1,167 results match your criteria Atlantoaxial Instability


Traumatic Atlantoaxial and Fracture-Related Dislocation.

Biomed Res Int 2019 18;2019:5297950. Epub 2019 Mar 18.

Department of Orthopaedics, Spine and Trauma Surgery, Helios Klinikum Siegburg, Siegburg, Germany.

Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In this level 4 study, a cohort of nine consecutive patients suffering from traumatic atlantoaxial dislocation has been analyzed regarding morphology of injury, trauma mechanism, and outcome since 2007. Read More

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http://dx.doi.org/10.1155/2019/5297950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442449PMC

Is central atlantoaxial instability the nodal point of pathogenesis of "idiopathic" dorsal spinal kyphoscoliosis?

Authors:
Atul Goel

J Craniovertebr Junction Spine 2019 Jan-Mar;10(1):1-2

Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India.

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http://www.jcvjs.com/text.asp?2019/10/1/1/255729
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http://dx.doi.org/10.4103/jcvjs.JCVJS_18_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469321PMC
April 2019
2 Reads

Three-Dimensional Printed Patient Models for Complex Pediatric Spinal Surgery.

Ochsner J 2019 ;19(1):49-53

The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.

Pediatric spinal deformity surgeries are challenging operations that require considerable expertise and resources. The unique anatomy and rarity of these cases present challenges in surgical training and preparation. We present a case series illustrating how 3-dimensional (3-D) printed models were used in preoperative planning for 3 cases of pediatric spinal deformity surgery. Read More

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http://www.ochsnerjournal.org/lookup/doi/10.31486/toj.18.011
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http://dx.doi.org/10.31486/toj.18.0117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447199PMC
January 2019
2 Reads

Basilar invagination associated with chiari malformation type I: A literature review.

Clinics (Sao Paulo) 2019 8;74:e653. Epub 2019 Apr 8.

Hospital Sao Marcos, Teresina, PI, BR.

Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. Read More

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http://dx.doi.org/10.6061/clinics/2019/e653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448527PMC
April 2019
3 Reads

Revision surgery for failed craniovertebral junction stabilization: a report of 30 treated cases.

World Neurosurg 2019 Apr 4. Epub 2019 Apr 4.

General Surgery, Senior Resident, Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai.

Objective: The authors analyse the probable causes of failed craniovertebral junction stabilization procedures. The advantages of the Goel technique in the revision surgery and the positive factors that lead to reduction of the instability and achieve ultimate arthrodesis are evaluated.

Material And Methods: During the period January 2010 to June 2018, the authors treated 30 cases where the previous attempt at craniovertebral stabilization with various fixation techniques had failed and the patients presented with progressively worsening neurological deficits. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.03.286DOI Listing
April 2019
1 Read

Occipito-cervical osteotomies and inter-facet grafts for reduction of occipitocervical kyphosis and basilar invagination.

World Neurosurg 2019 Apr 4. Epub 2019 Apr 4.

Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.

Background: Occipitocervical congential pathologies involving instability of the atlantoaxial joint and basilar invagination are challenging to treat due to the complex anatomy involving the neurovascular structures at the skull base and high-risk nature of operating close to the brainstem.

Case Presentation: We present a patient with Alagille syndrome with multiple segmentation/fusion anomalies of the cervical spine and craniocervical junction, including fusion of the skull base and occipital condyles and partial assimilation of the C1 anterior ring and C2 dens. The head was anteriorly displaced, with C2 located immediately below the foramen magnum. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750193095
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http://dx.doi.org/10.1016/j.wneu.2019.03.271DOI Listing
April 2019
9 Reads

Recovery of transcranial motor evoked potentials following atlantoaxial stabilization for Chiari formation: Report of 20 cases.

World Neurosurg 2019 Apr 1. Epub 2019 Apr 1.

Professor and Head of Department, Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai. and, Consultant Neurosurgeon, Lilavati Hospital and Research Centre, Bandra (E), Mumbai. Electronic address:

Aim: The outcome of neurophysiological motor evoked potential (MEP) monitoring during surgery for Chiari formation by atlantoaxial fixation and without any bone or dural foramen magnum decompression is analyzed.

