The inflammatory processes in craniovertebral region: clinical signs, diagnostics and surgical treatment strategy

Abstract

Objective: to determine the features of clinical manifestation, diagnostic methods and surgical strategy in treatment of craniovertebral junction (CVJ) spondylitis of various etiology. Material and methods: we present the surgical treatment outcomes at 37 patients with CVJ spondylitis, among them 19 patients had tuberculous spondylitis and 18 - spondylitis of nonspecific etiology. Results: the inflammatory injuries of CVJ had pathobiomechanic and morphological features in accordance with stage and localization of pathological process. These peculiarities should be classified according to developed three-column pathobiomechanic model of inflammatory processes in craniovertebral region. The middle column is the main one whose damage degree influences on segment stability. The preservation of support structures determines the choice of surgical strategy as well as method and extent of surgical intervention. It is necessary to create the posterior support complex using occipitospondylodesis in the case of inflammatory processes of CVJ with the damage of first support column while the injury of anterior and middle support columns require the performing of two support complexes by the way of simultaneous occipitospondylodesis and anterior craniovertebral or atlantoaxial stabilization by autograft after transoral removal of inflammatory focus. Conclusion: the suggested strategy of surgical treatment of CVJ spondylitis allowed achieving favorable outcomes in all cases with reversal of neurological signs and formation of bone ankylosis in atlantoaxial area with reconstruction of support ability of cervical spine.