The Severity of Basilar Invagination and Atlantoaxial Dislocation Correlates With Sagittal Joint Inclination, Coronal Joint Inclination, and Craniocervical Tilt: A Description of New Indexes for the Craniovertebral Junction

2014 ◽  
Vol 10 (4) ◽  
pp. 621-630 ◽  
Author(s):  
P. Sarat Chandra ◽  
Nishant Goyal ◽  
Avnish Chauhan ◽  
Abuzer Ansari ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Current Data ◽  
Atlantoaxial Dislocation ◽  
Joint Orientation ◽  
Control Subjects ◽  
Standard Procedures ◽  
Joint Distraction ◽  
The Mean ◽  
Joint Inclination

Abstract BACKGROUND: Joint-distraction and intra-operative manipulation surgeries to correct basilar invagination (BI) and atlantoaxial dislocation (AAD) are becoming standard procedures. However, current data are unable to aid in the understanding of normal and abnormal morphology of the C1/C2 joints. OBJECTIVE: To study various aspects of C1/C2 joint morphology to create normative and patient data on joint abnormalities that could provide the surgeon with objective data for surgical planning and approach. METHODS: Seventy patients (age, 15-45 years) were compared with an equal number of age- and sex-matched control subjects (age, 21.9 ± 8.2 years) with irreducible BI and AAD from a developmental origin (May 2010-July 2013). Joint anatomy was studied with the use of thin-slice computed tomography scans. The joint parameters studied included sagittal joint inclination, craniocervical tilt, coronal joint inclination, surface area, joint overlap index, and joint reciprocity. The severity of BI and the severity of AAD were compared. RESULTS: Sagittal joint inclination and craniocervical tilt significantly correlated with both BI and AAD (P < .01). Coronal joint inclination correlated with BI (P = .2). The mean sagittal joint inclination value in control subjects was 87.15 ± 5.65° and in patients with BI and AAD was 127.1 ± 22.05°. The mean craniocervical tilt value in controls was 60.2 ± 9.2° and in patients with BI and AAD was 84.0 ± 15.1°. The mean coronal joint inclination value in control subjects was 110.3 ± 4.23° and in patients with BI and AAD was 121.15 ± 14.6°. CONCLUSION: 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.

Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

2008 ◽  
Vol 9 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Atul Goel ◽  
Nitin Dange
Keyword(s):  
Bone Graft ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Postoperative Phase ◽  
Complete Disappearance ◽  
Lateral Mass ◽  
Rheumatoid Disease ◽  
Mass Reconstruction

The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

scholarly journals Foramen magnum decompression without bone removal: C1–C2 posterior fixation for Chiari with congenital atlantoaxial dislocation/basilar invagination

2019 ◽  
Vol 10 ◽  
pp. 38 ◽  
Author(s):  
Pravin Salunke ◽  
Madhivanan Karthigeyan ◽  
Puneet Malik
Keyword(s):  
Posterior Fossa ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Dislocation ◽  
Posterior Fixation ◽  
Foramen Magnum Decompression ◽  
Radiological Data ◽  
C2 Fixation ◽  
Small Posterior Fossa

Background: Atlantoaxial dislocation (AAD) and basilar invagination (BI) may coexist with Chiari malformations (CM) and a small posterior fossa volume. These are typically treated with craniovertebral junction fusion and foramen magnum decompression (FMD). Here, we evaluated whether C1–C2 posterior reduction and fixation (which possibly opens up the ventral foramen magnum) would effectively treat AAD and CM without additionally performing FMD. Methods: This is a retrospective analysis of 38 patients with BI, AAD, and CM who underwent C1–C2 posterior reduction and fusion without FMD. Baseline and follow-up clinical, demographic, and radiological data were evaluated. Results: The vast majority of patients (91.9%) improved both clinically and radiographically following C1–C2 fixation alone; none later required direct FMD. Notably, AAD was irreducible in 25 (65.8%) patients. Preoperatively, syringomyelia was present in 28 (73.7%) patients and showed resolution. In 3 (8.1%) patients, resolution of syrinxes did not translate into clinical improvement. Of interest, 5 patients who sustained inadvertent dural lacerations exhibited transient postoperative neurological worsening. Conclusions: Posterior C1–C2 distraction and fusion alone effectively treated AAD, BI, accompanied by CM. The procedure sufficiently distracted the dens, reversed dural tenting, and restored the posterior fossa volume while relieving ventral brainstem compression making FMD unnecessary. Surgeons should, however, be aware that inadvertent dural lacerations might contribute to unwanted neurological deterioration.