Material And Methods: During the period August 2017 to October 2018, 20 patients having Chiari formation with or without syringomyelia were surgically treated by atlantoaxial fixation. Apart from other forms of monitoring, MEP monitoring formed the basis of study. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.03.236DOI Listing
April 2019
1 Read

Biomechanical rationale for the development of atlantoaxial instability and basilar invagination in patients with occipitalization of the atlas: a finite element analysis.

World Neurosurg 2019 Mar 25. Epub 2019 Mar 25.

School of Materials Science and Mechanical Engineering, Beijing Technology and Business University. Electronic address:

Objective: Occipitalization of the atlas (OA) is often associated with atlantoaxial dislocation and basilar invagination. The purpose of this study is to determine the biomechanical difference between normal and OA conditions in the craniovertebral junction and to further explore the rationale for development of atlantoaxial dislocation and basilar invagination using the finite element model (FEM).

Methods: A ligamentous, nonlinear, sliding-contact, 3-dimensional FEM of the occipitoatlantoaxial complex was generated. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.03.174DOI Listing

Transposterior arch lateral mass screw for C1 fixation: Application of 3.5-mm-diameter screw in the vertebral artery groove with a height of ≤ 3.5 mm.

World Neurosurg 2019 Mar 25. Epub 2019 Mar 25.

Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, P.R. China.

Objective: This study aimed to explore the feasibility and effectiveness of C1 lateral mass fixation via the posterior arch using pedicle screws of 3.5-mm diameter in patients whose atlas in the vertebral artery groove (C1 pedicle) was ≤3.5 mm in height. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.03.175DOI Listing
March 2019
2.417 Impact Factor

[Clinical manifestations and imaging analysis of cervicogenic headache].

Zhongguo Gu Shang 2019 Feb;32(2):130-135

Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, 100029, China;

Objective: To investigate the clinical characteristics and mechanism of cervicogenic headache.

Methods: Fifty-seven patients with cervicogenic headache who were treated from May 2013 to December 2017 and had complete imaging data were selected, including 18 males and 39 females with an average age of(43.26±10. Read More

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http://dx.doi.org/10.3969/j.issn.1003-0034.2019.02.007DOI Listing
February 2019

Atlantoaxial instability in a patient with neck pain and rheumatoid arthritis.

J Spinal Cord Med 2019 Mar 15:1-4. Epub 2019 Mar 15.

c Department of Radiology , University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA.

Context: The purpose of this report is to describe the clinical decision-making process for a patient with rheumatoid arthritis with neck pain with underlying atlantoaxial instability.

Findings: The patient was evaluated for worsening upper neck pain that began insidiously 1 year prior. The patient denied numbness or tingling in her upper or lower extremities, dizziness or lightheadedness, difficulty maintaining balance with walking, or muscle weakness. Read More

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http://dx.doi.org/10.1080/10790268.2019.1580859DOI Listing

Retrospective analysis of surgical outcomes for atlantoaxial subluxation.

J Orthop Surg Res 2019 Mar 7;14(1):75. Epub 2019 Mar 7.

Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi City, Saitama, 332-8558, Japan.

Background: Atlantoaxial subluxation (AAS) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality. Surgical intervention is a therapeutic choice for AAS. In addition to C1 laminectomy (LAM), surgical fixation for subluxation or instability is performed by various techniques. Read More

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http://dx.doi.org/10.1186/s13018-019-1112-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407200PMC
March 2019
2 Reads

Accuracy and Safety in Screw Placement in the High Cervical Spine: Retrospective Analysis of O-arm-based Navigation-assisted C1 Lateral Mass and C2 Pedicle Screws.

Clin Spine Surg 2019 Mar 1. Epub 2019 Mar 1.

Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Study Design: This study was a retrospective analysis.

Objective: The purpose of present study was to evaluate accuracy, efficiency, and safety of intraoperative O-arm-based navigation system for the placement of C1 lateral mass screw (C1LMS) and C2 pedicle screws (C2PSs) in high cervical spine operations.

