Classification and surgical treatment strategy of basilar invagination (report of 103 cases)

Objective To investigate the classification,personalized operative plan and therapeutic evaluation of basilar invagination.Methods The clinical data of 103 patients who accepted microsurgical treatment in our hospital were retrospectively analyzed.Based on Atul Goel classification,the basilar invagination were diagnosed and divided into four categories.The selected personalized operative plans,imaging features,clinical characteristics and surgical methods were evaluated.Results 101 of 103 cases achieved good outcomes.The main Japanese Orthopaedic Association (JOA)scale was increased from 9.54 ±3.43 to 12.76 ±2.53(t =4.732,P =0.036) after the procedures.A complete reduction or partial reduction was achieved in all patients who had increased atlantodental interval.In 71 patients with syringomyelia,the syringomyelia was obviously shrinked in 49 cases (＞ 50％),shrinked in 21,and unchanged in 1.81 cases were followed-up from 12 to 72 months.The JOA scale was improved from 9.20±2.47 to 13.82 ±2.37(t =4.823,P =0.028)after follow-up.Conclusions According to the existence of syringomyelia and(or) atlantoaxial dislocation,all the basilar invagination could be divided into four types,which chould accurately reflect the pathological features of complicated basilar invagination.Through the comprehensive assessment of clinical manifestation and imaging features,a personalized surgical procedure could be selected to improve the effects of treatment of congenital basilar invagination. Key words: Basilar invagination ;  Clinical classification ;  Microsurgery ;  Treatment effect