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Int J Environ Res Public Health 2022 Apr 20;19(9). Epub 2022 Apr 20.

Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize 53100, Turkey.

I read with great interest the paper of Bunmaprasert et al. [.. Read More

Zhongguo Gu Shang 2022 May;35(5):495-9

Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing 100029, China.

Atlantoaxial dislocation (AAD) is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases. The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep. With the increase of the number of operations in the upper cervical region, postoperative complications such as failure of internal fixation, non fusion of bone graft and poor prognosis gradually increase. Read More

World Neurosurg 2022 May 5. Epub 2022 May 5.

SUNY Upstate Medical University, Department of Neurosurgery, 750 East Adams Street, Syracuse, NY 13210, USA; University of North Carolina, Department of Neurosurgery (current institution), Physicians Office Building, 170 Manning Drive, Campus Box 7060, Chapel Hill, NC 27599, USA.

Retro-odontoid pseudotumors are rare inflammatory complications of atlantoaxial instability often associated with cervical degenerative disease and rheumatoid arthritis. While propagation of these lesions has been shown to cause spinal cord compression and cervical myelopathy, intradural extension has rarely been reported. In this manuscript and two-dimensional illustrative intra-operative video, we demonstrate cervical decompression, removal of the intradural component, and stabilization with C1-2 instrumentation utilizing a posterior approach. Read More

Childs Nerv Syst 2022 May 5. Epub 2022 May 5.

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Purpose: Craniocervical junction abnormalities include a wide variety of disorders and can be classified into congenital or acquired. This study aimed to review the surgical outcome of pediatric patients who underwent craniocervical and/or atlantoaxial fusion.

Methods: This is a retrospective cohort study including all pediatric patients (≤ 18 years) who underwent craniocervical and/or atlantoaxial fusion between 2009 and 2019 at quaternary medical city. Read More

Surg Neurol Int 2022 8;13:132. Epub 2022 Apr 8.

Department of General Surgery, Hayatabad Medical Complex, Peshawar, Pakistan.

Background: Type 2 odontoid fractures are associated with a high rate of nonunion without surgical treatment. If neglected, they may become fixed in an abnormal position, causing progressive myelopathy. Conventionally, odontoidectomy or transoral release is performed to relieve symptoms in such cases. Read More

Surg Neurol Int 2022 8;13:133. Epub 2022 Apr 8.

Department of General Surgery, Hayatabad Medical Complex, Hayatabad, Peshawar, Pakistan.

Background: Multiple axis fractures with instability are rare and appropriate treatment modalities have not been established.

Case Description: A 33-year-old male presented with severe neck pain, bilateral upper-extremity numbness, and brisk reflexes in both lower extremities of 14 days' duration after a car accident. The cervical CT revealed an oblique C2 body fracture and asymmetrical neural ring fractures, while the MRI showed a normal C2-3 disk. Read More

Biology (Basel) 2022 Mar 24;11(4). Epub 2022 Mar 24.

Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.

Background: Morphological integration refers to the tendency of anatomical structures to show correlated variations because they develop in response to shared developmental processes or function in concert with other structures. The objective of this study was to determine the relationships between the dimensions of different cranial-cervical-facial structures in patients with Down syndrome (DS).

Methodology: The study group consisted of 41 individuals with DS who had undergone cone-beam computed tomography (CBCT) at the Dental Radiology Unit of the University of Santiago de Compostela (Spain). Read More

J Clin Neurosci 2022 Jun 19;100:124-130. Epub 2022 Apr 19.

Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan.

There are few reports of degenerative atlantoaxial stenosis and new stenosis after cervical decompression. We experienced four cases of atlantoaxial stenosis after muscle-preserving selective laminectomy. We compared these four cases with no stenosis cases after long-term follow-up of selective laminectomy, as well as healthy subjects. Read More

Sci Rep 2022 Apr 20;12(1):6484. Epub 2022 Apr 20.

Division of Spine Surgery, Department of Trauma Surgery and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Demographic aging accompanied by increased falls inevitably leads to an increased incidence of atlantoaxial instabilities (AAI). Minimally invasive surgical procedures decrease the perioperative risk and regarding the treatment of AAI, percutaneous transarticular screw fixation of C1/C2 was more frequently considered in the past. This study aims to investigate the outcome of patients treated for AAI by isolated percutaneous transarticular screw fixation of C1/C2 (IPTSFC1/C2) using 3. Read More

J Orthop Case Rep 2021 Jun;11(6):36-39

Department of Neurosurgery, Royal Preston Hospital, Fulwood, Preston, United Kingdom.