Summary Of Background Data: High screw misplacement rates, various pedicle morphometry and vertebral body size variations have led to a search of image-guided systems to improve the surgical accuracy of screw insertion in high cervical spine. Read More

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http://dx.doi.org/10.1097/BSD.0000000000000813DOI Listing
March 2019
3 Reads

Radiographic indices for the diagnosis of atlantoaxial instability in toy breed dogs.

Authors:

Vet Radiol Ultrasound 2019 03;60(2):246

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http://dx.doi.org/10.1111/vru.12703DOI Listing

Anaphylaxis after Elosulfase A infusion: Omalizumab as coadyuvant for enzyme replacement therapy desensitization.

Pediatr Allergy Immunol 2019 Feb 28. Epub 2019 Feb 28.

Department of Pediatrics, Complejo Hospitalario de Navarra. C/ Irunlarrea 4. Planta Baja. Pamplona., 31008, Spain.

Type IV A Mucopolysaccharidosis (MPS IV A) is a lysosomal storage disease caused by an autosomal recessive mutation in the gene encoding the enzyme galactosamine-6-sulfatase, which catalyses the degradation of glycosaminoglycans (GAGs). It leads to the accumulation of GAGs keratan sulfate. Symptoms include skeletal dysplasia, atlantoaxial instability, pectus carinatum, short stature, laxity of joints, cervical spinal cord compression, cardiac and pulmonary complications, corneal opacity, impaired hearing but normal cognitive development. Read More

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http://dx.doi.org/10.1111/pai.13049DOI Listing
February 2019
2 Reads

Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report.

Int J Spine Surg 2019 Jan 22;13(1):79-83. Epub 2019 Feb 22.

Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California.

Background: We report a case of an elderly patient who was diagnosed with lateral atlantoaxial subluxation with type II odontoid fracture, an extremely uncommon upper cervical spine injury that has not been previously reported in the literature to the knowledge of the authors.

Methods: An 87-year-old male reported to the emergency room following a syncopal episode after sustaining a fall. He complained of dizziness, fatigue, disruption of vision and audition, and worsening neck pain. Read More

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http://dx.doi.org/10.14444/6010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383461PMC
January 2019

Outcomes of Surgical Correction of Atlantoaxial Instability in Patients with Down Syndrome: Systematic Review and Meta-Analysis.

World Neurosurg 2019 Feb 18. Epub 2019 Feb 18.

Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address:

Background: Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial.

Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement to identify patients with AAI and DS were treated with upper cervical spine fusion. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.01.267DOI Listing
February 2019
1 Read

A Comparison of the Long-Term Results of Posterior Transarticular Stand-Alone Screw Instrumentation and Magerl Technique in Patients with Traumatic Atlantoaxial Instability: Mean 5-Year Follow-Up Study with Radiological and Patient-Rated Outcomes Assessments.

World Neurosurg 2019 Feb 16. Epub 2019 Feb 16.

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia; A.I. Evdokimov Moscow Medical University, Moscow, Russia.

Objective: To perform a radiological analysis of the degeneration of C1-C2 joints after C1-C2 transarticular fixation (TAF) and compare the long-term results of a routine Magerl technique (RMT) to a posterior transarticular C1-C2 stand-alone screw instrumentation (SAS) application.

Methods: A total of 40 patients (26 men and 14 women) were included in the present retrospective observational cohort study. The mean follow-up period was 61. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.01.263DOI Listing
February 2019
2 Reads

Atlantoaxial Instability Resulting in Intractable Nausea in a Person with C5 Complete Spinal Cord Injury: A Case Report.

PM R 2019 Apr 19;11(4):440-445. Epub 2019 Feb 19.

Division of Neurosurgery, University of Missouri School Medicine, Columbia, MO 65212.

