Spine Deformity & CV Junction Surgery

CV Junction Conditions

Atlantoaxial dislocation (AAD)

C1 slips forward on C2, narrowing the space for the spinal cord. It may be present from birth, follow an injury, or result from rheumatoid arthritis or infection. Symptoms include neck pain, weakness and stiffness in the arms and legs, and unsteady walking, sometimes worsening after a minor fall.

Basilar invagination

The top of C2 pushes upward into the base of the skull and presses on the brainstem. It often comes with a short neck or low hairline and is frequently associated with Chiari malformation.

Chiari malformation and syringomyelia

In Chiari malformation, the lowest part of the brain (the tonsils of the cerebellum) sits lower than normal, crowding the opening at the base of the skull. Headaches at the back of the head that get worse on coughing or straining are typical. Fluid may collect inside the spinal cord, forming a cavity called a syrinx, which causes loss of pain and temperature sensation in the hands, burns that are not felt, and weakness.

Investigations

MRI shows the cord and brainstem. CT with 3D reconstruction shows the bones in fine detail, and flexion-extension X-rays or dynamic CT show whether the joint moves abnormally. A CT angiogram may be needed to locate the vertebral arteries before screws are planned, since they run very close to these bones.

Surgery

The aim is to relieve pressure on the cord or brainstem and to make the junction stable.

• C1-C2 fixation: screws and rods hold the two bones in the corrected position until they fuse.
• Occipitocervical fusion: the skull is joined to the upper neck when the instability is more extensive.
• Foramen magnum decompression: for Chiari malformation, bone is removed at the base of the skull to give the brain and fluid more room.

Patients usually lose some ability to turn the head after C1-C2 fusion. Most adapt well, and this is discussed clearly before surgery.

Spinal Deformity: Scoliosis and Kyphosis

Scoliosis is a sideways curve of the spine; kyphosis is a forward hunch. In teenagers, mild curves are often watched, and moderate curves may be braced during growth. In adults, deformity can come from disc wear, old fractures, osteoporosis or tuberculosis of the spine. Surgery is considered when the curve is progressing, causing nerve symptoms, or seriously affecting balance and daily life. Correction uses screws and rods along the curved section, often guided by neuromonitoring.

Why Early Assessment Matters

Cord damage from long-standing compression does not always recover after surgery. People with slowly increasing clumsiness of the hands, a change in walking, or neck pain after a fall with a known CV junction problem should not keep postponing a specialist visit. For common neck problems, see cervical spine treatment.

Who Should Be Assessed?

Consider a specialist opinion if a child or teenager has uneven shoulders, a hip that sticks out on one side or a hump on bending forward; if an adult is becoming increasingly bent forward or leaning to one side; or if there is neck pain with progressive hand clumsiness and unsteady walking, particularly with a short neck or low hairline. Bring every scan and X-ray taken over the years, since comparing them shows whether the condition is progressing.

OPD Timings