Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach

Srivastava, Sudhir; Raj, Aditya; Bhosale, Sunil; Purohit, Shaligram; Marathe, Nandan; Gaddikeri, Manojkumar

doi:10.1007/s00586-020-06522-4

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…The surgery aims to decompress neural structures to achieve acceptable biomechanical alignment and function by fusing C1-C2, thereby improving the region's local hemodynamics. 2 However, lateral mass screws and pars screw placement is technically demanding and requires expertise.…”

Section: Discussionmentioning

confidence: 99%

“…Congenital CVJ anomalies are often associated with the anomalous course of VAs, including high-riding VA, fenestrated VA, persistent first intersegment arteries, and persistent second intersegmental arteries. 2 Persistent second intersegmental artery associated with CVJ anomalies like atlantoaxial dislocation (AAD) is uncommon. We report a case of management of an AAD with persistent second inter-segment artery and describe the role of VA mobilization during surgery.…”

Section: Introductionmentioning

confidence: 99%

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Atlantoaxial Instability with Persistent Second Intersegmental Artery

Diyora,

Wankhade,

Devani

et al. 2023

Asian J Neurosurg

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Understanding the anatomy of the vertebral artery is essential while manipulating the craniovertebral joint during surgery. Its anomalous course in congenital atlantoaxial dislocation makes it more vulnerable to injury. Preoperative dedicated computed tomography (CT) angiography helps identify the artery's position and plan for surgical procedure. A 13-year-boy presented with neck pain and spastic quadriparesis for 1 year. Radiological imaging of the craniovertebral junction revealed atlantoaxial instability with basilar invagination. His CT angiography of neck and brain vessels revealed an anomalous course of the vertebral artery due to a persistent second intersegment artery. He underwent posterior atlantoaxial fixation after mobilization of the vertebral artery. His clinical condition significantly improved after surgery. We report a case of management of an atlanto axial dislocation with persistent second intersegment artery and describe the role of vertebral artery mobilization during surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atlantoaxial Instability with Persistent Second Intersegmental Artery

Diyora,

Wankhade,

Devani

et al. 2023

Asian J Neurosurg

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“…The BI patients commonly co-occurred with symptoms such as weakness in limbs, neck pain, and gait disturbance 26 . We assume that the BI patients with a more severe pain would associate with larger cervical curvature.…”

Section: Effect Of Symptoms and Sub-typesmentioning

confidence: 99%

Cervical Alignment of Patients with Basilar Invagination: A Radiological Study

Lin

Bao

Shen

et al. 2022

Orthopaedic Surgery

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Objective: To investigate the cervical alignment and the relative range of motion (ROM) in patients with basilar invagination (BI).Methods: A total of 40 BI cases (38.1 years old AE 17.9 years old, 19 male and 21 female) and 80 asymptomatic individuals (33.8 years old AE 10.8 years old, 40 male and 40 female) were included. The Skull-C 2 /Skull-BV, Skull-C 7 , C 2 -C 7 /BV-C 7 wall angles, C 0 -C 2 /C 0 -BV, C 0 -C 7 , C 1 -C 7 , and C 2 -C 7 /BV-C 7 angles were measured in dynamic X-ray images (including neutral, extension, and flexion positions). Correlation between the upper and lower cervical curvatures were analyzed. The total, extension, and flexion ROMs of these angles were calculated, respectively. Results:The BI patients had a smaller C 0 -C 2 /C 0 -BV angle (18.2 AE 16.4 vs 30.9 AE 9.3 ), but larger C 2 -C 7 /BV-C 7 (32.2 AE 16.1 vs 19.4 AE 10.6 ) and C 2 -C 7 /BV-C 7 wall angles (37.8 AE 17.2 vs 23.6 AE 10.2 ) than the control group in neutral position. The upper and lower curvatures correlated negatively in neutral (r = À0.371), extension (r = À0.429), and flexion (r = À0.648) positions among BI patients, as well as in extension position (r = À0.317) among control group. The BI patients presented smaller total ROMs in Skull-C 2 /Skull-BV (12.3 AE 16.6 vs 19.7 AE 10.9 ), C 0 -C 2 /C 0 -BV (8.1 AE 11.1 vs 17.6 AE 10.5 ), and C 0 -C 7 angles (57.8 AE 14.2 vs 78.3 AE 17.9 ), but a larger total ROM in C 2 -C 7 /BV-C 7 wall angle (52.8 AE 13.9 vs 27.0 AE 16.1 ) than the control group. The BI patients also presented smaller extension ROMs in Skull-C 2 /Skull-BV (6.9 AE 9.4 vs 12.5 AE 9.3 ), Skull-C 7 (24.5 AE 10.9 vs 30.7 AE 12.5 ), and C 0 -C 2 /C 0 -BV angles (4.4 AE 7.8 vs 9.9 AE 8.6 ) than the control group. Moreover, the BI patients showed smaller absolute values of flexion ROMs in Skull-C 2 /Skull-BV (À5.2 AE 9.4 vs À7.3 AE 8.0 ), C 0 -C 2 /C 0 -BV (À3.2 AE 8.8 vs À7.7 AE 8.7 ), and C 0 -C 7 angles (À33.2 AE 13.0 vs À52.8 AE 19.2 ), but a larger absolute value of flexion ROM in C 2 -C 7 /BV-C 7 wall angle (À33.9 AE 14.8 vs À8.2 AE 15.1 ). Conclusion:The cervical spine was stiffer in BI patients than the asymptomatic individuals, especially in the upper cervical curvature. The negative correlation between upper and lower cervical curvatures was more obvious in BI patients.

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