Abstract
To propose an independent radiological index to evaluate surgical outcomes of A type basilar invagination, a retrospective study was conducted to compare the clinical outcome between procedures 1 and 2 by applying intraoperative consistent traction and manual reduction. Moreover, the atlantodental interval (ADI), cervicomedullary angle (CMA), bilateral sagittal inclination of atlantoaxial joint (SIAA) were measured and compared to pre-operation. Postoperatively, only these patients undergoing procedure 2 achieved significant neurological improvement. The ADIs and the SIAAs decreased in both groups, these differences are statistically significant between pre- and post- operation. For postoperative CMAs, only these patients undergoing modified surgery gained significant improvement of angle with mean 141°. We concluded that the CMA or SIAA could be a radiological predictor to evaluate surgical outcome in BI, among which the CMA is a more independent and easily measurable predictor that is closely correlated with satisfactory neurological improvements. Moreover, procedure 2 with intraoperative resistant cranial traction and manual reduction can help us achieve a good CMA.
Highlights
To propose an independent radiological index to evaluate surgical outcomes of A type basilar invagination, a retrospective study was conducted to compare the clinical outcome between procedures 1 and 2 by applying intraoperative consistent traction and manual reduction
Type A basilar invagination is characterized by atlantoaxial instability, accompanied by dislocation of the odontoid process into the foramen magnum according to the Chamberlain and Wackenheim lines[3]
This study investigated the correlation between these variations of anatomic parameters and surgical outcomes to screen out a reliable evaluation predictor for the treatment of type A basilar invagination
Summary
The Ethics Committee of our hospital approved this study, and signed informed consent was provided by all patients for their information to be stored in the hospital database and used for research. A retrospective study was conducted to compare differences in clinical outcomes between procedures 1 and 2 by applying intraoperative consistent traction and manual reduction. Cervical radiographs, MRI and CT scans with three-dimensional reconstructions were performed, and changes in related imaging parameters, including the CMA and SIAA (bilateral side), were evaluated both at preoperative and the final point of follow-up. The other 15 patients underwent procedure 2 at the latest time, in which consistent cranial traction were used both in preoperative and in intraoperative period and intraoperative manual reduction was conducted. The details of this procedure is described below. Variable VAS (average) ASIA Scale ASIA score sensation (light touch) ASIA score sensation (pin prick) ASIA score motion ADI (MM) CMA Left SIAA Right SIAA
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