Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Thakar, Sumit; Siddappa, Avinash Kurudi; Aryan, Saritha; Mohan, Dilip; Kiran, Narayanam Anantha Sai; Hegde, Alangar S.

doi:10.3171/2016.12.spine16914

Cited by 16 publications

(6 citation statements)

References 20 publications

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“…Noting a recent Epub prior to print study that reports greater cervical spine taper ratios in Chiari I than in controls, we performed a regression analysis of taper ratios and tonsil herniation in our data. 12 We found significantly steeper C1–C4 and C1–C7 taper ratios in our 23 patients with presyrinx, but no significant correlation of tonsil herniation and lower cervical spine tapering (C4–C7) in our patients.…”

Section: Discussioncontrasting

confidence: 52%

Anatomical features of the cervical spinal canal in Chiari I deformity with presyrinx: A case-control study

et al. 2017

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Purpose The relationship between syringomyelia and presyrinx, characterized by edema in the spinal cord, has not been firmly established. Patients with syringomyelia have abnormal spinal canal tapering that alters cerebrospinal fluid flow dynamics, but taper ratios in presyrinx have never been reported. We tested the hypothesis that presyrinx patients have abnormal spinal canal tapering. Materials and methods At six medical institutions, investigators searched the PACS system for patients with Chiari I and spinal cord edema unassociated with tumor, trauma, or other evident cause. In each case taper ratios were calculated for C1 to C4 and C4 to C7. In two age- and gender-matched control groups, Chiari I patients with no syringomyelia and patients with normal MR scans, the same measurements were made. Differences between groups were tested for statistical significance with t tests. Results The study enrolled 21 presyrinx patients and equal numbers of matched Chiari I and normal controls. C4 to C7 taper ratios were positive and steeper in presyrinx patients than in the normal controls ( p = 0.04). The upper cervical spine, C1 to C4, tapered negatively in cases and controls without significant differences between the groups. The difference in degree of tonsillar herniation was statistically significant between presyrinx patients and Chiari I controls ( p = 0.01). Conclusions Presyrinx patients have greater than normal positive tapering in the lower cervical spine and greater degree of tonsillar herniation than the controls.

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Section: Discussioncontrasting

confidence: 52%

Anatomical features of the cervical spinal canal in Chiari I deformity with presyrinx: A case-control study

et al. 2017

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“…In addition, the sectional area of the RCDmi myofibers in the BLM group was found to be larger and these myofibers appeared to be more tightly packed than those observed in the other groups. This suggests that the RCDmi might be accompanied by compensatory hypertrophy (Thakar et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

The relationship between compensatory hyperplasia of the myodural bridge complex and reduced compliance of the various structures within the cranio‐cervical junction

Song

Gong

et al. 2022

The Anatomical Record

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The myodural bridge complex (MDBC) is described as a functional anatomic structure that involves the dense connective tissue fibers, muscles, and ligaments in the suboccipital region. It has recently been proposed that the MDBC can influence cerebrospinal fluid (CSF) circulation. In the present study, bleomycin (BLM), a type of antibiotic that is poisonous to cells, was injected into the posterior atlanto-occipital interspace (PAOiS) of rats to induce fibrous hyperplasia of structures in PAOiS. Sagittal sections of tissues obtained from the posterioroccipital region of the rats were stained utilizing the Masson Trichrome staining method. Semiquantitative analysis evidenced that the collagen volume fraction of collagen fibers of the MDBC, as well as the sum of the area of the spinal dura mater and the posterior atlanto-occipital membrane in the BLM group were significantly increased (p < .05) compared to that of the other groups. This finding illustrates that the MDBC fibers as well as other tissues in the PAOiS of rats in the BLM group developed fibrotic changes which reduced compliance of the spinal dura mater. Indeed, the sectional area of the rectus capitis dorsal minor muscle in the BLM group was measured to be increased. These changes may further restrict CSF flow. The present research provides support for the recent hypothesis proposed by Labuda et al. concerning the pathophysiology observed in symptomatic adult Chiari malformation Type I patients, that there exists a relationship between the altered compliance of the anatomic structures within the craniocervical region and the resultant compensatory hyperplasia of the MDBC.

