Respiratory Dysfunction in Craniovertebral Junction Pathology: A Pulmonary Function Test Correlation

Introduction: Respiratory dysfunction in craniovertebral junction (CVJ) pathology can be due to (1) direct compression of neural tissue, or (2) weakness of muscles of respiration. Majority of the times, this impairment is clinically occult. The outcome of a patient with CVJ anomaly is also dependent upon his/her respiratory function. Objective: To assess the respiratory function following relief of compression in the early postoperative (within first week of surgery) and late postoperative period (3 months or more after surgery) and to compare with preoperative status using pulmonary function tests (PFTs). Materials and methods: Twenty-five patients with CVJ pathology underwent bedside evaluation with single breath count (SBC) and respiratory system examination. Spirometry was performed in the preoperative phase and immediate postoperative phase and on follow-up (3 months), and the results were compared and analyzed between the preoperative and postoperative phases and also were compared with healthy, ageand sex-matched controls. Descriptive statistical analysis was carried out using Student’s t-test. Wilcoxon signed rank test was used to find the significance of study parameters between preand postintervention in each group. Statistical software Statistical Package for the Social Sciences (SPSS) version 15.0, Stata 8.0, MedCalc 9.0.1, and Systat 11.0 were used for the analysis of the data. Results: Twenty-five patients underwent preoperative and early postoperative and late postoperative evaluation. Majority were in their second and third decades of life. Males were predominant (76%). Atlantoaxial dislocation (AAD) was the most common pathology. All parameters, viz., forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), ratio between FEV1 and FVC (FEV1:FVC), forced expiratory flow, maximal voluntary ventilation (MVV), and peak expiratory flow rate (PEFR) showed significant compromise in the preoperative period compared with normative data, and improvement in all these values occurred in late postoperative period only. JOSS