Application of a novel sliding ⁃ traction head holder in craniovertebral junction abnormalities surgery

Abstract

Objective In this study, a novel sliding ‐ traction head holder was independently developed, and its application efficacy in surgeries for craniovertebral junction abnormalities was evaluated. Methods A retrospective analysis was performed on 20 patients with congenital basilar invagination diagnosed and treated at Sanbo Brain Hospital, Capital Medical University from May 2022 to May 2024. Basilar invagination was classified into type Goel A patients (n = 12) and type Goel B patients (n = 8) according to the presence or absence of atlantoaxial dislocation. All patients underwent posterior facet distraction and fusion (PFDF) under traction of the novel sliding‐traction head holder. The operation time, intraoperative blood loss, and postoperative complications were recorded. The imaging indexes (atlanto ‐ dental interval, the distance from the odontoid tip to Chamberlain's line, clivus‐pivot angle, and medulla oblongata‐spinal cord angle) were recorded. The function impairment was assessed by Japanese Orthopedic Association (JOA). Results Compared with preoperatively, the clivus‐pivot angle (t = ‐ 3.499, P = 0.006; t = ‐ 4.249, P = 0.004) and the medulla oblongata‐spinal cord angle (t = ‐ 6.480, P = 0.000; t = ‐ 6.134, P = 0.000) were significantly increased in type Goel A and type Goel B patients, the atlanto‐dental interval (Z = ‐ 3.018, P = 0.003) in type Goel A patients and the distance from the odontoid tip to Chamberlain's line (Z = ‐ 2.485, P = 0.013; Z = ‐ 1.995, P = 0.050) in type Goel A and type Goel B patients were significantly reduced. All patients showed significant improvement in JOA score (Z = ‐ 4.389, P = 0.000). At one week and 3 months after surgery, there was no implant displacement in the craniocervical junction reconstructed by MRI and CT, and no serious complications such as aggravated neurological dysfunction, secondary revision and postoperative infection occurred. Conclusions The application of the sliding ⁃ traction head holder in surgery for the cranio⁃cervical junction area exhibits high safety and effectiveness. The stability of the head and the precise adjustment of traction force during the operation can reduce the risk of complications. Demonstrating significant therapeutic effects in the surgical treatment of patients with congenital basilar invagination.

doi：10.3969/j.issn.1672‐6731.2024.12.003