Individuals with spinal cord injury (SCI) have altered neurophysiology and present with symptoms that must be interpreted in the context of their specific neurologic injury. This is a case of a 16-year-old female adolescent with C5 American Spinal Injury Association Impairment Scale A SCI who presented with intractable nausea. Multiple etiologies for her nausea, including medication effect, metabolic and gastrointestinal disorders, autonomic dysreflexia, and mood disorder, were systematically ruled out. Read More

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http://dx.doi.org/10.1002/pmrj.12004DOI Listing

The occipitoatlantal capsular ligaments are the primary stabilizers of the occipitoatlantal joint in the craniocervical junction: a finite element analysis.

J Neurosurg Spine 2019 Feb 15:1-9. Epub 2019 Feb 15.

2Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.

OBJECTIVEThere is contradictory evidence regarding the relative contribution of the key stabilizing ligaments of the occipitoatlantal (OA) joint. Cadaveric studies are limited by the nature and the number of injury scenarios that can be tested to identify OA stabilizing ligaments. Finite element (FE) analysis can overcome these limitations and provide valuable data in this area. Read More

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http://dx.doi.org/10.3171/2018.10.SPINE181102DOI Listing
February 2019
2 Reads

Preclinical evaluation of a novel anterior non-fusion fixation device for atlantoaxial instability: an in vivo comparison study in a canine model.

Eur Spine J 2019 Feb 13. Epub 2019 Feb 13.

Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.

Purpose: The Anterior Atlantoaxial Non-Fusion Fixation System (AANFS) was a novel motion preservation device for atlantoaxial instability to replace traditional fusion techniques. The purpose of this in vivo study was to evaluate the clinical features and biomechanical properties of this new device in a canine model by comparing it with a conventional method.

Methods: Eighteen adult male canines were randomly divided into group 1, which received the AANFS replacement, group 2 which received the Harms rigid fixation procedures, and group 3, which served as the control group. Read More

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http://dx.doi.org/10.1007/s00586-019-05916-3DOI Listing
February 2019
1 Read
2.473 Impact Factor

Atlantoaxial instability management in down syndrome.

J Neurosurg Sci 2019 Feb 4. Epub 2019 Feb 4.

Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.

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http://dx.doi.org/10.23736/S0390-5616.19.04626-5DOI Listing
February 2019
1 Read

Odontoid cervical gout causing atlantoaxial instability: case report.

J Neurosurg Spine 2019 Jan 25:1-4. Epub 2019 Jan 25.

Departments of1Neurosurgery and.

The authors present a case report of a patient discovered to have a rotatory subluxation of the C1-2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1-2 instability. Read More

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http://dx.doi.org/10.3171/2018.9.SPINE18122DOI Listing
January 2019
15 Reads

Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients.

Pediatr Neurosurg 2019 24;54(1):12-20. Epub 2019 Jan 24.

Children's Hospital of Los Angeles, Los Angeles, California, USA.

Background/aims: Down syndrome is the most common inherited disorder. Some patients develop atlantoaxial instability. Existing screening guidelines were developed prior to availability of MRI. Read More

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http://dx.doi.org/10.1159/000495788DOI Listing
January 2019
1 Read

Influence of Atlantoaxial Fusion on Sagittal Alignment of the Occipitocervical and Subaxial spines in Os Odontoideum with Atlantoaxial Instability.

Asian Spine J 2019 Jan 24. Epub 2019 Jan 24.

Department of Orthopedic Surgery, Busan Korea Hospital, Busan, Korea.

Study Design: Retrospective case analysis.

Purpose: We hypothesized that larger the C1-C2 fusion angle, greater the severity of the sagittal malalignment of C0-C1 and C2- C7.

Overview Of Literature: In our experience, instances of sagittal malalignment occur at C0-C1 and C2-C7 following atlantoaxial fusion in patients with Os odontoideum (OO). Read More

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http://dx.doi.org/10.31616/asj.2018.0154DOI Listing
January 2019
2 Reads

Clinical Manifestations and Surgical Management of Spinal Lesions in Patients With Mucopolysaccharidosis: A Report of 52 Cases.

Spine Deform 2019 03;7(2):298-303

Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina.

Study Design: Descriptive retrospective cohort of 52 pediatric patients with mucopolysaccharidosis (MPS) and spinal cord disease and surgical outcomes in a reference hospital.

Objectives: To describe clinical manifestations and surgical management and outcomes of spinal lesions.

