APCSS-CVJ Special Topic Series

Shashank S. Kale; Sachin A. Borkar

doi:10.14245/ns.19int002

On behalf of Asia Pacific Cervical Spine Society (APCSS), it gives us immense pleasure to introduce this “Craniovertebral Junction” topic series for the readers of Neurospine. Craniovertebral junction (CVJ) is a complex anatomical region. Moreover, CVJ anomalies are considered one of the most difficult spinal ailments to treat owing to the anatomical location and proximity to important neurovascular structures.

APCSS founded in 2007, is now an internationally acclaimed society of health professionals dedicated to the cause of cervical spine surgery in Asia Pacific region. One of the themes of APCSS-2018 meeting held in New Delhi, India and hosted by us, was management of CVJ anomalies. The meeting brought together the luminaries in the field of CVJ surgery from across the globe to share their rich experience and expertise. Owing to its scientific content and the amount of interest generated by the CVJ plenary session, it was decided to publish this CVJ topic special series for wider dissemination of scientific knowledge. We sincerely thank Editors of Neurospine for his efforts to publish this special series.

The series starts with a debate regarding the management of Chiari malformation. Prof. Atul Goel, who is one of the pioneers of CVJ surgery, has written about his philosophy of Chiari malformation developing as a result of C1–2 instability. Thereby, through his vast experience and clinical data; he has advocated C1–2 fixation as a treatment of Chiari malformation, without the need for any decompression. Prof. Sanjay Behari has provided a scientific rebuttal for this philosophy with his article supporting conventional posterior fossa decompression for treatment of Chiari malformation. We are sure that readers will benefit from this interesting debate topic.

The next article in this series is about anatomy and biomechanics of the axis vertebra by Prof. K.V. Menon. He has discussed the trabecular anatomy of the C2 vertebra and its clinical implications. Also, through his illustrative article, he has explained the difference between flexion and extension type of Hangmann fracture and why it is critically important to distinguish between the two, owing to different management stategies.

Management of CVJ anomalies have undergone a paradigm change over the years. Prof. P. Sarat Chandra, through his work on single stage posterior reduction of irreducible atlanto-axial dislocaton and basilar invagination by DCER (distraction, compression, extension, and reduction) technique has discussed development of an universal CVJ reducer to reduce these complex anomalies by a single stage posterior approach. Prof. Sushil Patkar who is one of the proponents of anterior alone surgery for CVJ anomalies discusses the technique and advantages of anterior cage distraction and reduction of basialr invagination vis-à-vis posterior approach. Prof . N. Muthukumar, through his article, has touched upon the challenges and complications which can happen while dealing with syndromic pediatric CVJ anomalies. The series ends with the article on the more recent technique of endoscopic approach to the CVJ by Prof. J.C. Wu.

We hope that the readers will find this series informative and will provide a better clinical perspective in managing these complex spinal pathologies.

Thank you.