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Evaluation and Surgical Planning for Craniovertebral Junction Deformity

Neurospine 2020년 17권 3호 p.554 ~ 567
홍재택, 김일섭, 이호진, 박종혁, 허정우, 이종범, 이정재, 이상효,
소속 상세정보
홍재택 ( Hong Jae-Taek ) - Catholic University Eunpyeong St. Mary’s Hospital Department of Neurosurgery
김일섭 ( Kim Il-Sup ) - Catholic University St. Vincent’s Hospital Department of Neurosurgery
이호진 ( Lee Ho-Jin ) - Catholic University St. Vincent’s Hospital Department of Neurosurgery
박종혁 ( Park Jong-Hyuk ) - Catholic University Incheon St. Mary’s Hospital Department of Neurosurgery
허정우 ( Hur Jeong-Woo ) - Catholic University Eunpyeong St. Mary’s Hospital Department of Neurosurgery
이종범 ( Lee Jong-Beom ) - Chungbuk National University Hospital Department of Neurosurgery
이정재 ( Lee Jeong-Jae ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Neurosurgery
이상효 ( Lee Sang-Hyo ) - Catholic University Eunpyeong St. Mary’s Hospital Department of Neurosurgery

Abstract


Craniovertebral junction (CVJ) deformity is a challenging pathology that can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. Surgical management of CVJ deformity is complex for anatomical reasons; given the discreet relationships involved in the surrounding neurovascular structures and intricate biochemical issues, access to this region is relatively difficult. Evaluation of the reducibility, CVJ alignment, and direction of the mechanical compression may determine surgical strategy. If CVJ deformity is reducible, posterior in situ fixation may be a viable solution. If the deformity is rigid and the C1?2 facet is fixed, osteotomy may be necessary to make the C1?2 facet joint reducible. C1?2 facet release with vertical reduction technique could be useful, especially when the C1?2 facet joint is the primary pathology of CVJ kyphotic deformity or basilar invagination. The indications for transoral surgery are becoming as narrow as a treatment for CVJ deformity. In this article, we will discuss CVJ alignment and various strategies for the management of CVJ deformity and possible ways to prevent complications and improve surgical outcomes.

키워드

Craniovertebral junction; Alignment; Kyphosis; Basilar invagination; Deformity; Treatment

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