Craniovertebral Junction Injury: Clinical Presentation and Outcomes of Surgical Treatment
Akkapong Nitising MD*, Titima Ratanarungchainon MD*, Nanthasak Tisavipat MD**, Luckchai Phonwijit MD*
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Bangkok Neurological Surgery Center, Bangkok Hospital, Bangkok, Thailand
Background : Craniovertebral junction (CVJ) injury is an uncommon entity of vertebral trauma, which can lead to lethal
outcome or permanent neurological morbidity caused by associated spinal cord injury (SCI).
Objective : To study clinical presentation and surgical outcomes of patients with CVJ injury.
Material and Method: All patients with traumatic CVJ who underwent surgical treatment at Siriraj Hospital from 1997 to
2007 were studied. Various types of operation were selected based on pattern of spinal instability, location and severity of
spinal cord compression, as well as underlying spinal disorder. Clinical outcomes were evaluated by the Functional Indepen-
dence Measure (FIM) score.
Results : Twenty-five patients were divided into 2 groups; 18 patients were in the group of acute (early) presentation and 7 in
the group of chronic (late) presentation. The most common type of injury was C1-2 subluxation followed by odontoid fracture.
Four patients in the acute group had associated traumatic brain injury (TBI). Posterior cervical fixation using various types
of instrumentation was done in all patients. Good outcome (the FIM score of 4 or more) were found in 22 patients. On the
contrary, poor outcome (the FIM score of 1 or complete dependence) was found in the remaining 3 patients; all of them were
in the acute group. Two of them had associated TBI and the other was a patient with Klippel-Feil syndrome manifested by
quadriplegia due to severe SCI.
Conclusion : The surgical treatment of CVJ injury renders satisfactory result in most patients. Factors which may influence
the outcomes included associated TBI and severity of SCI.
Keywords : Craniovertebral junction injury, Cervical spine injury, Spinal cord injury
