A novel classification and algorithmic-based management of craniovertebral junction osteoarthrosis.

INTRODUCTION: The objective of this study is to propose a novel classification and algorithmic-based management plan for craniovertebral junction osteoarthrosis (CVJOA). MATERIALS AND METHODS: A retrospective study was done based on prospective database of radiological studies and clinical history. Twenty symptomatic patients (12 females and 8 males) with a mean age of 54.8 years were identified with CVJOA. These patients underwent either nonsurgical treatment only or surgical intervention and had follow-up of at least 14 months. Classification of CVJOA is based on coronal deformity, rigidity, stability, and two modifiers. The main surgical procedures done in the surgical arm of these patients included C1-C2 fusion, C1-C2 facet distraction and fusion, and unilateral subaxial facet distraction, and posterior column osteotomy. RESULTS: All the twenty patients included in this study complained of either sub-occipital or upper neck pain and had radiological evidence of CVJOA. Seven patients improved with nonsurgical management and 13 underwent surgical intervention. Surgical recommendations for each type of CVJOA have been described with case examples, and algorithm for the management of CVJOA has been developed based on this study. Interobserver agreement on CVJOA classification was measured using kappa value statistics which showed moderate strength of agreement (0.467). CONCLUSION: This study describes a novel classification and management of CVJOA based on algorithm and current surgical recommendations for each type of CVJOA.

Three-dimensional biomodel use in the surgical management of basilar invagination with congenital cervical scoliosis; correction by unilateral C1-C2 facet distraction.

Biomodels are produced using three-dimensional printers and their use in complex spine surgeries can be quite helpful, especially when complex anatomy is faced. In this case report, we presented a 14-year-old patient who had rigid congenital cervical scoliosis and basilar invagination and abnormalities on a neurological examination. This patient underwent atlantoaxial facet distraction and C1 C2 fusion while using a biomodel of his craniocervical junction in pre-operative planning and also as an anatomical reference per-operatively. Using biomodel in this case helped in achieving favorable surgical outcomes without any perioperative complications. Postoperative assessments including coronal deformity, basilar invagination, and neurological examination showed significant improvements and we recommend using biomodels in complex atlantoaxial distraction procedure to achieve favorable surgical outcomes with minimum complications.