Introduction: Anterior retropharyngeal realignment, distraction, and atlantoaxial fixation are an option for the treatment of symptomatic basilar invagination (BI). The anterior implants for distraction and fixation for atlantoaxial joints are still evolving. We share our experience using a novel implant which can easily, safely, and rigidly fix both lateral masses to the body of the axis. Read More

Childs Nerv Syst 2022 Apr 14. Epub 2022 Apr 14.

Department of Neurological Surgery, University of California, San Francisco, CA, USA.

Purpose: Rigid occipitocervical (O-C) instrumentation can reduce the anterior pathology and has a high fusion rate in children with craniovertebral instability. Typically, axis (C2) screw fixation utilizes C1-C2 transarticular screws or C2 pars screws. However, anatomic variation may preclude these screw types due to the size of fixation elements or by placing the vertebral artery at risk for injury. Read More

J Vet Med Sci 2022 May 5;84(5):694-699. Epub 2022 Apr 5.

The Laboratory of Veterinary Surgery, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan.

We evaluated the completeness of bony fusion of the atlantoaxial joint (AAJ) through polymethylmethacrylate fixation (PMF) and atlantoaxial plate fixation (APF) using six canine models with dens partial resection. In both groups, the hydroxyapatite content at the AAJ was measured up to 7 months postoperatively using quantitative computed tomography. Histological assessment revealed fibrous fusion in the PMF group. Read More

Clin Case Rep 2022 Apr 4;10(4):e05675. Epub 2022 Apr 4.

Department of Physical Medicine and Rehabilitation School of Medicine Student Research Committee Child Growth and Development Research Center Research Institute for Primordial Prevention of Non-Communicable Disease Isfahan University of Medical Sciences Isfahan Iran.

A 61-year-old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Read More

J Craniovertebr Junction Spine 2022 Jan-Mar;13(1):72-79. Epub 2022 Mar 9.

Department of Neurosurgery, Pomeranian Medical University Hospital, Szczecin, Poland, Europe.

Objective: Health-related quality of life (HRQoL) in craniocervical instability (CCI) before and after posterior fixation is yet to be determined. This study aimed to deliver novel and clinically relevant data about HRQoL (baseline, at follow-up, predictors, and correlates) in subjects with CCI treated with posterior fixation with or without occipital plating, and to compare it with matched datasets.

Methods: EuroQol-5 dimensions (EQ-5D) questionnaires were collected to evaluate HRQoL before surgery and at follow-up. Read More

J Integr Neurosci 2022 Mar;21(2):70

Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, 400016 Yuzhong District, Chongqing, China.

Background: The frequent association of basilar invagination (BI) makes the understanding of the pathogenesis of Chiari malformation type I (CMI) difficult. The influence of group B type of BI (the BI without obvious atlantoaxial instability) on the skeletal morphology has not been thoroughly studied. The objective of this study is to evaluate the skeletal alterations in the posterior cranial fossa (PCF) of adult CMI cases with and without group B BI. Read More

J Neurosurg Spine 2022 Apr 1:1-7. Epub 2022 Apr 1.

Objective: With an increasing number of disease-modifying drugs available to manage rheumatoid arthritis (RA), spine surgeons have anecdotally noted decreased rates of cervical spine surgical procedures in this population. Although these medications have been shown to mitigate RA progression and its systemic effects on joint destruction, there are currently no large-scale studies of RA patients that suggest the use of these disease-modifying drugs has truly coincided with a decline in cervical spine surgery.

Methods: Patients with RA who underwent cervical spinal fusion from 1998 to 2021 performed by the senior author were retrospectively reviewed. Read More

Oper Neurosurg (Hagerstown) 2022 May;22(5):284-289

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Many studies have described different C1-2 fusion techniques that have evolved over time. We introduced an easy and effective C1-2 fusion technique using local bone chips combined with atlantoaxial instrumentation.

Objective: To identify the efficacy of interfacetal fusion using local bone combined with atlantoaxial instrumentation by assessment of clinical outcomes and fusion rate. Read More

Oper Neurosurg (Hagerstown) 2022 May;22(5):322-327

Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.

Background: Pathological changes in the atlantoaxial joint often lead to instability, pain, and neurological deterioration. One treatment option is the surgical stabilization of the atlantoaxial joint. In other areas of the spine, fusion rates have been improved by the introduction of an interbody cage. Read More

Pediatric Health Med Ther 2022 14;13:53-62. Epub 2022 Mar 14.

Division of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.

