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Chiari and disorders of the craniovertebral junction (CVJ)

Published Oct. 21, 2015
• Reviewed by a UI Health Care Provider

University of Iowa Iowa Stead Family Hospital is one of the most experienced hospitals in the world treating Chiari and disorders of the craniovertebral junction (CVJ). Since 1977, more than 6,000 children and adults have been treated for Chiari and wide-ranging CVJ conditions, and more than 800 surgeries have been performed for the most complex type of CVJ and Chiari abnormalities. Our doctors have published more 150 scholarly publications, numerous book chapters, and some of the most cited papers on the presenting symptoms and treatment strategies for Chiari type I malformation and CVJ conditions.

In fact, UI Iowa Stead Family Hospital is one of the pioneering institutions in treating Chiari and CVJ disorders. In the late 1970s, Arnold Menezes, MD, perfected the transoral approach through the back of the mouth to the CVJ. This technique revolutionized the treatment of Chiari and CVJ pathology. In the late 1970s, the UI was one of the first institutions to publish and adopt an algorithmic (decision tree based) treatment strategy for patients with Chiari and CVJ conditions based on different approaches. This treatment strategy has since been accepted and used throughout the world. Over the past 40 years, we have developed a better understanding of CVJ disorders and established multiple microscopic and minimally invasive approaches to the CVJ by developing new approaches using an endoscope. This has resulted in excellent outcomes and minimal complications. In addition, we have developed and implemented new reduction strategies that have diminished the need to perform approaches through the back of the mouth or through the nose.

We care for each patient on an individual basis to provide the appropriate, optimal, and tailored treatment strategy. By treating both children and adults with Chiari and CVJ conditions, we have gained significant experience and a better understanding of these conditions and are able to follow our patients throughout their lives. Doctors from across the nation and around world refer their patients to us because of our experience in treating these complex conditions.

Conditions we treat

  • Achondroplasia associated spinal disorders
  • Atlantoaxial instability or dislocation
  • Atlantoaxial rotatory subluxation/dislocation
  • Atlas assimilation (occipitalization of the atlas)
  • Atlas or C1 fractures and Jefferson fractures
  • Axis or C2 fractures and Hangman’s fractures
  • Basilar Invagination
  • Basilar Impression
  • Calcium pyrophosphate deposition disease (CPPD) of the spine
  • Chiari malformation – all types
  • Complex Chiari malformation
  • Condylar fractures
  • Cranial settling (rheumatologic basilar impression)
  • Down’s syndrome associated spinal disorders
  • Hypermobility syndromes (Ehlers-Danlos Syndrome)
  • Klippel-Feil Syndrome
  • Occipitocervical instability or dislocation
    • Occipitoatlantal instability or dislocation
    • Occipitoatlantoaxial instability or dislocation
  • Os Odontoideum
  • Proatlas segmentation abnormalities
  • Rheumatoid Arthritis associated spinal disorders
  • Tumors of the clivus, atlas, and odontoid

Surgeries we perform

  • C1-C2 fusion
  • Endoscopic endonasal approach (through the nose)
  • Extended transoral approaches
  • Occipital cervical fusion
  • Posterior fossa extradural decompression for Chiari malformations
  • Posterior fossa intradural decompression for Chiari malformations and syringomyelia
  • Posterior fusion for craniovertebral junction instability
  • Transoral approach (through the back of the mouth)