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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2020; 9(03): 157-161
DOI: 10.1055/s-0040-1712064
Original Article

Pattern of Pulmonary Dysfunctions in Craniovertebral Junction Anomaly and Its Persistence after Rigid Occipitocervical Fixation

Shaam Bodeliwala
1   Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, Delhi, India
,
Vikas Nagar
1   Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, Delhi, India
,
Hukum Singh
1   Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, Delhi, India
,
Daljit Singh
1   Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, Delhi, India
,
Anita Jagetia
1   Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, Delhi, India
,
Sharad Pandey
2   Department of Neurosurgery, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, Delhi, India
,
Rajesh Ruttala
3   Department of Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
,
Pankaj Kumar 
2   Department of Neurosurgery, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, Delhi, India
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Abstract

Introduction Despite a significant advancement in operative techniques of occipitocervical fixation, there is a poor postoperative patient outcome. This can be attributed to restrictive lung pattern in craniovertebral junction anomalies (CVJAs) patients resulting from repeated trauma to cervicomedullary junction by the pincer action of the bony anomalies and compression of the brainstem. We evaluate the changes in pulmonary function tests (PFTs) following rigid occipitocervical fixation in CVJA.

Methods PFTs of 20 CVJA patients were measured pre and postoperatively using spirometry. Measurements included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum forced mid-expiratory flow rate (FEF25–75%), and ratio of FEV1 and FVC (FEV1%). The parameters were compared with the predicted normal values based on their age and sex. PFTs were repeated on the seventh postoperative day. McCormick grading was used to assess neurological function.

Results  The values of PFTs in the preoperative period were significantly lower than predicted normal values. The mean values of FVC, FEV1, FEF25–75% were 72, 68, and 71% of their mean predicted values, with FEV1% in the range of 70 to 95% with a mean of 81.4%. Postoperatively there was further significant reduction in the mean values of FVC, FEV1, FEF25–75%, and FEV1% compared with the preoperative values. There was neurological improvement in McCormick grades of patients postoperatively (from grade III and IV to grade II).

Conclusion A significant restrictive lung disease is present in patients of CVJA, even though not clinically apparent, and it persists in the early postoperative period. However, a long-term follow-up is required to assess whether pulmonary function parameters improve subsequently.

Keywords

craniovertebral junction anomalies - rigid occipitocervical fixation - pulmonary function test


