Chiari I malformation and cervical stenosis are different clinical entities with clinical presentations that can sometimes be simila , ranging from mild headache and axial neck pain to severely disabling myelopathy. The present study aims at evaluating effectiveness in treatment of these conditions in settings where resources are scarce by restoration of adequate CSF flow around the cervical spinal cord and Cranio-Cervical junction by means of decompression surgery only.
This is a prospective outcome study. We prospectively recorded pre operative and post operative neurological data of all the patients who met our inclusion criteria over a period of six months. All the patients underwent decompressive surgeries by posterior fossa decompression with duroplasty using autologous pericranium for patients with Chiari I malformation, and posterior cervical decompression without fusion for patients with cervical spondylotic myelopathy.
A total of 21 patients met the inclusion criteria for our study. Most (90%) of them had severe myelopathy with high Nurick grades. There was considerable delays in first presentation to neurosurgical care; most patients had symptoms lasting for more than 1 year.
Pseudomeningocele was the most common post operative complication; this was found in 3 patients, and it was self limiting in all 3 cases. All the patients reported significant improvement after treatment. Outcome results reported here are short term data. All the patients are being prospectively followed for long-term outcome analysis.
Discussion and Conclusion
Restoration of adequate CSF flow around neural elements of the spinal cord and cranio-cervical junction by means of decompression surgery only is an elegant treatment option of myelopathy caused by cervical spondylosis and/or chiari malformation type I. The results presented here show that this can be done effectively and yield favorable results even in settings where resources are scarce.