Evaluation and Surgical Planning for Craniovertebral Junction Deformity.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Craniovertebral junction (CVJ) deformity presents significant challenges, leading to myelopathy, pain, and functional deficits.
• The complex anatomy and neurovascular relationships make surgical access to the CVJ difficult.

Purpose of the Study:

• To discuss craniovertebral junction alignment.
• To review various surgical strategies for managing CVJ deformities.
• To explore methods for complication prevention and outcome improvement.

Main Methods:

• Evaluation of CVJ reducibility, alignment, and compression direction.
• Surgical strategies include posterior in situ fixation for reducible deformities.
• Osteotomy and C1-2 facet release with vertical reduction for rigid deformities or primary C1-2 facet joint pathology.

Main Results:

• Posterior in situ fixation is viable for reducible CVJ deformities.
• Osteotomy may be required for rigid deformities with fixed C1-2 facet joints.
• C1-2 facet release is effective for specific CVJ kyphotic deformities and basilar invagination.

Conclusions:

• Surgical strategy for CVJ deformity depends on reducibility and specific pathology.
• Techniques like posterior fixation, osteotomy, and facet release offer tailored solutions.
• Careful planning and execution are crucial for successful CVJ deformity management and complication avoidance.