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

scholarly journals C1C2 Distraction and Compression Technique for Craniovertebral Junction Anomalies with Basilar Invagination and Irreducible Atlantoaxial Dislocation

2018 ◽  
Vol 07 (03) ◽  
pp. 184-189
Author(s):  
Vamsi Yerramneni ◽  
Vamshi Kotha ◽  
Ramanadha Reddy
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Screw Placement ◽  
Compression Technique ◽  
Irreducible Atlantoaxial Dislocation

AbstractThe authors describe four cases of basilar invagination (BI) with irreducible atlantoaxial dislocation (AAD) by distraction and compression technique. The article describes the technique in detail and the principles of the reduction achieved in all the planes by C1C2 screw placement, the cage insertion in the C1C2 joint, and manipulation of the joint. They described in the literature well-discussed various modifications and their application for treatment of BI with irreducible AAD.

scholarly journals Craniovertebral junction anomaly with kissing carotids

2020 ◽  
Vol 11 ◽  
pp. 377
Author(s):  
Nitin Kumar ◽  
Jaskaran Singh Gosal ◽  
Sarbesh Tiwari ◽  
Mayank Garg ◽  
Suryanarayanan Bhaskar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Retropharyngeal Space ◽  
Case Description ◽  
Transoral Decompression

Background: “Kissing carotids” typically involves the lower C4-C6 retropharyngeal space. Here, we describe a case of “kissing carotids” observed at the C1-C2 level in conjunction with basilar invagination (BI). Case Description: A 34-year-old-male presented with congenital atlantoaxial dislocation and BI. The initial surgical plan was for a transoral decompression (TOD). However, this approach was abandoned when the preoperative computed tomography angiography (CTA) documented “kissing carotids” lying anteriorly at the C1-C2 level. Conclusion: Obtaining a CTA before performing a TOD for BI is essential to prevent an intraoperative catastrophic hemorrhage due to the laceration of “kissing carotids.”

scholarly journals Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

2018 ◽  
Vol 28 (3) ◽  
pp. 262-267 ◽  
Author(s):  
Tatsushi Inoue ◽  
Natsuki Hattori ◽  
Tsukasa Ganaha ◽  
Tadashi Kumai ◽  
Shinichiro Tateyama ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Intervention Strategy ◽  
Essential Element ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Type I ◽  
Atlantoaxial Joint ◽  
Chiari Malformation Type I ◽  
Neurological Improvement ◽  
Joint Distraction

Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

scholarly journals Navigated transoral odontoidectomy to treat congenital basilar invagination after failed posterior reduction and fusion

2020 ◽  
Vol 3 (1) ◽  
pp. V8
Author(s):  
Wanru Duan ◽  
Dean Chou ◽  
Fengzeng Jian ◽  
Zan Chen
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Navigation Systems ◽  
Severe Osteoporosis ◽  
Posterior Surgery ◽  
Image Guided ◽  
Transoral Odontoidectomy ◽  
History Of ◽  
Modern Image

Transoral odontoidectomy is a traditional technique to treat congenital basilar invagination (BI) associated with atlantoaxial dislocation (AAD). Although posterior surgery has been a trend to treat most cases, there are still cases that need to be treated through a transoral approach. In addition, intraoperative modern image-guided navigation systems help identify any remnants of the dens and decrease the risk of vertebral artery injury. For symptomatic cases with a history of previous posterior fusion and severe osteoporosis, transoral odontoidectomy is preferred over a posterior-only approach. Our video demonstrates the surgical technique for transoral revision odontoidectomy to treat congenital basilar invagination associated with atlantoaxial dislocation after previous posterior craniovertebral junction surgery.The video can be found here: https://youtu.be/vzcAW8oLcZY

scholarly journals Posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination

2020 ◽  
Vol 3 (1) ◽  
pp. V2
Author(s):  
Wanru Duan ◽  
Dean Chou ◽  
Fengzeng Jian ◽  
Zan Chen
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Facet Joint ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Link Type

Congenital atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is a complex congenital malalignment at the craniovertebral junction. The olisthesis, atlantoaxial facet joint arthropathy, and the contraction of the anterior soft tissue make the treatment challenging. Our video demonstrates the surgical technique for posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination.The video can be found here: https://youtu.be/7EQqW96HhN8

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