Methods: All medical records of 52 patients with mucopolysaccharidosis (I, II, III, IV, and VI) diagnosed between 1992 and 2011 were identified and followed at a single spine center of a pediatric hospital. Read More

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http://dx.doi.org/10.1016/j.jspd.2018.07.005DOI Listing
March 2019
1 Read

The Transspinal Canal Screwing Technique for Atlantoaxial Anomalies: A Technical Note and 2 Case Reports.

Neurospine 2018 Oct 2. Epub 2018 Oct 2.

Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

Introduction: It is difficult to treat atlanto-axial instability in cases with high riding vertebral artery or anomalies of craniocervical junction. We report two successful cases with trans-spinal canal screwing technique because of difficulty to perform conventional fixation methods. Case presentation. Read More

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http://dx.doi.org/10.14245/ns.1836118.059DOI Listing
October 2018

[A strategy of combining posterior occipitocervical angle with occipital-C angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 01;33(1):35-40

Operating Room, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,

Objective: To assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C (O-C ) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion.

Methods: The clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44. Read More

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http://www.rrsurg.com/article/10.7507/1002-1892.201807115
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http://dx.doi.org/10.7507/1002-1892.201807115DOI Listing
January 2019
15 Reads

Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature.

Acta Neurochir Suppl 2019;125:279-288

, New York, USA.

Background: In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_40DOI Listing
January 2019
4 Reads

Retro-odontoid Degenerative Pseudotumour Causing Spinal Cord Compression and Myelopathy: Current Evidence on the Role of Posterior C1-C2 Fixation in Treatment.

Acta Neurochir Suppl 2019;125:259-264

Department of Neurological Surgery, Policlinico "Gaspare Rodolico" University Hospital, Catania, Italy.

Background: A retro-odontoid pseudotumour compressing the spinal cord and causing myelopathy is often associated with an inflammatory condition such as rheumatoid arthritis. A degenerative non-inflammatory retro-odontoid pseudotumour responsible for clinically relevant spinal cord compression is a rare condition described in small clinical series and is likely associated with craniovertebral junction hypermobility or instability-like conditions. For several years, direct removal of the lesion through an anterior or lateral approach has been advocated as the best surgical option. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_37DOI Listing
January 2019
3 Reads

Atlantoaxial Fixation for Treatment of Chiari Formation and Syringomyelia with No Craniovertebral Bone Anomaly: Report of an Experience with 57 Cases.

Acta Neurochir Suppl 2019;125:101-110

Department of Neurosurgery, KEM Hospital and Seth GS Medical College, Mumbai, India.

Aim: In this paper we evaluate the role of atlantoaxial instability in the pathogenesis of Chiari formation type I and the role of atlantoaxial stabilization for treatment of this condition in cases with no obvious bone malformation in the region of the craniovertebral junction.

Materials, Methods And Results: During the period from January 2010 to July 2016, we identified 57 cases of Chiari formation where there was no bone malformation or evidence of craniovertebral junction instability that could be diagnosed on the basis of an abnormal increase in the atlantodental interval on dynamic imaging. Forty-eight of these patients had syringomyelia. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_15DOI Listing
January 2019
1 Read

The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art.

Acta Neurochir Suppl 2019;125:79-86

Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder, characterized by polyarticular inflammation causing progressive joint damage and disability. The mechanisms underlying its pathogenesis involve activation of innate and adaptive immunity, microvascular endothelial cell activation, and inflammatory infiltration of lymphocytes and monocytes into the synovium. Spinal involvement in RA is not typical; when it occurs, the main radiological features are (1) atlantoaxial subluxation (AAS), which is the most typical form of cervical spine involvement; (2) cranial settling-also known as basilar impression, atlantoaxial impaction or superior migration of the odontoid-which is the most severe form of associated spinal instability; and (3) subaxial subluxation. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_12DOI Listing
January 2019
4 Reads

Role of Subaxial Spinal and Atlantoaxial Instability in Multisegmental Cervical Spondylotic Myelopathy.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:71-78

Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India.

