neurologic disorders
Craniocervical Junction Abnormalities
Treatment of Craniocervical Junction Abnormalities
Reduction and immobilization Sometimes surgical decompression, fixation, or both If neural structures are compressed, treatment consists of reduction (traction or changes in head position to realign the craniocervical junction and thus relieve neural compression). After reduction, the head and neck are immobilized.Acute or suddenly progressive spinal cord compression requires emergency reduction. For most patients, reduction involves skeletal traction with a crown halo ring and weight of up to about 4 kg. Reduction with traction may take 5 to 6 days. If reduction is achieved, the neck is immobilized in a halo vest for 8 to 12 weeks; then x-rays must be taken to confirm stability. If reduction does not relieve neural compression, surgical decompression, using a ventral or a dorsal approach, is necessary. If instability persists after decompression, posterior fixation (stabilization) is required. For some abnormalities (eg, due to rheumatoid arthritis), external immobilization alone is rarely successful; if it is unsuccessful, posterior fixation or anterior decompression and stabilization are required. Several different methods of instrumentation (eg, plates or rods with screws) can be used for temporary stabilization until bones fuse and stability is permanent. In general, all unstable areas must be fused. Radiation therapy and a hard cervical collar often help patients with Treatment . may help patients with Treatment . 