A novel classification and management scheme for craniocervical junction disorders with ventral neural element...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Radiology

Background:

• Craniocervical junction (CCJ) pathologies causing ventral neural element compression are not well understood.
• Accurate classification and nomenclature are needed for effective management of these complex disorders.

Purpose of the Study:

• To evaluate patients with ventral CCJ compression to identify anatomical clusters.
• To better classify CCJ disorders with ventral compression and guide treatment strategies.

Main Methods:

• Retrospective review of 51 adult and pediatric patients with ventral CCJ compression (2008-2022).
• Assessment of anatomical abnormalities and compressive etiologies.
• Association rules analysis (ARA) to identify variable clustering and surgical outcomes.

Main Results:

• Identified three major clusters: 1) retroflexed dens, platybasia, Chiari malformation; 2) basilar invagination (BI), C1-2 subluxation, reducibility; 3) degenerative pannus.
• BI cases often showed reducible C1 anterolisthesis (steep C1-2 facet angle).
• Endonasal decompression with posterior fixation was the most common surgical approach (94%), with 88.9% symptom improvement.

Conclusions:

• Classifying CCJ ventral compression into anatomical clusters aids in treatment selection.
• Endonasal decompression with posterior fixation is ideal for bony and pannus compression.
• Posterior reduction/fixation is preferred for reducible BI with favorable anatomy.