Aim: In this paper the role of atlantoaxial and multilevel subaxial spinal instability as the primary nodal point of the pathogenesis of degenerative cervical spinal disease-related myelopathy, and the focus of surgical treatment for it, is evaluated.

Materials And Methods: The series analyses the treatment of 73 patients with single or multilevel degenerative cervical spinal disease by fixation of the involved spinal segment(s) alone, aimed at arthrodesis. No bone decompression or disc/osteophyte resection was done. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_11DOI Listing
January 2019
2 Reads

Ossification of the Posterior Longitudinal Ligament: Analysis of the Role of Craniovertebral and Spinal Instability.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:63-70

Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India.

Background: This paper reviews an experience of surgically treating ossification of the posterior longitudinal ligament (OPLL) with fixation of the involved spinal segments alone, without resorting to any bony or soft tissue decompression or attempts at direct resection of the OPLL. While in the early part of the experience, stabilization of only the involved subaxial cervical spinal segments was done, in the later part of the experience, atlantoaxial fixation was included in the multisegmental spinal fixation construct. This treatment is based on the understanding that spinal instability that includes atlantoaxial instability forms the nodal point of the pathogenesis and development of OPLL, and maturation of the presenting clinical symptoms. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_10DOI Listing
January 2019

Atlantoaxial Instability: Evolving Understanding.

Authors:
Atul Goel

Acta Neurochir Suppl 2019;125:59-62

Department of Neurosurgery, King Edward VII Memorial Hospital and Seth GS Medical College, Mumbai, India.

The atlantoaxial joint is the most mobile joint in the body. The physical architecture of the joint is characterized by a uniformly round and approximately flat surface, which allows a wide range of unobstructed movements. The standing human posture and lifelong heartbeat like uninterrupted activity of the atlantoaxial joint, and its ability to facilitate saying both 'yes' and 'no' necessarily requires smooth and 'fluid' movements that are supported by strong yet supple ligaments. Read More

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http://dx.doi.org/10.1007/978-3-319-62515-7_9DOI Listing
January 2019

The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita: Observational study.

Medicine (Baltimore) 2019 Jan;98(1):e13780

Department of Medical Chemistry, Medical University of Vienna, Vienna, Austria.

Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Read More

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http://dx.doi.org/10.1097/MD.0000000000013780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344193PMC
January 2019
15 Reads
5.723 Impact Factor

Odontoid fracture with missed diagnosis of Transverse Atlantal Ligament (TAL) injury resulting in late-onset instability.

Surg Neurol Int 2018 28;9:240. Epub 2018 Nov 28.

Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India.

Background: Concurrent injuries to both the odontoid and transverse atlantal ligament are rare and can be easily missed. Failure to diagnose both lesions potentially leads to the late onset of sagittal plane instability and acute myelopathy. Here, we present a patient with an odontoid fracture whose transverse atlantal ligament (TAL) injury was originally missed on magnetic resonance imaging (MRI) and computed tomography (CT) scans. Read More

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http://dx.doi.org/10.4103/sni.sni_315_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287336PMC
November 2018
3 Reads

Evaluation of atlantooccipital overlapping and cerebral ventricle size in dogs with atlantoaxial instability.

J Vet Med Sci 2019 Feb 24;81(2):229-236. Epub 2018 Dec 24.

The Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonan, Musashino-shi, Tokyo 180-0023, Japan.

This study investigated cerebral ventricle size and concurrent craniocervical junction abnormality in relation to atlantooccipital overlapping (AOO) in dogs with atlantoaxial instability (AAI). A total of 61 dogs were treated with atlantoaxial ventral fixation. Medical records of each dog, including magnetic resonance (MR) and computed tomography (CT) images, were retrospectively reviewed. Read More

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http://dx.doi.org/10.1292/jvms.17-0553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395205PMC
February 2019

Occipital Condyle Fracture: A Case Report of a Typically Stable Fracture That Required Surgical Treatment.

Case Rep Orthop 2018 15;2018:2809546. Epub 2018 Nov 15.

