Recent techniques in the management of craniocervical instability / Yasser Ahmed Abdelreheem Abdelkader ; Supervised Nasser Mohamed Fathy Elghandour , Mostafa Zein elabedein Ali , Wael Mohamed Nazim

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

The present study included 20 patients, 12 males and 8 females. Their ages ranged from 10 to 70 years. Instability resulted from fracture of the odontoid process in 7 cases, transverse atlantal ligament injury with C1 C2 sub laxation in 6 cases, os odontodium in 3 cases, Morquios{u2019}s syndrome in 2 cases , C2 Hangman{u2019}s fracture type III one case, and transverse atlantal ligament injury with sub axial sub laxation in one case. Trauma was the most common cause of instability. Single hollow titanium anterior odontoid screw was done in 4 cases , posterior atlanto-axial fixation in 10 patients three of them needed trans oral odontoidectomy prior to fixation, fixation was performed from C1to C4 in one patient , and occipitocervical fixation in 5 patients (occipit +C3 C4 C5 in 4 cases and occipit + C3 C4 C5 C6 in one case). Postoperative Philadelphia neck collar was applied for 8-12 weeks. Outcome Measures included radiological evaluation of successful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, and neck disability index (NDI). Evaluations were conducted preoperatively and at end of follow-up period which ranged from 4 to 8 months.Results: Postoperative clinical evaluation revealed significant improvement of neurological ASIA grading. 9 patients had improved 45% (three patients improved from ASIA score D to E, three patients from C to D, one patient from B to D, one patient from B to C, and one patient from A to C), while 10 patients 50% remained at the same ASIA score as pre-operative (5 patients were ASIA score E, 3 patients were C, and 2 patients were D), and only one patient deteriorated from ASIA score D to A. Both pain and neck disability scores decreased postoperatively compared to preoperative scores. Fusion was achieved in 15 cases (75%) at last follow-up. Instrumentation failure occurred in only 2 cases. 3 mortality cases due to respiratory problems (2cases died in the first week after surgery and the third case died one month after the surgery)

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