Redefining Congenital Atlantoaxial Dislocation: Objective Assessment in Each Plane Before and After Operation

Salunke, Pravin; Sahoo, Sushanta K.; Deepak, Arsikere N; Khandelwal, Niranjan

doi:10.1016/j.wneu.2016.07.097

Cited by 28 publications

(22 citation statements)

References 23 publications

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“…It may be difficult in certain cases with pseudofacets or supernumerary facets to dissect and safeguard the VA.[ 14 ] Similarly, significant planning may be necessary for lateral translation or angular dislocation. [ 15 16 ] However, with experience, one can easily safeguard the artery without compromising the C1–C2 joint dissection and manipulation in any plane of dislocation. The insertion of a C1–C2 prosthesis may be difficult in the presence of FIA or inverted VA.[ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Delineate, yet not dread: Anomalous vertebral artery in pediatric congenital atlantoaxial dislocation and basilar invagination

Salunke

2017

J Pediatr Neurosci

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Introduction:The deformed joints seen in congenital atlantoaxial dislocation (CAAD) are often associated with vascular anomalies. It is important to identify these vascular anomalies and address them appropriately without compromising the manipulation and fusion of C1–C2 joints. The small bones in pediatric age group pose an additional challenge.Materials and Methods:Data of fifty-six children with CAAD operated in the last 4 years was analyzed. A computed tomography angiogram was obtained preoperatively to assess for the course of the third segment of vertebral artery (VA). The anomalous VA was dissected and safeguarded during drilling and manipulation of the C1–C2 joints.Results:Of the 112 VAs, 5 were aplastic, 21 crossed the joint posteriorly. Only one patient with reducible atlantoaxial dislocation (AAD) had anomalous VA crossing the joint posteriorly, the remaining VA anomalies were seen with irreducible AAD. Anomalous VA was seen on both sides in 2 patients. The most common anomaly was an inverted VA seen in seven sides. In all patients, the anomalous VA could be dissected and safeguarded without compromising the C1–C2 dissection and manipulation and fusion. In children, even the normal VA may occasionally pose difficulties while manipulation of joints. Challenges while addressing the anomalous and normal VA in pediatric age group have been described. Techniques to overcome these have been discussed.Conclusion:It is important to delineate the anomalous VA. However, the presence of such an artery is not a deterrent to the manipulation of C1–C2 joint, essential for best results. Special attention needs to be paid to the extent of distraction, medial C2 transverse foramen, and dissection/drilling of the area superior to the anomalous VA in the pediatric age group.

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Section: Discussionmentioning

confidence: 99%

Delineate, yet not dread: Anomalous vertebral artery in pediatric congenital atlantoaxial dislocation and basilar invagination

Salunke

2017

J Pediatr Neurosci

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“…AAD itself may be multiplanar. [ 22 ] The current management focuses on the lateral C1-2 joints by comprehensively drilling them and reducing the dislocation. [ 3 ] Further manipulation of these drilled facets realigns the C1-2 joints in all planes.…”

Section: Discussionmentioning

confidence: 99%

“Soft that molds the hard:” Geometric morphometry of lateral atlantoaxial joints focusing on the role of cartilage in changing the contour of bony articular surfaces

Prasad

Salunke

Sahni

et al. 2017

J Craniovert Jun Spine

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Purpose:The existing literature on lateral atlantoaxial joints is predominantly on bony facets and is unable to explain various C1-2 motions observed. Geometric morphometry of facets would help us in understanding the role of cartilages in C1-2 biomechanics/kinematics.Objective:Anthropometric measurements (bone and cartilage) of the atlantoaxial joint and to assess the role of cartilages in joint biomechanics.Materials and Methods:The authors studied 10 cadaveric atlantoaxial lateral joints with the articular cartilage in situ and after removing it, using three-dimensional laser scanner. The data were compared using geometric morphometry with emphasis on surface contours of articulating surfaces.Results:The bony inferior articular facet of atlas is concave in both sagittal and coronal plane. The bony superior articular facet of axis is convex in sagittal plane and is concave (laterally) and convex medially in the coronal plane. The bony articulating surfaces were nonconcordant. The articular cartilages of both C1 and C2 are biconvex in both planes and are thicker than the concavities of bony articulating surfaces.Conclusion:The biconvex structure of cartilage converts the surface morphology of C1-C2 bony facets from concave on concavo-convex to convex on convex. This reduces the contact point making the six degrees of freedom of motion possible and also makes the joint gyroscopic.

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“…[ 1 ] The deformity can be objectively measured in sagittal and coronal planes. [ 1 4 ] The sagittal inclination of joint leads to anterior and inferior slip of C1 over C2. [ 1 4 ] Increased coronal inclination adds further to vertical slipping of C2 within C1.…”

Section: N Ature's E Ngineeringmentioning

confidence: 99%

“…[ 1 4 ] The sagittal inclination of joint leads to anterior and inferior slip of C1 over C2. [ 1 4 ] Increased coronal inclination adds further to vertical slipping of C2 within C1. [ 1 4 ] The inclination often exists in both coronal and sagittal plane, which leads to a combination of anteroposterior and vertical dislocation of C1 over C2 [ Figure 5 ].…”

Section: N Ature's E Ngineeringmentioning

confidence: 99%

“…[ 1 4 ] Increased coronal inclination adds further to vertical slipping of C2 within C1. [ 1 4 ] The inclination often exists in both coronal and sagittal plane, which leads to a combination of anteroposterior and vertical dislocation of C1 over C2 [ Figure 5 ]. The degree of deformity of lateral masses and C1-2 joints decides the rate of dislocation.…”

Section: N Ature's E Ngineeringmentioning

confidence: 99%

See 1 more Smart Citation

Congenital atlantoaxial dislocation: Nature’s engineering gone wrong and surgeon’s attempt to rectify it

Salunke

2018

J Pediatr Neurosci

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Redefining Congenital Atlantoaxial Dislocation: Objective Assessment in Each Plane Before and After Operation

Cited by 28 publications

References 23 publications

Delineate, yet not dread: Anomalous vertebral artery in pediatric congenital atlantoaxial dislocation and basilar invagination

Delineate, yet not dread: Anomalous vertebral artery in pediatric congenital atlantoaxial dislocation and basilar invagination

“Soft that molds the hard:” Geometric morphometry of lateral atlantoaxial joints focusing on the role of cartilage in changing the contour of bony articular surfaces

Congenital atlantoaxial dislocation: Nature’s engineering gone wrong and surgeon’s attempt to rectify it

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