Комплексна оцінка хірургічних, клінічних та радіологічних результатів при аномаліях краніо-вертебрального переходу з базилярною інвагінацією та атлантоаксіальною дислокацією: початковий досвід 5 випадків

Objective: The craniovertebral junction (CVJ) plays a pivotal role in stabilizing and facilitating movement within the craniospinal axis. This study aimed to evaluate the clinical, radiological characteristics and surgical outcomes in patients with CVJ anomalies associated with basilar invagination and atlantoaxial dislocation. Materials and methods: A retrospective analysis of five patients with CVJ anomalies, who underwent surgical management at Sardar Vallabhbhai Patel (SVP) Hospital, Ahmedabad, Gujarat, India. They were analyzed for clinical characteristics, radiological parameters and various surgical procedures. Patient's clinical and radiological status was assessed pre- and postoperatively at discharge and at 6 months of follow-up. Nurick grading system and Modified Japanese Orthopedic Association (mJOA) score was used. Radiological assessment was done by atlantodental interval (ADI), craniobasal angle, and craniometric lines. Results: Most patients presented with neck pain, followed by motor weakness as the second most common symptom, while sensory deficits were the least frequent. Congenital atlantoaxial dislocation was the most prevalent CVJ anomaly observed. Clinically, significant postoperative improvements were observed in both Nurick grade and Modified Japanese Orthopedic Association (mJOA) score. Radiological findings showed a reduction in the atlanto-dens interval (ADI), a less acute clivus-canal angle, and downward movement of the odontoid process in the postoperative period. All cases had favorable postoperative outcomes, with no mortality reported at the one-year follow-up, and the condition of all patients stabilized. Conclusion: Favorable outcomes were achieved through posterior fixation without anterior exposure in selected cases. The key to achieving excellent clinical and radiological outcomes with minimal complications lay in a thorough preoperative evaluation, timely surgical intervention, and the selection of an individualized surgical technique.