Rapid magnetic resonance imaging–guided reduction of craniovertebral junction deformities

Abstract

The authors demonstrate the utility of an MR imaging–compatible traction board for the rapid reduction of craniovertebral junction (CVJ) deformities. To choose the appropriate surgical management, patients with compressive CVJ deformities often undergo a trial of traction. Conventional traction trials require the treating surgeon to infer from plain radiographs the manner in which traction forces affect neural and ligamentous structures at the CVJ. To avoid overdistraction injury, low increments of weight are added in a gradual fashion, a process that typically requires 48–72 hours. The authors outline the use of an MR imaging–compatible traction board to determine reducibility safely and rapidly in 4 patients with compressive CVJ deformities. Four patients with advanced CVJ deformities underwent a trial of MR imaging–guided traction performed using an MR imaging–compatible spine board. Serial sagittal images were acquired at baseline and following each sequential addition of force. All patients tolerated traction without neurological worsening. The neural elements were seen to be adequately decompressed in all cases during a single MR imaging session. Patients subsequently underwent craniocervical stabilization and fusion. Postoperative imaging showed maintenance of the reduction without neural compression. An MR imaging–guided trial of traction can facilitate the rapid and safe determination of the reducibility of compressive lesions in patients with advanced CVJ deformities. Rapidly acquired sagittal MR images permit the surgeon to evaluate the effects of traction on the soft tissues at the CVJ, thereby expediting the traction trial and avoiding the risks of immobility in this often-fragile patient population.