Treatment of craniocervical instability using a posterior-only approach: report of 3 cases

J Neurosurg Spine. 2014 Aug;21(2):239-48. doi: 10.3171/2014.3.SPINE13684. Epub 2014 May 2.


The object of this study was to demonstrate that a posterior-only approach for craniocervical junction pathology is feasible with intraoperative reduction. The authors reviewed 3 cases of craniocervical instability. All patients had craniocervical instability according to radiological imaging and various methods of measurement, with results outside the normal range. Posterior instrumentation aided the intraoperative reduction techniques while maintaining structural integrity and the desired fusion construct. No anterior approach was necessary in any of the patients. Neurological symptoms resolved in two patients and significantly improved in another. Follow-up imaging demonstrated stable constructs. There are many approaches to anterior cervical pathology at the craniocervical junction. Posterior instrumented reduction and stabilization of the occipitocervical spine can be safely achieved, obviating the need for a transoral approach in the setting of craniocervical junction settling.

Keywords: OC = occipitocervical; RA = rheumatoid arthritis; SSEP = somatosensory evoked potential; basilar invagination; cervical fusion; cranial settling; craniocervical instability.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / complications
  • Atlanto-Axial Joint / physiopathology
  • Atlanto-Axial Joint / surgery*
  • Cervical Vertebrae / physiopathology
  • Cervical Vertebrae / surgery*
  • Decompression, Surgical
  • Diagnosis, Differential
  • Female
  • Humans
  • Internal Fixators
  • Joint Instability / diagnosis*
  • Joint Instability / physiopathology
  • Joint Instability / surgery*
  • Laminectomy
  • Magnetic Resonance Imaging
  • Middle Aged
  • Neck Pain / diagnosis
  • Neck Pain / physiopathology
  • Neck Pain / surgery*