Different Facets in Management of Congenital Atlantoaxial Dislocation and Basilar Invagination

Salunke, Pravin; Sahoo, Sunil Kumar; Deepak, Arsikere N

doi:10.1227/neu.0000000000000958

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…This technique has effectively been utilized in over 200 congenital craniovertebral junction anomalies with moderate to severe BI and atlantoaxial dislocation. 6,13,[27][28][29][30] The principle of the method is based on using the spacers as a pivot, which converts the C1/C2 joints into a type II pivot (in the present study, occipital-C2 joint after drilling the lateral mass of C1 thoroughly). Thus, compression applied posteriorly translates into a movement of extension, resulting in the dens' forward movement, effectively reducing the atlantoaxial dislocation.…”

Section: Discussionmentioning

confidence: 99%

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique

et al. 2023

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Objective: Chronic ‘displaced’ displaced type II fractures, though uncommon, are difficult to manage. They usually require a transoral procedure followed by a posterior instrumented fusion. We describe here, a new method to reduce the fractured displaced odontoid using a posterior cervical approach only.Methods: Prospective and observational, n = 14 had a ‘displaced and irreducible’ old fracture dens causing cord compression (type I, 1; type II, 13). They underwent a novel technique to reduce the fracture. The C1 arch was first drilled and removed. The C1 lateral masses on both sides were then drilled completely and a spacer was placed between the occiput and C2 facet. Following this, an intraoperative reducing maneuver was performed, utilizing the spacer as a fulcrum, and then achieving complete reduction and realignment.Results: All patients improved clinically (mean Nurick preoperative score: 4.07 ± 0.8; the postoperative score was 1.3 ± 0.4). The mean correction in effective canal diameter was 74.3% ± 9.5% and the mean correction in actual canal diameter was 77% ± 8.7%. Solid bone fusion was demonstrated in 12 patients with at least 1-year follow-up (follow-up range, 12–35 months; mean, 21.8 ± 9.8 months).Conclusion: The new described modification of distraction, compression extension, and reduction seems to be effective for ‘displaced’ chronic fracture dens with cord compression. It avoids additional transoral surgery in these patients.

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Section: Discussionmentioning

confidence: 99%

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique

et al. 2023

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“…The deformed CVJ could cause significant neck pain due to arthritis or C2 foraminal stenosis and cervicomedullary compressive myelopathy. [11][12][13][14] There have been numerous diagnostic criteria for CVJ disease. However, most of the current radiographic parameters are…”

Section: Introductionmentioning

confidence: 99%

“…These CVJ diseases consequently result in CVJ instability and alignment change. The deformed CVJ could cause significant neck pain due to arthritis or C2 foraminal stenosis and cervicomedullary compressive myelopathy [ 11 - 14 ].…”

Section: Introductionmentioning

confidence: 99%

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Chang

et al. 2022

Neurospine

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Objective: Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes.Methods: Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared.Results: A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2).Conclusion: In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.

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“…15 One of the most common CVJ anomalies is basilar invagination (BI), either congenital or degenerative, as represented by the upward migration of the odontoid process into an already limited space of the foramen magnum, causing compressive myelopathy around the cervicomedullary junction. 16,17 Many bony anomalies are associated with BI, such as clivus and condyle hypoplasia, occipital assimilation, os odontoideum, bifid C1 arch, and Klippel-Feil syndrome. 18,19 RA is the leading cause of secondary BI, which is also called basilar impression, atlantoaxial impaction, vertical settling, and cranial settling.…”

Section: Introductionmentioning

confidence: 99%

“…CVJ deformity has various etiologies, such as congenital anomaly, tumor, infection, rheumatoid arthritis (RA), and trauma [ 15 ]. One of the most common CVJ anomalies is basilar invagination (BI), either congenital or degenerative, as represented by the upward migration of the odontoid process into an already limited space of the foramen magnum, causing compressive myelopathy around the cervicomedullary junction [ 16 , 17 ]. Many bony anomalies are associated with BI, such as clivus and condyle hypoplasia, occipital assimilation, os odontoideum, bifid C1 arch, and Klippel-Feil syndrome [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

et al. 2020

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Craniovertebral junction (CVJ) deformity is a challenging pathology that can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. Surgical management of CVJ deformity is complex for anatomical reasons; given the discreet relationships involved in the surrounding neurovascular structures and intricate biochemical issues, access to this region is relatively difficult. Evaluation of the reducibility, CVJ alignment, and direction of the mechanical compression may determine surgical strategy. If CVJ deformity is reducible, posterior in situ fixation may be a viable solution. If the deformity is rigid and the C1-2 facet is fixed, osteotomy may be necessary to make the C1-2 facet joint reducible. C1-2 facet release with vertical reduction technique could be useful, especially when the C1-2 facet joint is the primary pathology of CVJ kyphotic deformity or basilar invagination. The indications for transoral surgery are becoming as narrow as a treatment for CVJ deformity. In this article, we will discuss CVJ alignment and various strategies for the management of CVJ deformity and possible ways to prevent complications and improve surgical outcomes.

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Different Facets in Management of Congenital Atlantoaxial Dislocation and Basilar Invagination

Cited by 4 publications

References 5 publications

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

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