Is C2-3 fusion an evidence of atlantoaxial instability? An analysis based on surgical treatment of seven patients

Goel, Atul; Jadhav, Dikpal; Shah, Abhidha; Rai, Survendra; Dandpat, Saswat; Jadhav, Neha; Vaja, Tejas

doi:10.4103/jcvjs.jcvjs_25_20

Cited by 5 publications

(8 citation statements)

References 19 publications

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“…Short head, short neck, and short spine were identified in association with basilar invagination in general and type B basilar invagination in particular. [5][6][7][8][9][10][11][12][13][14]43,44 Neural alterations secondary to chronic atlantoaxial instability include Chiari formation, syringomyelia, external syringomyelia, syringobulbia, and external syringobulbia. 5,14,[43][44][45][46][47][48] We observed that all these "secondary" musculoskeletal, structural, and neural alterations, when present in isolation or in cohort, indicate the presence of atlantoaxial instability and suggest the need for atlantoaxial fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical procedures that involve decompression by bone or softtissue resection were not used in any of these cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][23][24][25][26][27][28][29][30][31][32][33][34][35] The articles that have been included were all published in peer-reviewed journals and are indexed in the Medline and PubMed databases. Selected editorials on the subject are also included for the sake of discussion.…”

Section: Methodsmentioning

confidence: 99%

“…Group A CAAD includes cases that involve musculoskeletal and neural alterations that are primarily associated with the craniovertebral junction. These entities, which may be present discretely or in cohort, include basilar invagination, 5,6 Chiari formation, 7,8 syringomyelia, 9 Klippel-Feil alteration, 8 assimilation of the atlas, 10 C2-3 fusion, 11 bifid arch of the atlas, 12 torticollis, 13 and dorsal kyphoscoliosis. 14 Group B CAAD is associated with subaxial spinal instability.…”

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confidence: 99%

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Central or axial atlantoaxial dislocation and craniovertebral junction alterations: a review of 393 patients treated over 12 years

Shah

Vutha

Prasad

et al. 2023

Neurosurgical Focus

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OBJECTIVE The authors reviewed their scientific publications and updated their clinical material obtained over the last 12 years for cases of central or axial atlantoaxial dislocation (CAAD) identified in the presence of craniovertebral musculoskeletal and/or neural alteration(s). The management implications of diagnosing and treating CAAD are highlighted. METHODS During a 12-year period, CAAD was diagnosed in 393 patients with craniovertebral junction–related musculoskeletal and neural alterations who underwent atlantoaxial fixation. No bone decompression was done. All CAAD-related craniovertebral junction structural changes were identified to have a naturally protective role. Hence, in this paper the term "craniovertebral alterations" is used for "craniovertebral junction anomalies" and the term "Chiari formation" is used instead of the commonly used term "Chiari malformation." RESULTS The major radiological diagnosis was determined either singly or in cohort with one or more of other so-called pathological entities that included Chiari formation (367 cases), syringomyelia with Chiari (306 cases), idiopathic syringomyelia (12 cases), type B basilar invagination (147 cases), bifid arch of the atlas (9 cases), assimilation of the atlas (119 cases), C2–3 fusion (65 cases), Klippel-Feil alteration (4 cases), and dorsal kyphoscoliosis (15 cases). The follow-up period ranged from 6 to 155 months. Clinical improvement was observed in all patients. CONCLUSIONS Understanding and treating CAAD may have significant implications in the surgical treatment of a number of clinical entities. The gratifying clinical outcomes obtained in patients after atlantoaxial fixation, without any type of decompression involving bone or soft-tissue resection, consolidate the concept that atlantoaxial instability has a defining role in the pathogenesis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Central or axial atlantoaxial dislocation and craniovertebral junction alterations: a review of 393 patients treated over 12 years

Shah

Vutha

Prasad

et al. 2023

Neurosurgical Focus

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“…In the scenario of chronic, subtle or potential and less frequently manifest atlantoaxial instability, there are a number of secondary so-called “pathological” musculoskeletal, spinal structural, or neural alterations that include basilar invagination, Chiari formation, syringomyelia, Klippel-Feil alteration, assimilation of atlas, C2-3 fusion, os-odontoideum, bifid arch of atlas, platybasia, short neck, and torticollis. [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] Whenever any of these radiologically identifiable alterations are present discretely or in the cohort, they are indicative of atlantoaxial instability and suggest the need for atlantoaxial stabilization. All these secondary alterations have a neural protective role and are potentially reversible following atlantoaxial stabilization.…”

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confidence: 99%

External syringomyelia − is it an evidence of focal spinal instability?

Goel

2022

J Craniovert Jun Spine

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“…Bone fusion alterations include platybasia, assimilation of atlas, C2–3 fusion and Klippel-Feil abnormalities, and pan cervical vertebral fusions. [ 15 16 17 ] Other bone abnormalities that include bifid arches of atlas, absent posterior arch of axis and os-odontoideum are also secondary alterations that are dynamic and protective. [ 18 19 20 ] Retroodontoid and retro-C2 body pseudotumor and cyst formation are secondary alterations and have a neural protective function.…”

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confidence: 99%