Abstract
Introduction Despite a significant advancement in operative techniques of occipitocervical fixation,
there is a poor postoperative patient outcome. This can be attributed to restrictive
lung pattern in craniovertebral junction anomalies (CVJAs) patients resulting from
repeated trauma to cervicomedullary junction by the pincer action of the bony anomalies
and compression of the brainstem. We evaluate the changes in pulmonary function tests
(PFTs) following rigid occipitocervical fixation in CVJA.
Methods PFTs of 20 CVJA patients were measured pre and postoperatively using spirometry.
Measurements included forced vital capacity (FVC), forced expiratory volume in one
second (FEV1), maximum forced mid-expiratory flow rate (FEF25–75%), and ratio of FEV1
and FVC (FEV1%). The parameters were compared with the predicted normal values based
on their age and sex. PFTs were repeated on the seventh postoperative day. McCormick
grading was used to assess neurological function.
Results The values of PFTs in the preoperative period were significantly lower than predicted
normal values. The mean values of FVC, FEV1, FEF25–75% were 72, 68, and 71% of their
mean predicted values, with FEV1% in the range of 70 to 95% with a mean of 81.4%.
Postoperatively there was further significant reduction in the mean values of FVC,
FEV1, FEF25–75%, and FEV1% compared with the preoperative values. There was neurological
improvement in McCormick grades of patients postoperatively (from grade III and IV
to grade II).
Conclusion A significant restrictive lung disease is present in patients of CVJA, even though
not clinically apparent, and it persists in the early postoperative period. However,
a long-term follow-up is required to assess whether pulmonary function parameters
improve subsequently.
Keywords
craniovertebral junction anomalies - rigid occipitocervical fixation - pulmonary function
test
