Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression

Behari, Sanjay; Kalra, Samir Kumar; Kumar, Munish; Salunke, Pravin; Jaiswal, Awadhesh Kumar; Jain, Vibha

doi:10.1007/s00701-006-1047-3

Cited by 24 publications

(16 citation statements)

References 20 publications

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“…[29,30] This technique cannot be used when ACM is associated with AAD; when posterior elements of the axis are hypoplastic [31] or when one has to remove the bone for posterior decompression. [32,33] Occipito-cervical fusion Many techniques have been described for occipitocervical fusion. Most often contoured rods are used for this purpose.…”

Section: Surgical Management Of Atlanto-axial Dislocationmentioning

confidence: 99%

Atlantoaxial dislocation

Jain

2012

Neurol India

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Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anteroposterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible (RAADs) and irreducible (IAADs). Posterior fusion is the treatment of choice for RAAD. Transarticular screw fixation with sub-laminar wiring is the most stable& method of posterior fusion. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles. If the anatomy at the occipito-atlanto-axial region {O-C1-C2; O: occiput, C1: atlas, C2: axis} is normal on X-ray, the dislocation should be reducible. In case congenital anomalies at O-C1-C2 and IAAD are seen on flexion/extension studies of the cervical spine, the C1-C2 joints should be seen in computerized tomography scan (CT). If the C1-C2 joint facet surfaces are normal, the AAD should be reducible by cervical traction or during surgery by mobilizing the joints. The entity termed "dolichoodontoid" does not exist. It is invariably C2-C3 (C3- third cervical vertebra) fusion which gives an appearance of dolichoodontoid on plain X-ray or on mid-saggital section of magnetic resonance imaging (MRI) or CT scan. The central dislocation and axial invagination should not be confused with basilar invagination. Transoral odontoidectomy alone is never sufficient in cases of congenital IAAD, adequate generous three-dimensional decompression while protecting the underlying neural structures should be achieved. Chronic post-traumatic IAAD are usually Type II odontoid fractures which get malunited or nonunited with pseudoarthrosis in dislocated position. All these dislocations can be reduced by transoral removal of the offending bone, callous and fibrous tissue.

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Section: Surgical Management Of Atlanto-axial Dislocationmentioning

confidence: 99%

Atlantoaxial dislocation

Jain

2012

Neurol India

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“…In some series of Chiari malformation, syringomyelia developed in 58-65% of cases. 1,[5][6][7] The most frequent types of Chiari malformation have been considered to result from mesodermal defects. Acquired forms of Chiari malformation are often seen after lumbar shunting procedures, such as lumbo-peritoneal shunts indicated for the treatment of certain forms of communicating hydrocephalus, or after drainage or serial spinal taps for the treatment of postoperative or post-traumatic cerebrospinal fluid leakage.…”

Section: Discussionmentioning

confidence: 99%

Acquired Chiari Malformation Secondary to Atlantoaxial Vertical Subluxation in a Patient With Rheumatoid Arthritis Combined With Atlanto-occipital Assimilation

Kimura

Seichi

Gomi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 65-year-old woman with a history of rheumatoid arthritis presented with a rare case of acquired Chiari malformation secondary to atlantoaxial vertical subluxation, associated with congenital atlantooccipital assimilation. Syringomyelia and tetraparesis improved immediately after posterior fossa decompression and simultaneous occipito-cervical junction fusion. The progression of acquired Chiari malformation is not well known. We concluded that coexisting assimilation accelerated crowded foramen magnum following atlantoaxial vertical subluxation and induced acquired Chiari malformation over the course of a few years.

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“…The symptoms usually occur due to associated AAD, compression from canal stenosis or thickened posterior dural band. The common associations include congenital C 2 -C 3 fusion, BI, CIM, and manifestations of occipital vertebrae [7]. The associated AAD is usually irreducible and is primarily responsible for the neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Craniovertebral Junction Anomaly with Atlas Assimilation and Reducible Atlantoaxial Dislocation: A Rare Constellation of Bony Abnormalities

et al. 2008

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Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression

Abstract: Patients with Chiari I malformation should be investigated for the presence of atlanto-axial dislocation. In case atlantoaxial dislocation coexists, priority must be given to relieving anterior cervicomedullary compression.

Cited by 24 publications

References 20 publications

Atlantoaxial dislocation

Atlantoaxial dislocation

Acquired Chiari Malformation Secondary to Atlantoaxial Vertical Subluxation in a Patient With Rheumatoid Arthritis Combined With Atlanto-occipital Assimilation

Craniovertebral Junction Anomaly with Atlas Assimilation and Reducible Atlantoaxial Dislocation: A Rare Constellation of Bony Abnormalities

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