Decompressive C1 Laminectomy without Fusion for the Treatment of Craniovertebral Junction Stenosis with Myelopathy: Could It be One of Option?

Corresponding author: Kyung-Hyun Kim Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea Tel: +82-2-2019-3390 Fax: +82-3-3461-9229 E-mail: nskhk@yuhs.ac Objective: Trans-oral approach or occipitocervical/atlantoaxial fusion with/without posterior decompression has been considered to be an appropriate surgical strategy for craniovertebral junction (CVJ) stenosis with myelopathy. However, decompressive C1 laminectomy without posterior stabilization was reported recently for treating retro-odontoid pseudotumor. This study aimed to evaluate surgical outcomes of the patients treated with decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy. Methods: Ten patients underwent decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy from August 2007 to December 2016. All patients were evaluated preoperatively for spinal canal stenosis, cord signal changes, and instability based on preoperative computed tomography, magnetic resonance imaging, and plain dynamogram. We retrospectively reviewed the clinic charts and radiographs for investigating clinical outcomes such as the visual analog scale (VAS), and Ranawat grade scale and complications. Radiographic parameters including preand postoperative atlas-dens interval change in flexion and extension, O-C2 angle, C2-C7 Cobb angle, and C2-C7 sagittal vertical axis were measured. Results: The mean follow-up time was 41 months. Eight men and 2 women with a mean age of 58 years (range, 45-69 years) were enrolled. Preoperative neck pain by the VAS was improved significantly in all patients (p<0.01). Nine of 10 patients showed improvement on the Ranawat grading scale, but 1 patient who required a Halo-vest due to aggravated instability after surgery remained unchanged. The statistical results of the preoperative and postoperative radiographic measurements were not significant. Conclusion: In select patients with certain indications, decompressive C1 laminectomy could be a viable option, especially in the elderly, patients with comorbidity, and patients with poor bone quality.