Department of Orthopaedic Surgery, Chiba University, Graduate School of Medicine, 1-8-1 Inohana Chuou-ku, Chiba, Chiba 260-8670, Japan.

An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2. Read More

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http://dx.doi.org/10.1155/2018/2809546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276388PMC
November 2018
1 Read

Cervical Fusion as a Protective Response to Craniovertebral Junction Instability: A Novel Concept.

Authors:
Atul Goel

Neurospine 2018 Dec 19;15(4):323-328. Epub 2018 Dec 19.

Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.

The author reviews the various types of cervical fusion that are associated with instability of the craniovertebral junction. Assimilation of the atlas, C2-3 fusion, the Klippel-Feil abnormality, and pancervical fusion are amongst the more common types of bone abnormalities. It is conceptualised that these types of cervical fusion are not related to any kind of embryological dysgenesis or fault, but instead emerge due to longstanding muscle spasms of the neck in response to atlantoaxial instability. Read More

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http://dx.doi.org/10.14245/ns.1836236.118DOI Listing
December 2018
2 Reads

Atlantoaxial fixation using C1 posterior arch screws: feasibility study, morphometric data, and biomechanical analysis.

J Neurosurg Spine 2018 Dec;30(3):314-322

4Department of Neurological Surgery, University of California, Davis, Sacramento, California.

OBJECTIVEC1-2 is a highly mobile complex that presents unique surgical challenges to achieving biomechanical rigidity and fusion. Posterior wiring methods have been largely replaced with segmental constructs using the C1 lateral mass, C1 pedicle, C2 pars, and C2 pedicle. Modifications to reduce surgical morbidity led to the development of C2 laminar screws. Read More

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http://dx.doi.org/10.3171/2018.8.SPINE18160DOI Listing
December 2018
4 Reads

Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability.

Eur Spine J 2019 Feb 11;28(2):362-369. Epub 2018 Dec 11.

Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, People's Republic of China.

Purpose: To investigate the anatomical and biomechanical feasibility of the unilateral C1 double screw [pedicle screw (PS) + lateral mass screw (LMS)] and ipsilateral C2 PS combined with contralateral C2 laminar screw (LS)-rod fixation for atlantoaxial instability by comparison with traditional posterior fixation methods.

Methods: Fifteen sets of complete dry bony specimens of atlas were used for morphometric analysis. The working length, width and thickness of the C1 PSs and LMSs were manually measured. Read More

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http://dx.doi.org/10.1007/s00586-018-5853-0DOI Listing
February 2019
3 Reads

Fatal atlantoaxial dislocation due to an odontoid synchondrosis fracture in a child with chromosome 9 abnormality: A case report.

J Forensic Leg Med 2019 Feb 29;61:92-96. Epub 2018 Nov 29.

Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

A 5-year-old boy with a chromosome-9 abnormality and multiple external and visceral malformations was found in cardiopulmonary arrest during a regular visit to the hospital; he did not respond to cardiopulmonary resuscitation and died. An odontoid process fracture and calcification and fibrosis of the muscles around the superior cervical vertebra were observed during the autopsy. Postmortem computed tomography revealed an anterior dislocation of the atlas; odontoid synchondrosis fracture; and delayed, incomplete bony fusion of the odontoid process relative to his age. Read More

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http://dx.doi.org/10.1016/j.jflm.2018.11.011DOI Listing
February 2019
5 Reads

Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch.

Authors:
Lei Zhang Huan Wang

Kaohsiung J Med Sci 2018 Dec 19;34(12):700-704. Epub 2018 Sep 19.

Spinal Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, PR China. Electronic address:

Atlanto-axial instability (AAI) is a congenital or developmental condition that leads to instability/subluxation of the atlantoaxial joint. This study is performed to determine anatomic feasibility of trajectory L and help select an optimal screw trajectory in treating patients with AAI with a narrow C1 posterior arch. Sixty patients who underwent cervical three dimensional-computed tomography (3D-CT) were chosen from the hospital's picture archiving and communication system (PACS). Read More

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http://dx.doi.org/10.1016/j.kjms.2018.08.001DOI Listing
December 2018
2 Reads
0.805 Impact Factor

Posterior Sublaminar Wiring and/or Transarticular Screw Fixation for Reducible Atlantoaxial Instability Secondary to Symptomatic Os Odontoideum: A Neglected Technique?

