Intra-articular Distraction Versus Decompression to Treat Basilar Invagination Without Atlantoaxial Dislocation: A Retrospective Cohort Study of 54 Patients

Zhang, B Y; Qi, Maoyang; Zong, Xin; Du, Yue-Qi; Zhang, C; Liu, Zhenlei; Guan, Jian; Wang, Z W; Jian, Fu; Duan, Wanru; Chen, Zan

doi:10.14245/ns.2244910.455

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…[1][2][3][4][5] Current management strategies are based on this philosophy and C1-2 facet joint alignment and fusion are the mainstay of the treatment. [7][8][9][10] Authors have been using digital software to plan CVJ surgeries using three-dimensional (3D) images of computed tomography angiography (CTA) for all CVJ surgeries and report their findings to revisit screw insertion into C2, especially in anomalous CVJ. 11,12 This study may help increase access to surgical treatments for patients suffering from diseases due to traumatic and congenital CVJ instabilities.…”

Section: Introductionmentioning

confidence: 99%

C2 Vertebra: An Enigma for Young Spine/Neurosurgeons

Garg,

Sharma,

Janu

et al. 2024

J Neurol Surg B Skull Base

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Background: Instrumentation of C2 vertebra is considered the most difficult for young neurosurgeons and trainees due to its complex anatomical structures, variety of surgical approaches and techniques, and proximity to important neurovascular structures. Key points from a surgical perspective for midline posterior approach is described in the era of neuroradiological advancements. Method: Computed Tomography Angiographies (CTA) of a total of 92 patients were evaluated with special attention to the key findings for insertion of screws for craniovertebral junction fixations. All these patients were operated though midline posterior approach in last 4 years. Results: CTAs included various CVJ disorders which included traumatic (n= 14), congenital (n= 55) and rheumatoid arthritis (n= 2) patients. Established landmarks for screw insertion sites don’t prove safe for congenital anomalous CVJ conditions. Instead of highlighting screw insertion entry points, part of the corridor which is relevant, should be stressed up on. Conclusion: Mid-point of portion of bone segment medial to vertebral artery foramen should be the focus which is important for pars interarticularis (and transarticular) and pedicle screws. A laminar screw should cross the midpoint of the lamina on each side.

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Section: Introductionmentioning

confidence: 99%

C2 Vertebra: An Enigma for Young Spine/Neurosurgeons

Garg,

Sharma,

Janu

et al. 2024

J Neurol Surg B Skull Base

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“…“Intra-Articular Distraction Versus Decompression to Treat Basilar Invagination Without Atlanto-Axial Dislocation: A Retrospective Cohort Study of 54 Patients” by Zhang et al [ 3 ]…”

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confidence: 99%

From the Editor-in-Chief: Featured Articles in the June 2023 Issue

Han

2023

Neurospine

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Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision

Zhang,

Du,

Zhang

et al. 2024

Orthopaedic Surgery

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ObjectiveThe craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire.MethodsThis was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus‐canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF‐12 scores were used for clinical assessment. Independent sample t‐tests were employed. A significance level of p < 0.05 indicates statistically significant differences.ResultsWe analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus‐canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments.ConclusionSevere atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.

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Intra-articular Distraction Versus Decompression to Treat Basilar Invagination Without Atlantoaxial Dislocation: A Retrospective Cohort Study of 54 Patients

Cited by 3 publications

References 25 publications

C2 Vertebra: An Enigma for Young Spine/Neurosurgeons

C2 Vertebra: An Enigma for Young Spine/Neurosurgeons

From the Editor-in-Chief: Featured Articles in the June 2023 Issue

Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision

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