1.Q: What is cranial spine surgery, and what is the difference between cervical spine surgery? A: Cranial spine surgery specializes in congenital and developmental deformities in the area from the skull to the cardinal spine (second cervical spine), as well as atlantoaxial instability or dislocation caused by trauma and inflammation. The field of craniospinal surgery does not cover the area below the third cervical vertebra. Patients in craniospinal surgery may present not only with symptoms of cervical myelopathy (varying degrees of dysfunction of the extremities), but also with symptoms of low-level cranial neuropathy (dysphagia, slurred speech, visual field jumping triggered by nystagmus). 2.Q: Why is it said that cranial spine surgery are high-risk? A: Cranial spine surgery in the head and neck junction area, where there is a high cervical spinal cord and medulla oblongata, once damaged during surgery, it will cause tetraplegia and respiratory failure, without ventilator support, it is difficult for the patient to survive. The atlantoaxial spine is closely related to the location of the vertebral artery, and surgical operations can easily damage the vertebral artery. Vertebral artery injury may affect the blood supply to the brain, eventually forming a cerebral infarction, and the patient will have difficulty surviving. 3.Q: What is the main purpose of cranial spine surgery? A: The main treatment purpose of cranial spine surgery is to restore the normal alignment and stability of the atlantoaxial joint. Regardless of the developmental or congenital deformity, or inflammation and trauma, the atlantoaxial joint may lose its stability, and the neural tissue located in this area (high cervical spinal cord or medulla oblongata) gradually becomes symptomatic under the compression and impact of excessive atlantoaxial joint activity, resulting in various degrees of paralysis. If atlantoaxial instability is not treated with timely surgery, it will develop into atlantoaxial dislocation over time, and the nerve structures will be continuously compressed, making treatment more difficult. 4.Q: Is it “atlantoaxial subluxation” if the open-ended X-ray shows unequal spacing between the odontoid process and the lateral blocks of the atlantoaxial spine on both sides? A: Open-view X-ray is used to diagnose atlantal fracture, if no serious head and neck trauma has occurred, it is not necessary to do such a film. If the atlas is not severely traumatized, it is not necessary to take such a radiograph. If the atlas is not equally spaced from the lateral blocks of the atlantoaxial vertebrae, it cannot be considered as “atlantoaxial subluxation”. In most normal people, the atlas is not in a median position, and many people are off to the side, which is not harmful and should not be considered an abnormality. As long as the transverse atlantoaxial ligament is intact (low head position film, the atlanto-anterior gap is not greater than 3 mm), the atlas is not in the center will not affect the stability of the atlanto-axial joint, there is no need to care. 5.Q: Cranial spine surgery is very risky, is it worth the risk? A: It is worth it. Once the atlantoaxial joint becomes unstable or dislocated, it is very dangerous not to operate, and the risk is lifelong and increasing. Patients may gradually develop clumsy weakness in their extremities or become paralyzed after a heavy head and neck impact. It is a wise decision to undergo surgery as early as possible and to choose the surgeon who has personally performed the most surgical cases to lead the operation. The more experience you have in surgery, the higher the success rate will be. 6.Q: Is it difficult to register for a consultation? A: It is not difficult at all. If you can’t get an appointment online or by phone, you can go directly to the orthopedic clinic on Tuesday afternoon (we also have a clinic on Wednesday afternoon, but it is recommended to come on Tuesday for a follow-up appointment the next day) and ask the nurse to add my number, and they will definitely do it. My clinic only sees patients with high cervical spine disease, and I have 20-30 visits. This disease is rare, and there are not that many patients coming to the clinic, so I have plenty of clinic time. 7.Q: Does the surgery cost a lot? A: The vast majority of patients have a smooth surgery and cost on average 20-30,000 (40-50,000 for the hospital deposit). However, it should be taken into account that in case of surgical complications, which require resuscitation or follow-up treatment, it will cost a huge amount of money and should be prepared. 8.Q: How is the surgery done? A: In about half of the patients, the atlantoaxial joint is unstable because the atlas is not connected to the vertebral body properly and a free atlas is formed, so posterior atlantoaxial fusion is done directly in such cases. Using a peg plate device, screws are placed in the lateral atlantoaxial block and the pivotal pedicle and fixed with a connecting plate. A small incision is made through the posterior superior iliac crest of the hip and cancellous bone is hollowed out and implanted in granular form in the posterior atlantoaxial spine. If the disease is long-standing and a severe atlantoaxial dislocation has developed and intraoperative traction cannot reset the atlantoaxial spine, a repositioning procedure via the oral cavity must be performed first, followed by posterior fixation of the bone graft. The craniocervical junction area is prone to congenital deformities, and the most common congenital deformity is atlanto-occipitalization (i.e., congenital fusion of the atlanto-occipital joint). In patients with this deformity, the atlanto-occipital joint has to bear too much stress due to the lack of the atlanto-occipital joint, which is responsible for head and neck flexion and extension, and over time, the atlanto-occipital joint becomes loose and gradually forms a dislocation. In patients with atlanto-occipital deformity, once the atlanto-occipital joint is dislocated, it appears on the image as a depression of the skull base. Therefore, such cases are often diagnosed as “skull base depression” in neurosurgery. The key to treating this condition is to correct the dislocated atlantoaxial joint. If the atlantoaxial joint can be completely repositioned surgically, the compression of the higher cervical cord and medulla oblongata can be relieved and the symptoms may disappear. The dislocated atlantoaxial joint can be repositioned with intraoperative cranial traction, so that only a posterior peg plate fixation and fusion is necessary to prevent recurrence of the dislocation. In patients with late surgery, where traction repositioning is not successful, the atlantoaxial joint must be released through an oropharyngeal approach, followed by a posterior approach. In such cases, the method of removing the occipital bone and opening the foramen magnum to obtain nerve decompression has been proven to be wrong.