Treatment of craniocervical instability using a posterior-only approach

Report of 3 cases

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  • 1 Departments of Neurological Surgery and
  • 2 Orthopaedic Surgery, George Washington University Medical Center, Washington, DC
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The object of this study was to demonstrate that a posterior-only approach for craniocervical junction pathology is feasible with intraoperative reduction. The authors reviewed 3 cases of craniocervical instability. All patients had craniocervical instability according to radiological imaging and various methods of measurement, with results outside the normal range. Posterior instrumentation aided the intraoperative reduction techniques while maintaining structural integrity and the desired fusion construct. No anterior approach was necessary in any of the patients. Neurological symptoms resolved in two patients and significantly improved in another. Follow-up imaging demonstrated stable constructs.

There are many approaches to anterior cervical pathology at the craniocervical junction. Posterior instrumented reduction and stabilization of the occipitocervical spine can be safely achieved, obviating the need for a transoral approach in the setting of craniocervical junction settling.

Abbreviations used in this paper:OC = occipitocervical; RA = rheumatoid arthritis; SSEP = somatosensory evoked potential.

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Contributor Notes

Address correspondence to: Richard M. Young, M.D., 2150 Pennsylvania Ave., NW, Ste. 7-420, Washington, DC 20037. email: rmyoung@gwu.edu.

Please include this information when citing this paper: published online May 2, 2014; DOI: 10.3171/2014.3.SPINE13684.

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