Publication History

Article published online:
10 June 2020

© 2020. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Vender JR, Rekito AJ, Harrison SJ, McDonnell DE. The evolution of posterior cervical and occipitocervical fusion and instrumentation. Neurosurg Focus 2004; 16 (01) E9
    CrossrefPubMedGoogle Scholar
  • 2 Crockard HA, Stevens JM. Craniovertebral junction anomalies in inherited disorders: part of the syndrome or caused by the disorder. ? Eur J Pediatr 1995; 154 (07) 504-512
    CrossrefPubMedGoogle Scholar
  • 3 Crockard HA. Transoral surgery: some lessons learned. Br J Neurosurg 1995; 9 (03) 283-293
    CrossrefPubMedGoogle Scholar
  • 4 Erbengi A, Oge HK. Congenital malformations oh the craniovertebral junction: classification and surgical treatment. Acta Neurochir (Wien) 1994; 127: 180-185
    CrossrefPubMedGoogle Scholar
  • 5 Menezes AH, Ryken TC. Craniovertebral abnormalities in Down’s syndrome. Pediatr Neurosurg 1992; 18 (01) 24-33
    CrossrefPubMedGoogle Scholar
  • 6 Menezes AH, VanGilder AC. Abnormalities of the Craniovertebral Junction. In: Youmans J, Becker P, Dunker S. eds. Neurological Surgery. 3rd ed.. Philadelphia PA: Saunders; 1990: 1350-1420
    Google Scholar
  • 7 VanGilder JC, Menezes AH. Craniovertebral Abnormalities and Their Treatment. In: Schmidek HH, Sweet WH. eds. Operative Neurosurgical Techniques. New York, NY: Grune and Stratton; 1982: 1221-1235
    Google Scholar
  • 8 VanGilder JC, Menezes AH. Craniovertebral Junction Abnormalities. In: Wilkins RH, Rengachary SS, eds. Neurosurgery, Vol 3. New York, NY: McGraw-Hill 1985: 2097-2101
  • 9 Garrido BJ, Myo GK, Sasso RC. Rigid versus nonrigid occipitocervical fusion: a clinical comparison of short-term outcomes. J Spinal Disord Tech 2011; 24 (01) 20-23
    CrossrefPubMedGoogle Scholar
  • 10 Vaiman M, Beckerman I. Importance of preoperative detection of vertebral artery anomalies in neck surgery. ANZ J Surg 2011; 81 (03) 164-167
    CrossrefPubMedGoogle Scholar
  • 11 Yeom JS, Buchowski JM, Park KW, Chang BS, Lee CK, Riew KD. Undetected vertebral artery groove and foramen violations during C1 lateral mass and C2 pedicle screw placement. Spine 2008; 33 (25) E942-E949
    CrossrefPubMedGoogle Scholar
  • 12 VanGilder JC, Menezes AH. Craniovertebral abnormalities: symptoms, etiology and treatment. Contemp Neurosurg 1981; 3: 1-6
    PubMedGoogle Scholar
  • 13 Fehlings MG, Errico T, Cooper P, Benjamin V, DiBartolo T. Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation. Neurosurgery 1993; 32 (02) 198-207, discussion 207–208
    CrossrefPubMedGoogle Scholar
  • 14 Lu DC, Roeser AC, Mummaneni VP, Mummaneni PV. Nuances of occipitocervical fixation. Neurosurgery 2010; 66 (suppl 3) 141-146
    CrossrefPubMedGoogle Scholar
  • 15 Nishikawa M, Ohata K, Baba M, Terakawa Y, Hara M. Chiari I malformation associated with ventral compression and instability: one-stage posterior decompression and fusion with a new instrumentation technique. Neurosurgery 2004; 54 (06) 1430-1434, discussion 1434–1435
    CrossrefPubMedGoogle Scholar
  • 16 Milhorat TH, Chou MW, Trinidad EM. et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999; 44 (05) 1005-1017
    CrossrefPubMedGoogle Scholar
  • 17 Smith JS, Shaffrey CI, Abel MF, Menezes AH. Basilar invagination. Neurosurgery 2010; 66 (Suppl. 03) 39-47
    CrossrefPubMedGoogle Scholar
  • 18 Jain VK, Mittal P, Banerji D, Behari S, Acharya R, Chhabra DK. Posterior occipitoaxial fusion for atlantoaxial dislocation associated with occipitalized atlas. J Neurosurg 1996; 84 (04) 559-564
    CrossrefPubMedGoogle Scholar
  • 19 McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72 (04) 523-532
    CrossrefPubMedGoogle Scholar
  • 20 Yu X, Li L, Wang P, Yin Y, Bu B, Zhou D. Intraoperative computed tomography with an integrated navigation system in stabilization surgery for complex craniovertebral junction malformation. J Spinal Disord Tech 2014; 27 (05) 245-252
    CrossrefPubMedGoogle Scholar
  • 21 Zausinger S, Scheder B, Uhl E, Heigl T, Morhard D, Tonn JC. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine 2009; 34 (26) 2919-2926
    CrossrefPubMedGoogle Scholar
  • 22 Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop 2009; 33 (04) 895-903
    CrossrefPubMedGoogle Scholar
  • 23 Chen L-f, Yang YYUX-gBUBXUB-nZhouD-b. Revision surgery after inappropriate posterior fossa decompression for craniocervical junction malformation [in Turkish]. Neurol Sci Physiol 2013; 30: 515-524
    PubMedGoogle Scholar
  • 24 Rosomoff HL. Occult respiratory and autonomic dysfunction in craniovertebral anomalies and upper cervical spinal disease. Spine 1986; 11 (04) 345-347
    CrossrefPubMedGoogle Scholar
  • 25 Rath GP, Bithal PK, Guleria R. et al. A comparative study between preoperative and postoperative pulmonary functions and diaphragmatic movements in congenital craniovertebral junction anomalies. J Neurosurg Anesthesiol 2006; 18 (04) 256-261
    CrossrefPubMedGoogle Scholar