Introduction: The atlantoaxial dislocation causes instability and remodeling of the musculoskeletal and neural structures at the craniovertebral junction, resulting in the Chiari malformation with or without basilar invagination and syringomyelia. Its treatment is surgical, involving atlantoaxial fixation.
Methods: This systematic review was conducted using the following databases: PubMed (MEDLINE) and Embase. The search strategy employed specific descriptors combined with Boolean operator AND: Arnold-Chiari malformation AND joint instability AND spinal fusion. Article selection was guided by three inclusion criteria: 1. full-length original research articles; 2. studies addressing the review's objectives; and 3. publications between 2014 to 2024.
Results: The fixation technique most used in studies was Goel-Harms arthrodesis. It consists of C1-C2 arthrodesis through the scraping of the articular cartilage and the insertion of a bone graft, derived from the iliac crest, followed by fixation with plates and screws inserted into the facets of the atlas and axis. Several studies, including those by Goel, Kaswa, and Shah, as well as Iştemen et al., report favorable outcomes following C1-C2 fusion in the resolution of syringomyelia. However, as highlighted by Goel and Wagner et al., there is a lack of homogeneity in the studied populations, which undermines the notion that the Goel-Harms arthrodesis can be considered a universal solution. Recently, Rathod et al. proposed a new retropharyngeal approach that, while promising, has statistical limitations, as it was presented only as a single case report.
Conclusion : The studies reviewed focus on C1-C2 arthrodesis as a surgical solution for Chiari malformation. However, no technique has been universally recognized as the ideal standard for treatment. The choice of approach may vary based on factors such as anatomical variations and the surgeon's familiarity with specific techniques. Therefore, further research is essential to develop new methods and enhance existing ones, fostering a more effective approach for each case.
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