• Abhinandan Reddy Mallepally, Yelamarthy Karthik, Neshar Ansari, Harvinder Singh Chhabra, and Shakti Amar Goel.
• Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India. Electronic address: mabhi28@gmail.com.
• World Neurosurg. 2019 Nov 1; 131: 120-125.

BackgroundA noninvasive approach for basilar invagination (BI) and moreover, cervical traction to reduce odontoid invagination, has not been thoroughly described in the literature. We report a case of BI with Arnold-Chiari malformation in which preoperative reduction using Gardner well cervical traction was attempted and the patient developed central hypoventilation syndrome.Case DescriptionA 15-year-old boy presented with a 6-month history of progressive cervical myelopathy signs and symptoms, modified Japanese orthopedic association score 12 of 18. Radiology showed type A BI with occipitalization of atlas and a posterior arch defect of axis. A preoperative closed cervical traction followed by occipitocervical fusion via a posterior-only approach was planned. The patient developed 3 episodes of apnea on sleeping when on traction. Labeled as central hypoventilation, he was operated by foramen magnum decompression and occipitocervical fusion.ConclusionsCervical traction followed by posterior fixation is an effective way to manage basilar invagination with Arnold-Chiari malformation and assimilated C1. However, patients should be monitored closely for respiratory dysfunction.Copyright © 2019 Elsevier Inc. All rights reserved.

27 keywords...

hide…