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“…However, we observed the same tendency that the CSA of Trap, SSC, LS, SCM, and LCap & LC were smaller in BI patients. Moreover, we supposed that the FCSA/CSA ratio was more meaningful than muscle size, but it was absent in the study of Thakar et al [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, the muscle morphology in BI patients had been rarely reported so far. Thakar et al [ 18 ] investigated the cervical paraspinal muscles in 25 patients with Chiari I malformation, a common complication of BI, and found that the dimension of cervical paraspinal muscles including superficial, deep flexor and extensor were smaller than that of the control group. The authors calibrated the muscle CSA with vertebra body CSA to eliminate biases in body size so that we could not directly compare our muscle CAS results with theirs.…”

Section: Discussionmentioning

confidence: 99%

“…So far, most studies reported that the cervical/lumbar muscle were correlated with cervical/lumbar alignment (e.g., sagittal vertical axis) and clinical outcomes, such as visual analogue score and Neck Disability Index scores [ 7 , 10 , 11 , 18 , 20 ]. Yoon et al [ 8 ] investigated the ratio of flexor to extensor muscle CSAs and found that it positively correlated with the cervical lordotic angle, recommending exercise programs to strengthen the extensor muscles.…”

Section: Discussionmentioning

confidence: 99%

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The Morphological Evaluation of the Cervical Muscle in Patients With Basilar Invagination: A Magnetic Resonance Imaging-Based Study

Lin¹,

Xu²,

Zheng³

et al. 2023

Neurospine

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Objective: To investigate the characteristics of functional muscle and muscle size in patients with basilar invagination (BI) and explore the effects of atlantoaxial dislocation.Methods: Eighty BI patients (BI group) and 80 age- and sex-matched asymptomatic people (control group) were included. Axial T2 magnetic resonance imaging image was used to measure the cross-sectional area (CSA) and functional CSA (FCSA). The sternocleidomastoid (SCM), longus capitis and longus colli (LCap & LC), trapezius (Trap), splenius capitis (SpCap), splenius cervicis (SpC), semispinalis capitis (SSCap), semispinalis cervicis (SSC), multifidus (MS), levator scapulae (LS) and posterior deep layer muscles (PDLM) were evaluated. Correlations between age, atlantodental interval (ADI), Chamberlain distance and muscles were observed.Results: BI group (39.4 ± 18.4 years; 33 males/47 females) exhibited significantly lower FCSA/CSA ratios than the control group in all extensor and flexor muscles, and presented smaller CSAs on the right and left Trap, SSC, LS, SCM, and left LCap & LC. FCSA/CSA ratios were significantly lower in BI patients with dislocation on the right Trap, SpCap, SpC, SSCap, MS, LS, LCap & LC, and PDLM, and the left SSCap, MS, and LCap & LC than in patients without deformity. Additionally, functional muscles of all parameters decreased with age in BI patients. Excluding children, the Trap, SpC, MS, and LS muscle sizes of BI patients tended to increase with age. ADI and Chamberlain distance tended to correlate negatively with FCSA/CSA ratio.Conclusion: The BI patients, especially those with atlantoaxial dislocation, had less functional muscles compared with the control group. Moreover, their functional muscles decreased with age more obviously.

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Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Cited by 16 publications

References 20 publications

Anatomical features of the cervical spinal canal in Chiari I deformity with presyrinx: A case-control study

Anatomical features of the cervical spinal canal in Chiari I deformity with presyrinx: A case-control study

The relationship between compensatory hyperplasia of the myodural bridge complex and reduced compliance of the various structures within the cranio‐cervical junction

The Morphological Evaluation of the Cervical Muscle in Patients With Basilar Invagination: A Magnetic Resonance Imaging-Based Study

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