Abnormalities of the cranio-vertebral junction with cervico-medullary compression. A rational approach to surgical treatment in children.

8 children with cranio-vertebral abnormalities and neurological deficits are reviewed. The specific treatment is dependent on etiology, mechanisms of compression, and whether the bony abnormality can be reduced to its normal position. Irreducible ventral compression of the cervico-medullary junction was relieved by transoral removal of the odontoid-clivus complex in 3 patients. Primary posterior decompression was done in 4 children with dorsal encroachment. A reducible C1-C2 dislocation in 1 child with juvenile rheumatoid arthritis underwent primary posterior fusion. A detailed surgical physiological approach is described.