Outcomes of the application of the dominant clinical syndrome concept in the surgical treatment of craniovertebral junction pathology

   AIM. To analyze the outcomes of applying differentiated surgical strategies in groups of patients formed based on the dominant clinical syndrome (DCS).

   MATERIALS AND METHODS. A retrospective analysis of treatment outcomes was performed in 181 patients who underwent surgery for CVJ pathology between 1998 and 2023 at two neurosurgical centers (St. Petersburg, Novosibirsk). The mean age of patients was 46.7 years. The study included five nosological forms: trauma (42 %), intradural (28 %) and extradural (15 %) tumors, developmental anomalies (10 %), inflammatory and genetic diseases (5 %). The systematization of the material was based on the identification of two DCS. DCS I (compression) – compression of cervicomedullary structures, clinically manifested by myelopathy and bulbar disorders (n = 9, 54 %). DCS II (instability) – craniovertebral instability with severe pain syndrome (n = 84, 46 %). Outcomes were assessed using the Karnofsky Performance Status Scale, Frankel grade, and Numerical Rating Scale (NRS) for pain before surgery, at discharge, and at 1-year follow-up.

   RESULTS. In group I (compression) 57 (58.8 %) patients underwent decompression; 40 (41.2 %) patients underwent decompression combined with fusion. In group II (instability), 64 (76.2 %) patients underwent fusion, while in 20 (23.8 %) patients, fusion was combined with resection of the pathological substrate. Group I showed positive dynamics in neurological status: the proportion of patients with mild impairments (Frankel E) increased from 37 to 53 % at one year. In group II, patients initially predominantly had relatively preserved neurological status (Frankel E – 87 %); no significant dynamics were observed; however, substantial regression of pain syndrome (from 7.62 to 0.92 points on NRS) and improvement in Karnofsky functional status (from 67.6 to 87.9) were achieved.

   CONCLUSION. The integrative approach of applying the DCS concept allows for the selection of justified surgical strategies for heterogeneous CVJ pathology. Differentiated strategies ensured the possibility of optimal surgical correction, determination of timing and sequence of surgical intervention stages. Functional outcome is a key criterion in assessing clinical results of surgical treatment of CVJ pathology.

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