Baziler İnvajinasyonun Cerrahi Tedavisi: Farklı Cerrahi Yaklaşımların Klinik ve Radyografik Sonuçların Karşılaştırılması

Abstract

Aim: Previous studies have outlined various surgical approaches to treatment of basilar invagination, but none have compared multiple different treatment options using objective clinical and radiological criteria. Material and Methods: We retrospectively reviewed the records of 30 patients with basilar invagination treated by five different surgical approaches. The surgical outcomes were evaluated and compared using objective clinical (Ranawat score) and radiological parameters (Chamberlain distance, atlantodental interval, and craniovertebral angle). Results: Our results show a statistically significant improvement in the Ranawat score for patients undergoing 1) anterior decompression with posterior stabilization, 2) posterior decompression with posterior stabilization, and 3) the Goel procedure (posterior decompression, posterior reduction, cage distraction, and posterior stabilization). Of these, the Goel procedure produced the most significant improvement in functional and radiographic outcomes. Neither group without posterior stabilization (posterior decompression alone or endoscopic transnasal odontoidectomy alone) had a significant improvement in Ranawat score or radiographic outcomes. Conclusion: For surgical management of basilar invagination, a combination of posterior decompression, posterior reduction, cage distraction, and posterior stabilization yielded the best clinical and radiological outcome. There is a risk of craniocervical instability and kyphosis and recurrence of stenosis in patients treated surgically without posterior stabilization. Therefore, when deciding on bacillary invagination surgery without posterior stabilization, it should be carefully considered.