Asian Spine J 2019 Apr 7;13(2):233-241. Epub 2018 Dec 7.

Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Study Design: Retrospective case analysis.

Purpose: We retrospectively evaluated the clinical and radiological outcomes of posterior sublaminar wiring (PSLW) and/or transarticular screw fixation (TASF) for reducible atlantoaxial instability (AAI) secondary to os odontoideum.

Overview Of Literature: Limited information is available about the surgical outcomes of symptomatic os odontoideum with AAI. Read More

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http://asianspinejournal.org/journal/view.php?doi=10.31616/a
Publisher Site
http://dx.doi.org/10.31616/asj.2018.0155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454275PMC
April 2019
14 Reads

Craniovertebral Junction Anomalies in Small Breed Dogs with Atlantoaxial Instability: A Multicentre Case-Control Study.

Vet Comp Orthop Traumatol 2019 Jan 28;32(1):33-40. Epub 2018 Nov 28.

Department of Clinical Veterinary Medicine, Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.

Objective:  The main purpose of this study was to define criteria to systemically describe craniovertebral junction (CVJ) anomalies and to report the prevalence of CVJ anomalies in small breed dogs with and without atlantoaxial instability (AAI).

Materials And Methods:  Retrospective multicentre matched case-control study evaluating magnetic resonance imaging and computed tomographic images of small breed dogs with and without AAI for the presence of CVJ anomalies.

Results:  One hundred and twenty-two dogs were enrolled (61 with and 61 without AAI). Read More

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http://dx.doi.org/10.1055/s-0038-1675797DOI Listing
January 2019
2 Reads

Splitting of the semispinalis capitis muscle as a less invasive approach for atlantoaxial fusion - A technical note.

J Clin Neurosci 2019 Apr 22;62:260-263. Epub 2018 Nov 22.

Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria.

Purpose: Atlantoxial fusion with screw rod constructs traditionally requires subperiostal dissection of the C1/C2 muscle attachments, which may lead to postoperative axial neck pain and intraoperative blood loss. We evaluate a potentially less invasive, muscle splitting approach for atlantoaxial fusion in a cadaver model.

Methods: A technical feasibility study was performed in a human cadaveric specimen with standard surgical instruments and an operating microscope. Read More

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http://dx.doi.org/10.1016/j.jocn.2018.11.044DOI Listing
April 2019
3 Reads

Clinical Outcomes of Atlantoaxial Dislocation Combined with High-Riding Vertebral Artery Using C2 Translaminar Screws.

World Neurosurg 2019 Feb 22;122:e1511-e1518. Epub 2018 Nov 22.

Department of Orthopedics, Peking University Third Hospital, Beijing, China.

Objective: Atlantoaxial stabilization procedures in high-riding vertebral artery (HRVA) cases are challenging. C2 translaminar screws are rigid and pose no risk to the vertebral artery. The aim of this study was to present clinical outcomes of atlantoaxial dislocation combined with HRVA using C2 translaminar screws. Read More

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http://dx.doi.org/10.1016/j.wneu.2018.11.092DOI Listing
February 2019
12 Reads

Posterior atlantoaxial dislocation without fracture or neurological symptoms treated by transoral-posterior approach surgery: a case report and literature review.

Eur Spine J 2018 Nov 17. Epub 2018 Nov 17.

Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, Xingtai, 054000, Hebei, China.

Background: Atlantoaxial dislocation usually results from hyperextension trauma and is almost always accompanied by odontoid fracture and neurological symptoms. In most cases, patients with atlantoaxial dislocation die instantly. This is a rare report of posterior atlantoaxial dislocation without fracture and neurological symptoms effectively treated by transoral-posterior approach surgery, and only eleven similar cases have been previously reported. Read More

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http://link.springer.com/10.1007/s00586-018-5823-6
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http://dx.doi.org/10.1007/s00586-018-5823-6DOI Listing
November 2018
12 Reads