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There are various surgical approaches to treat Chiari I malformation. In spite of the good clinical results that are reported with most of them, there is still controversy about the optimal treatment of this pathology.To compare the clinical and radiological results of surgical treatment of the Chiari I malformation with suboccipital craniectomy, posterior arch of C1 resection with or without dural graft, analyzing clinical and radiological findings and describing the complications.Retrospectively clinical cases series of patients who underwent Chiari I malformation surgery between 1998 and 2006 in the Hospital Germans Trias i Pujol in Badalona. The inclusion criteria consisted in: patients older than 18 years, who have had surgery in our hospital, detailed neurological examination before and after surgery (calculating the EDSS scale punctuation), craniospinal magnetic resonance imaging before and after surgery and minimal follow up period of 6 months. The election of the surgical approach was left to the discretion of the main surgeon. Patients were divided in two groups depending of the surgical technique: Group A (with dural graft) and Group B (without dural graft). To evaluate the morphological results in both groups, measurements of the position of the fastigium above a basal line in the midsagittal T1 weighted magnetic resonance images were obtained. In patients with syringomyelia, siringo-to-cord ratio was measured before and after surgery. To evaluate the clinical results, neurological examination was recorded in both groups before and after surgery.The mean age of Group A patients was 47 (-/+12.89) years, and of Group B was 38.3 (-/+7.77) years. Mean follow up period was 2.48 (-/+2.44) years in Group A and 4.2 (-/+4.46) in Group B. Creation of an artificial cisterna magna was observed en 35.7% of Group A patients and only in 3.5% of Group B patients (p=0.022). In 8 patients front Group A, 8 patients (28.6%) an upward migration of the cerebellum was seen, whereas any of the Group B patients presented it (p=0.022) Siringo-to-cord ratios were decreased in both groups without significant differences. All of the Group A patients improved their clinical exploration. In Group B, 60% of the patients improved and the 40% left maintained clinical stability. Any patient worsened. All patients that maintained clinical stability belonged to Group B, the differences between the two groups were statistically significant (p=0.04). Five patients presented immediate surgical complications (2 pseudomeningoceles, 2 meningitis and 1 hydrocephalus). All this patients where operated with dural graft (p=0.049).According to our study, suboccipital craniectomy with resection of the posterior arch of C1 and dural graft shows better clinical and radiological results than without dural graft. Nevertheless this technique can increase the incidence of surgical complications.

To analyze cervical discectomy complications with anterior approach.Retrospectively clinical cases series of 193 patients, between December 1989 to December 2004, in the Hospital Germans Trias i Pujol in Badalona. We analyzed complications arisen with cervical anterior approach and its relation with differents procedures. Demographic variables (age, sex), clinical variables (onset symptoms, cervical pathology cause, complication type, and duration time) and surgical variables (operated levels number, procedure, graft used) were analyzed. We made a statistical analysis with multivariant analysis, T-Student test and Chi-square test to analyze the relation between the complications and different studied variables.We found complications in 50 patients (25.91%). Most frequent has been dysphagia, present in 15 patients. Most of them appear with transitory form (13 patients) and in very few occasions permanent form (2 patients). T-Student test in statistical analysis showed no statistically significant differences (p=0.431) between the ages and complications, and were not statistically significant differences, used Chi-square test, in sex (p=0.515), in onset symptoms (p=0.923), in pathology origin (p=0.364), in a procedure(p=0.295), and graft used (p=0.382). We found statistically significant differences in operated levels number (p=0.018) with a ratio for the advantages (single /multiple) of 2.221. Multivariant analysis with linear regression model considering age, sex and operated levels number, showed that persistist the risk of complications in operated number levels, independently of the age or sex, being the multiple spaces a 117.3% more frequent than the single space (OR 2.173; IC95% 1.104-4.279).1. Cervical anterior approach, is a simple technique, and safe surgically procedure with under number of complications. 2. Dysphagia is most frequent complication, but it is inherent to the procedure and it is solved without treatment in most ocasions. 3. Have been many the procedures used for the cervical spine fixation, with more than 40 years of experience, and still it is to define as he is the best one. It would be necessary more studies of prospective multicentric character to be able to compare clinical, radiological results, and the presence of complications.