OBJECT: Patients with hindbrain herniation or the so-called Chiari malformation Type I (CM-I) and/or syringohydromyelia are treated with dorsal decompression alone; however, a small percentage of patients with other associated abnormalities require concomitant dorsal craniocervical junction (CCJ) fusion. The authors surveyed the indications for CCJ fusions in this population. METHODS: A retrospective review of University of Iowa medical records and radiographs obtained between 1996 and 2005 was performed. Inclusion criteria encompassed patients with diagnoses of CM-I and/or syringohydromyelia requiring dorsal CCJ fusions, and others with CCJ abnormalities who had CM-I and/or syringohydromyelia. RESULTS: Two hundred thirty-four patients were identified, all of whom were symptomatic at presentation. Their ages ranged from 2.5 to 86 years; 33% of the patients were < 16 years of age. Patients were categorized as follows, with some being assigned to > 1 category: Group I, congenital or acquired CCJ abnormalities with reducible bone compression (25% of patients); Group II, previous anterior CCJ/upper brainstem decompression (44%); Group III, occipitocervical complex instability with CM-I and/or syringohydromyelia but without CCJ bone abnormalities requiring adjunctive posterior fossa decompression (26%); and Group IV, musculoligamentous instability, either from pathological states or from muscle dehiscence from repeated posterior fossa procedures (14%). Instrumentation was used in 96% of patients, with all 96% receiving semirigid fixation with titanium loop and sublaminar cables; all fusion constructs incorporated autologous bone. At last follow-up evaluation, fusion was radiographically complete in 97%, and symptom improvement was seen in 92%. CONCLUSIONS: Dorsal CCJ fusions are required in patients with CM-I and/or syringohydromyelia who have concomitant CCJ abnormalities (Groups I and II). A definite group (CM-I and/or syringohydromyelia) without bone abnormality exists (Groups III and IV). This may be due to muscle weakness secondary to a high syrinx.
OBJECT: Patients with hindbrain herniation or the so-called Chiari malformation Type I (CM-I) and/or syringohydromyelia are treated with dorsal decompression alone; however, a small percentage of patients with other associated abnormalities require concomitant dorsal craniocervical junction (CCJ) fusion. The authors surveyed the indications for CCJ fusions in this population. METHODS: A retrospective review of University of Iowa medical records and radiographs obtained between 1996 and 2005 was performed. Inclusion criteria encompassed patients with diagnoses of CM-I and/or syringohydromyelia requiring dorsal CCJ fusions, and others with CCJ abnormalities who had CM-I and/or syringohydromyelia. RESULTS: Two hundred thirty-four patients were identified, all of whom were symptomatic at presentation. Their ages ranged from 2.5 to 86 years; 33% of the patients were < 16 years of age. Patients were categorized as follows, with some being assigned to > 1 category: Group I, congenital or acquired CCJ abnormalities with reducible bone compression (25% of patients); Group II, previous anterior CCJ/upper brainstem decompression (44%); Group III, occipitocervical complex instability with CM-I and/or syringohydromyelia but without CCJ bone abnormalities requiring adjunctive posterior fossa decompression (26%); and Group IV, musculoligamentous instability, either from pathological states or from muscle dehiscence from repeated posterior fossa procedures (14%). Instrumentation was used in 96% of patients, with all 96% receiving semirigid fixation with titanium loop and sublaminar cables; all fusion constructs incorporated autologous bone. At last follow-up evaluation, fusion was radiographically complete in 97%, and symptom improvement was seen in 92%. CONCLUSIONS: Dorsal CCJ fusions are required in patients with CM-I and/or syringohydromyelia who have concomitant CCJ abnormalities (Groups I and II). A definite group (CM-I and/or syringohydromyelia) without bone abnormality exists (Groups III and IV). This may be due to muscle weakness secondary to a high syrinx.
Authors: Kristen S Pan; John D Heiss; Sydney M Brown; Michael T Collins; Alison M Boyce Journal: J Bone Miner Res Date: 2018-08-03 Impact factor: 6.741
Authors: John D Heiss; Giancarlo Suffredini; René Smith; Hetty L DeVroom; Nicholas J Patronas; John A Butman; Francine Thomas; Edward H Oldfield Journal: J Neurosurg Spine Date: 2010-12
Authors: Phillip A Bonney; Adrian J Maurer; Ahmed A Cheema; Quyen Duong; Chad A Glenn; Sam Safavi-Abbasi; Julie A Stoner; Timothy B Mapstone Journal: J Neurosurg Pediatr Date: 2015-11-27 Impact factor: 2.375
Authors: Travis S CreveCoeur; Alexander T Yahanda; Cormac O Maher; Gabrielle W Johnson; Laurie L Ackerman; P David Adelson; Raheel Ahmed; Gregory W Albert; Phillipp R Aldana; Tord D Alden; Richard C E Anderson; Lissa Baird; David F Bauer; Karin S Bierbrauer; Douglas L Brockmeyer; Joshua J Chern; Daniel E Couture; David J Daniels; Robert C Dauser; Susan R Durham; Richard G Ellenbogen; Ramin Eskandari; Herbert E Fuchs; Timothy M George; Gerald A Grant; Patrick C Graupman; Stephanie Greene; Jeffrey P Greenfield; Naina L Gross; Daniel J Guillaume; Gabe Haller; Todd C Hankinson; Gregory G Heuer; Mark Iantosca; Bermans J Iskandar; Eric M Jackson; Andrew H Jea; James M Johnston; Robert F Keating; Michael P Kelly; Nickalus Khan; Mark D Krieger; Jeffrey R Leonard; Francesco T Mangano; Timothy B Mapstone; J Gordon McComb; Arnold H Menezes; Michael Muhlbauer; W Jerry Oakes; Greg Olavarria; Brent R O'Neill; Tae Sung Park; John Ragheb; Nathan R Selden; Manish N Shah; Chevis Shannon; Joshua S Shimony; Jodi Smith; Matthew D Smyth; Scellig S D Stone; Jennifer M Strahle; Mandeep S Tamber; James C Torner; Gerald F Tuite; Scott D Wait; John C Wellons; William E Whitehead; David D Limbrick Journal: Neurosurgery Date: 2021-01-13 Impact factor: 4.654