ArticleNeurospine2025
Surgical Strategy Analysis of Chiari Malformation With or Without Type II Basilar Invagination According to the Morphological Types of the Atlanto-Occipital Joint: A Retrospective Study of 212 Patients.
Article in Neurospine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Posterior Fossa Decompression Alone versus Craniovertebral Junction Fixation-Inclusive Strategies in Chiari I Malformation with Syringomyelia: A Propensity Score-Matched Retrospective Cohort Study.Journal of multidisciplinary healthcare · 2026Article
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Abstract
objectiveOur previous study categorized atlanto-occipital joint (AOJ) morphology into 3 types, with types II and III-AOJ associated with Chiari malformation (CM) with and without type II basilar invagination (II-BI), respectively. This study aimed to assess the feasibility of tailoring surgical strategies for patients with CM based on AOJ morphological types.
methodsWe retrospectively studied 212 CM patients who underwent foramen magnum decompression (FMD) or combined occipitocervical fusion (OCF). Patients were divided into 4 groups: (1) pure CM with II-AOJ who underwent FMD (CM-II-FMD); (2) pure CM with III-AOJ who underwent FMD+OCF (CM-III-OCF); (3) CM-III-FMD; and (4) CM+ II-BI with III-AOJ who underwent FMD+OCF (BI-III-OCF). Clinical data, including manifestations, imaging findings, surgical details, and neurological assessments, were analyzed at the final follow-up to assess surgical efficacy.
resultsPatients in the BI-III-OCF, CM-III-OCF, and CM-II-FMD groups exhibited a significant improvement in clinical symptoms (pain, sensory disturbances, motor weakness, gait ataxia, and bladder and bowel dysfunction) compared to preoperative levels (p<0.05). Results from the Japanese Orthopaedic Association scale and Neck Disability Index indicated a significant reduction in the degree of neurological impairment within these groups (p<0.05). Furthermore, the Chicago Chiari Outcome Scale scores indicated superior surgical outcomes for patients in these groups. Imaging analyses demonstrated significant reductions in the syringomyelic segment, syringomyelia width, and tonsillar herniation distance among these patients (p<0.05). However, the CM-III-FMD group did not significantly improve in these areas (p>0.05). Postoperative complications occurred in 4.3% of FMD+OCF patients and 3.3% of FMD-only patients.
conclusionAOJ morphological types can guide surgical treatment strategies for CM with or without II-BI. FMD alone is suitable for II-AOJ cases, whereas III-AOJ cases should be treated with FMD combined with OCF.
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