Posterior Fossa Decompression Alone versus Craniovertebral Junction Fixation-Inclusive Strategies in Chiari I Malformation with Syringomyelia: A Propensity Score-Matched Retrospective Cohort Study

Purpose

The optimal surgical strategy for patients with Chiari malformation type I (CMI) and syringomyelia remains debated, particularly regarding when additional craniovertebral junction (CVJ) stabilization is required in patients with anatomical abnormalities or suspected instability.

Methods

We performed a propensity score–matched retrospective analysis of 145 pairs (N=290) based on ten preoperative variables, including detailed CVJ morphometrics. The primary outcome was the 6-month neurological dysfunction score. Secondary outcomes included syrinx regression, operative metrics, and severe complications (ICU stay > 24 h, prolonged ventilation, reintubation, or tracheotomy).

Results