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Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion.
Spine (Phila Pa 1976). 2011 Sep 01; 36(19):1528-31.S

Abstract

STUDY DESIGN

This retrospective study was conducted to analyze the radiographic and clinical results in seven patients with primary basilar invagination who accepted a combination of continuous cervical traction before operation and posterior screw/rod system reduction together with occipitocervical fusion.

OBJECTIVE

To evaluate the radiographic and clinical outcomes of this treatment regimen in combination of continuous cervical traction and posterior instrumented reduction with pedicle screw/rod system.

SUMMARY OF BACKGROUND DATA

Primary basilar invagination poses considerable difficulties in the surgical management regarding surgical approach, reduction, and decompression. A variety of methods have been described to treat primary basilar invagination and all methods existed limits.

METHODS

There were four male and three female patients, and the ages ranged from 12 to 40 years (average age, 22.3 yr). Six patients presented neurologic deficits. The Nurick scale was from 1 grade to 4 grades (average, 2.7 grades). The distance of the odontoid tip in relation to Wackenheim line, atlantodental interval, Klaus height index, craniospinal angle, modified Omega angle, and cervicomedullary angle were measured pretreated and after surgery. When the tip of odontoid process was inferior or approximate to Wackenheim line and McRae line after cervical traction, the operation of reduction and fixation should be accepted.

RESULTS

After surgery, the mean Wackenheim value and atlantodental distance were reduced 9.3 mm and 2.0 mm, respectively. The mean Klaus height index, craniospinal angle, Omega angle, and cervicomedullary angle improved 6.5 mm, 17.0°, 11.6°, and 27.4°, respectively. All postoperative data had a significance compared with pretreatment data (P < 0.05). There was a tendency that younger patients were able to obtain more ideal reduction than adults. Of six patients with neurologic symptoms, five patients were normal or nearly normal. All patients achieved solid fusion.

CONCLUSION

This case series demonstrates a safe, easy, and effective treatment regimen for the patients with primary basilar invagination.

Authors+Show Affiliations

Spine Section/Department of Orthopaedic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21270707

Citation

Peng, Xinsheng, et al. "Treatment of Primary Basilar Invagination By Cervical Traction and Posterior Instrumented Reduction Together With Occipitocervical Fusion." Spine, vol. 36, no. 19, 2011, pp. 1528-31.
Peng X, Chen L, Wan Y, et al. Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. Spine (Phila Pa 1976). 2011;36(19):1528-31.
Peng, X., Chen, L., Wan, Y., & Zou, X. (2011). Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. Spine, 36(19), 1528-31. https://doi.org/10.1097/BRS.0b013e3181f804ff
Peng X, et al. Treatment of Primary Basilar Invagination By Cervical Traction and Posterior Instrumented Reduction Together With Occipitocervical Fusion. Spine (Phila Pa 1976). 2011 Sep 1;36(19):1528-31. PubMed PMID: 21270707.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. AU - Peng,Xinsheng, AU - Chen,Liyan, AU - Wan,Yong, AU - Zou,Xuenong, PY - 2011/1/29/entrez PY - 2011/1/29/pubmed PY - 2012/2/16/medline SP - 1528 EP - 31 JF - Spine JO - Spine (Phila Pa 1976) VL - 36 IS - 19 N2 - STUDY DESIGN: This retrospective study was conducted to analyze the radiographic and clinical results in seven patients with primary basilar invagination who accepted a combination of continuous cervical traction before operation and posterior screw/rod system reduction together with occipitocervical fusion. OBJECTIVE: To evaluate the radiographic and clinical outcomes of this treatment regimen in combination of continuous cervical traction and posterior instrumented reduction with pedicle screw/rod system. SUMMARY OF BACKGROUND DATA: Primary basilar invagination poses considerable difficulties in the surgical management regarding surgical approach, reduction, and decompression. A variety of methods have been described to treat primary basilar invagination and all methods existed limits. METHODS: There were four male and three female patients, and the ages ranged from 12 to 40 years (average age, 22.3 yr). Six patients presented neurologic deficits. The Nurick scale was from 1 grade to 4 grades (average, 2.7 grades). The distance of the odontoid tip in relation to Wackenheim line, atlantodental interval, Klaus height index, craniospinal angle, modified Omega angle, and cervicomedullary angle were measured pretreated and after surgery. When the tip of odontoid process was inferior or approximate to Wackenheim line and McRae line after cervical traction, the operation of reduction and fixation should be accepted. RESULTS: After surgery, the mean Wackenheim value and atlantodental distance were reduced 9.3 mm and 2.0 mm, respectively. The mean Klaus height index, craniospinal angle, Omega angle, and cervicomedullary angle improved 6.5 mm, 17.0°, 11.6°, and 27.4°, respectively. All postoperative data had a significance compared with pretreatment data (P < 0.05). There was a tendency that younger patients were able to obtain more ideal reduction than adults. Of six patients with neurologic symptoms, five patients were normal or nearly normal. All patients achieved solid fusion. CONCLUSION: This case series demonstrates a safe, easy, and effective treatment regimen for the patients with primary basilar invagination. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/21270707/Treatment_of_primary_basilar_invagination_by_cervical_traction_and_posterior_instrumented_reduction_together_with_occipitocervical_fusion_ L2 - https://doi.org/10.1097/BRS.0b013e3181f804ff DB - PRIME DP - Unbound Medicine ER -