Nonspecific craniovertebral spondylitis: features of surgical tactics

Objective. To evaluate the effectiveness of surgical treatment of nonspecific spondylitis in the area of craniovertebral junction taking into account the clinical and pathomorphological features of the disease.

Material and Methods. The study included 11 patients with nonspecific craniovertebral spondylitis: 4 women and 7 men aged 31 to 75 years. In 8 patients, the clinical picture was represented by neurological symptoms, and in 3 – by pain syndrome. Combined interventions were performed in 7 patients who had compression of the spinal cord and medulla oblongata. Of these, 5 patients first underwent transoral decompression, and then occipitospondylodesis. In the rest patients, the sequence of surgical treatment had the reverse order. In 6 cases, combined operations were performed simultaneously, and in one case — with an interval of 7 days. In one patient, the first stage was external ventricular drainage of hydrocephalus due to occlusion of the cerebrospinal fluid pathways by a displaced odontoid process, and the second stage was transoral decompression. Patients with pain syndrome underwent occipitospondylodesis. In one case, after combined surgery, ventriculoperitoneal shunting was performed for aresorptive hydrocephalus that developed after meningitis.

Results. In 10 patients, the pain intensity according to VAS decreased by 5–7 points (6.3 on average) in the postoperative period. Out  of 8 patients with conductor symptoms, regression of neurological disorders after surgery was achieved in 3, complete recovery (Frankel E) in 4, and one patient died of purulent ventriculitis. Control examination of 10 patients confirmed the relief of the inflammatory process and the absence of compression of the spinal cord and medulla oblongata. Among the early postoperative complications, one case of  postoperative liquorrhea and the divergence of the edges of the wound of the posterior pharyngeal wall were recorded. Fracture of metal structure elements was observed in one patient 3 years after surgery.

Conclusion. In nonspecific craniovertebral spondylitis, an active surgical tactic is justified. Occipitospondylodesis at an early stage of the disease allows to eliminate atlantoaxial instability and prevent the associated risk of neurological complications. In conduction disorders, if the patient’s condition allows, simultaneous transoral decompression and craniocervical fixation is the best option for surgical treatment of nonspecific spondylitis of the craniovertebral region. Preservation of mobility in the cervical spine facilitates the transoral stage, therefore occipitospondylodesis is advisable to be performed at the second stage.

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