BACKGROUND Operative management of craniovertebral junction (CVJ) osteomyelitis has traditionally been extracranial and focused on debriding the infection. In select patients, the endoscopic endonasal approach (EEA) with a focus on additional resection versus debridement may be preferred. The goal of this study is to present the authors’ experience with the EEA with gross or subtotal resection for the treatment of osteomyelitis at the CVJ and describe their technique in the context of the literature. OBSERVATIONS Two patients of the authors’ and 6 detailed case reports in the literature were identified with a mean age of 58.9 years. Most patients (n = 5; 62.5%) underwent skull base surgery and debridement (n = 5; 62.5%). Although more common, debridement was inferior to resection in terms of neurological improvement (66.7% vs. 100.0%) postoperatively. The majority (n = 7; 87.5%) of patients underwent occipitocervical fusion. LESSONS Osteomyelitis is an exceedingly rare lesion of the CVJ. Despite the region’s delicate biomechanical stability, resection of infected bone may be superior to debridement alone in terms of clinical outcome. Given how well established the safety of the EEA is to this region, further study of outcomes with resection is warranted.

Background Context. Adult spinal deformity (ASD) is a prevalent condition often requiring surgical intervention. Improved outcomes among ASD patients have been shown to correlate with postoperative spinopelvic parameters, yet little is currently known about the role of postural stability and balance assessment for ASD patients.Purpose. Explore early changes in postural stability following ASD correction. Study Design. Prospective cohort study. Patient Sample. Sixteen adult patients who underwent four-level or greater posterolateral fusion to address global spinal malalignment and 14 healthy controls with no known spinal deformity nor surgery. Outcome Measures. Postural stability parameters, spinopelvic parameters preoperatively and postoperatively. Methods. Force plate balance assessment was completed where participants and healthy controls were instructed to stand with their hands at their sides, standing still, with eyes open. Center of pressure (COP), center of gravity (COG), and cone of economy (COE) parameters were analyzed with paired and unpaired t tests with an alpha of 0.05. Results. Preoperatively, ASD patients demonstrated more COG (P = 0.0244) and sagittal and coronal head (P < 0.05) sway than healthy controls. Postoperatively, ASD patients exhibited less COP (P = 0.0308), COG (P = 0.0276) and head (P = 0.0345) sway. Compared to healthy controls, ASD patients postoperatively exhibited similar postural stability, aside from COP and COG sway amplitudes (P < 0.05), and coronal head sway (P = 0.0309). Pelvic incidencelumbar lordosis and sagittal vertical axis improved from 16.2°to 4.8°( P < 0.01) and 82.2 to 22.5 mm (P < 0.01), respectively. Conclusion.We report a novel early improvement in postural stability, comparable to healthy controls, following ASD correction that may be related to improved spinopelvic alignment. Force plate evaluation may be a useful tool for ASD patients postoperatively. Future clinical trials assessing the impact of postural stability on clinical and radiographic outcomes are warranted.