10%),1 case was grade II(5%),11 cases were grade I(55%)and 6 cases were normal(30%).The difference between mJOA pre- and postop. was P=0.004;3 cases(15%)caused by tumor were improved,2 cases(10%)caused by Down syndrome were stationary,1 case(5%) caused by Rh.A was improved & 2 cases(10%)were stationary.6 cases(30%)caused by trauma were improved & 6 cases (30%)were stationary.Total of 10 cases(50%)were improved,10 cases(50%)were stationary.The mean blood loss was 385 ml.,and the mean op. time was 215.7 min.;complications,CSF leak in 1 case,neurological deficit in 2 cases,wound infection in 3 cases
Conclusions: •Posterior fixation using screw-rod technique is indicated in the management of craniocervical instability resulting from trauma,tumor,Rh.A and congenital anomalies of the craniocervical region
•Posterior fixation using this technique improves the clinical outcome
•It can be performed with high solid fusion rates and low morbidity rates
Patient Care: -Improving surgical technique.
-Decreasing mortality.
-Decreasing morbidity.
-Achieve patient satisfaction.
Learning Objectives: By the conclusion of this session, participants should be able to:
•Good knowledge of the anatomy of the craniocervical region.
•Good study of the biomechanics of the craniocervical region to exclude any form of instability.
•Thorough examination for each case including history taking and physical signs in order to reach a provisional diagnosis.
•Good selection of patients with craniocervical region instability.
•Wise planning and decision making regarding the surgical procedure.
•Good postoperative follow up of the patients for a period of time after surgery to notice improvement or any deterioration or complications related to surgery.