We present the case of a 15-year-old boy with symptoms due to
Klippel-Feil syndrome. Radiographs and CT scans demonstrated
basilar impression, occipitalisation of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Skull
traction was undertaken pre-operatively to determine whether the
basilar impression could be safely reduced. During
traction, the C3/C4 junction migrated 12 mm caudally and spasticity resolved. Peri-operative skull-femoral
traction enabled posterior occipitocervical fixation without
decompression. Following surgery, cervical alignment was restored and spasticity remained absent. One year after surgery he was not limited in his activities. The surgical strategy for patients with
basilar impression and congenital anomalies remains controversial. The anterior approach with
decompression is often recommended for patients with ventral compression of the medullocervical region, but such procedures are technically demanding and carry a significant risk of complications. Our surgical strategy was an alternative
solution. Prior to a posterior cervical fixation, without
decompression, skull
traction was used to confirm that the
deformity was reducible and effective in resolving associated
myelopathy.