[Treatment policy for craniovertebral spondylitis]

The paper summarizes the results of surgical treatment in 25 patients with atlantoaxial spondylitis, including 15 with spondylitis of tuberculous etiology and 10 with nonspecific etiology. Ten patients were found to have severe neurological disorder requiring application of skeletal traction behind the malar arches in 5 cases and that of a halo-apparatus to 2 cases in order to eliminate the occurred dislocation and to relieve neurological symptoms. According to the P. Denis concept adapted for the craniovertebral region, all the patients were divided into 3 groups in relation to the degree of anatomic and biomechanical changes. Group 1 patients received medical treatment with firm collar fixation. Group 2 patients with anterior pillar injury underwent transpharyngeal sanitation of an infectious focus and occipitospondylodesis. Decompressive stabilizing operations were performed in all the patients, which consisted of two stages: 1) occipitospondylodesis made, by using a titanium wire and No. 91/198 Simplex bone cement (Howmedica, United Kingdom); 2) transoral access with abscess cavity sanitation; removal of necrotic tissues; thrifty resections of bone tissue portions within the intact tissues; anterior stabilization of the affected portion with an autologous bone graft. Postoperatively, the cervical spine was fixed with a head holder for as long as 3-5 months (until there were clear X-ray signs of bony ankylosis (block) in the area of osteoplasty). Quaternary antituberculous therapy was compulsorily made for 6-9 months. The described procedure for surgical treatment of craniovertebral spondylitis could yield positive results in all cases, by abolishing neurological symptoms and forming bony ankylosis in the atlantoaxial area to restore the supporting capacity of the cervical spine.