The Severity of Basilar Invagination and Atlantoaxial Dislocation Correlates With Sagittal Joint Inclination, Coronal Joint Inclination, and Craniocervical Tilt

Chandra, P. Sarat; Goyal, Neeraj Kumar; Chauhan, Avnish; Ansari, Abuzer; Sharma, Bhawani Shankar; Garg, Ajay

doi:10.1227/neu.0000000000000470

Cited by 45 publications

(49 citation statements)

References 30 publications

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“…In the plain radiographs era, Smoker et al[19] had demonstrated that this angle changed about 30 o from flexion to extension neck position, also reporting that normal range varied from 150° to 180°. Our limited variation from flexion to extension compared to the reported by Chandra et al[11] may be explained by the fact that some of our patients had clivus hypoplasia and atlas assimilation which may decrease CVJ motion when compared with normal subjects. Platybasia may lead to a lower CCA and CVJ kyphosis, with brainstem symptoms as well as compensatory subaxial hyperlordosis.…”

Section: Discussioncontrasting

confidence: 55%

“…Symptomatic congenital CVJ malformation: Chiari Malformation (CM), characterized by tonsillar herniation through the foramen magnum or BI with or without CM who underwent posterior fossa decompression; age > 15 years old (younger patients have incomplete ossification of the region and were excluded)[11]; a complete sagittal CT scan of the CVJ in flexion and in extension (a head holder was used to flex the neck and a pad roll was placed below the shoulders for the extended position); non evident AAD or facet subluxation on static radiological exams.…”

Section: Methodsmentioning

confidence: 99%

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Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations

Silva

Ghizoni

Tedeschi

et al. 2017

WJO

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AIMTo evaluate the role of dynamic computed tomography (CT) scan imaging in diagnosing craniovertebral junction (CVJ) instability in patients with congenital CVJ malformations.METHODSPatients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study. Measurements of the following craniometrical parameters were taken in flexed and extended neck position: Atlanto-dental interval (ADI), distance of the odontoid tip to the Chamberlain’s line, and the clivus-canal angle (CCA). Assessment of the facet joints congruence was also performed in both positions. Comparison of the values obtained in flexion and extension were compared using a paired Student’s t-test.RESULTSA total of ten patients with a mean age of 37.9 years were included. In flexion imaging, the mean ADI was 1.76 mm, the mean CCA was 125.4° and the mean distance of the odontoid tip to the Chamberlain’s line was + 9.62 mm. In extension, the mean ADI was 1.46 mm (P = 0.29), the mean CCA was 142.2° (P < 0.01) and the mean distance of the odontoid tip to the Chamberlain’s line was + 7.11 mm (P < 0.05). Four patients (40%) had facetary subluxation demonstrated in dynamic imaging, two of them with mobile subluxation (both underwent CVJ fixation). The other two patients with a fixed subluxation were not initially fixed. One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan. Patients with basilar invagination had a lower CCA variation compared to the whole group.CONCLUSIONCraniometrical parameters, as well as the visualization of the facets location, may change significantly according to the neck position. Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability. Future studies addressing the relationship between craniometrical changes and neck position are necessary.

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Section: Discussioncontrasting

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations

Silva

Ghizoni

Tedeschi

et al. 2017

WJO

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“…These findings suggest that reciprocal interaction may likely affect not only global balance but also regional balance. 33 Another interesting finding is that neck flexion, and extension movement is initiated primarily by motions between the head and C1. 34 As the head approaches full flexion and extension, contributions from the upper cervical segments decrease, whereas the lower cervical segments' contribution increases.…”

Section: A B Cmentioning

confidence: 97%

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

et al. 2020

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Craniovertebral junction (CVJ) deformity is a challenging pathology that can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. Surgical management of CVJ deformity is complex for anatomical reasons; given the discreet relationships involved in the surrounding neurovascular structures and intricate biochemical issues, access to this region is relatively difficult. Evaluation of the reducibility, CVJ alignment, and direction of the mechanical compression may determine surgical strategy. If CVJ deformity is reducible, posterior in situ fixation may be a viable solution. If the deformity is rigid and the C1-2 facet is fixed, osteotomy may be necessary to make the C1-2 facet joint reducible. C1-2 facet release with vertical reduction technique could be useful, especially when the C1-2 facet joint is the primary pathology of CVJ kyphotic deformity or basilar invagination. The indications for transoral surgery are becoming as narrow as a treatment for CVJ deformity. In this article, we will discuss CVJ alignment and various strategies for the management of CVJ deformity and possible ways to prevent complications and improve surgical outcomes.

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“…In patients with IrAAD, the C1-2 joints were oblique, both in sagittal and coronal planes. The joint orientation can be quantified using technique described by Chandra et al 1 or Salunke et al 23 We chose the latter method. The joints were relatively normal or slightly oblique in patients with RAAD.…”

Section: Radiological Differencesmentioning

confidence: 99%

Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1–2 joint manipulation

Deepak¹,

Salunke²,

Sahoo³

et al. 2017

SPI

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OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1–2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era. METHODS Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied. The preoperative and follow-up clinical statuses for both groups were studied and compared using Japanese Orthopaedic Association (JOA) scores. The radiological findings of the 2 groups were compared, and the intraoperative challenges described. RESULTS A poor preoperative JOA score (clinical status) was seen in one-fifth of patients with IrAAD, although the mean JOA score was nearly similar in the RAAD and IrAAD groups. There was significant improvement in follow-up JOA score in both groups. However, segmentation defects (such as an assimilated arch of the atlas and C2–3 fusion) and anomalous vertebral arteries were found significantly more often in cases of IrAAD compared with those of RAAD. Os odontoideum was commonly seen in the RAAD group. The C1–2 joints were acute in IrAAD compared with RAAD. Preoperative traction in IrAAD resulted in vertical distraction and improvement in clinical and respiratory status. Surgery for IrAAD required much more drilling and manipulation of the C1–2 joints while safeguarding the anomalous vertebral artery. CONCLUSIONS Bony and vascular anomalies were much more common in patients with IrAAD, which made surgery more challenging than it was in RAAD despite similar approaches. An irreducible dislocation seen on preoperative radiographs made surgeons aware of difficulties that were likely to be encountered and helped them to better plan the surgery. Distraction achieved through preoperative traction reaffirmed the feasibility of intraoperative reduction. This made the differentiation between the 2 groups and the use of preoperative traction equally important.

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The Severity of Basilar Invagination and Atlantoaxial Dislocation Correlates With Sagittal Joint Inclination, Coronal Joint Inclination, and Craniocervical Tilt

Abstract: This study has demonstrated for the first time the important role of joint orientation and its correlation with the severity of BI and AAD and has described new joint indexes.

Cited by 45 publications

References 30 publications

Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations

Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations

Evaluation and Surgical Planning for Craniovertebral Junction Deformity

Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1–2 joint manipulation

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