Down syndrome (DS) is one of the most common birth defects in the United States, the most common genomic disorder of intellectual disability, and results from trisomy 21. This chromosome disorder causes an extensive, heterogenous phenotype that results in a broad presentation of symptoms that includes atlantoaxial instability, congenital heart defects, muscle hypotonia, hypothyroidism, hematologic disorders, recurrent infections, and autoimmune diseases. The autoimmune diseases are caused by immune system dysregulation that results in increased pro-inflammatory cytokines, along with other innate and adaptive immune system dysregulation. Read More

Vet Surg 2022 May 16;51(4):620-630. Epub 2022 Mar 16.

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

Objective: To determine cutoff values for the diagnosis of atlantoaxial instability (AAI) based on cross-sectional imaging in small-breed dogs.

Study Design: Retrospective multicenter study.

Sample Population: Client-owned dogs (n = 123) and 28 cadavers. Read More

BMC Vet Res 2022 Mar 1;18(1):82. Epub 2022 Mar 1.

College of Veterinary Medicine, Research Institute for Veterinary Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.

Spine (Phila Pa 1976) 2022 Feb 22. Epub 2022 Feb 22.

Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Beijing, People's Republic of China Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Beijing, People's Republic of China Department of Endocrinology, Genetics and Metabolism, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University. Beijing, People's Republic of China.

Study Design: Observational and morphological study with three-dimensional (3D) computed tomography (CT) analysis.

Objective: To discover the morphology and configuration deformities of craniovertebral junction (CVJ) and upper cervical spine in children with unilateral hemifacial microsomia (HFM). To determine whether there are specific HFM patients who are at higher risk of certain cervical vertebral anomaly. Read More

Zhongguo Gu Shang 2022 Feb;35(2):132-5

The Third Clinical Medical College of Zhejiang Traditional Chinese Medicine University, Hangzhou 310053, Zhejiang, China.

Objective: To investigate the correlation between the changes of cervical curvature and atlantoaxial instability.

Methods: The correlation between the changes of cervical curvature and atlantoaxial instability was retrospectively studied in 50 outpatients with abnormal cervical curvature (abnormal cervical curvature group) from January 2018 to December 2019. There were 24 males and 26 females in abnormal cervical curvature group, aged from 18 to 42 years old with an average of(30. Read More

Yonsei Med J 2022 Mar;63(3):265-271

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures.

Materials And Methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Read More

World Neurosurg 2022 May 17;161:e192-e198. Epub 2022 Feb 17.

Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address:

Objective: The feasibility of anterior transarticular crossing screw (ATCS) fixation for atlantoaxial instability was confirmed in adults. However, atlantoaxial instability is more common in children. Therefore this study was aimed to ascertain the pediatric morphometric characteristics of ATCS in C1-2. Read More

Global Spine J 2022 Feb 14:21925682221074671. Epub 2022 Feb 14.

Department of Neurosurgery, 232890Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA.

Study Design: Retrospective cohort.

Objective: To radiographically evaluate Craniovertebral junction (CVJ) tuberculosis infection pathogenesis and to propose a modification to the Lifeso classification.

Methods: A cohort of patients with radiologically or microbiologically identified CVJ tuberculosis treated at a single tertiary referral center in a TB endemic area was queried for characteristics about clinical presentation, treatment, and radiographic evidence of bone destruction and abscess formation were included. Read More

N Am Spine Soc J 2021 Sep 14;7:100073. Epub 2021 Jul 14.

Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Dhonde Marg, Mumbai, Maharashtra, India.

Background: Computed tomography (CT) images provided by the radiology department may be inadequate for planning screws for rigid craniovertebral junction (CVJ) instrumentation. Although many recommend using multiplanar reconstruction (MPR) in line with screw trajectories, this is not always available to all surgeons. The current study aims to present a step-by-step workflow for preoperative planning for pediatric CVJ anomalies. Read More

Oral Radiol 2022 Jan 28. Epub 2022 Jan 28.

Department of Maxillofacial Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.

Objective: To calculate the prevalence of ponticulus posticus and its association with headache.

Methods: The presence and types of ponticulus posticus were investigated on 640 digital lateral cephalograms. Patients with complete or partial ponticulus posticus were further evaluated and questioned for a history of cervicogenic headache. Read More

Medicina (Kaunas) 2022 Jan 12;58(1). Epub 2022 Jan 12.

Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden.

: Posterior C1-C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. : A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1-C2 fixation, using TAS or CRS, between 2005-2019. Read More

BMC Vet Res 2022 Jan 18;18(1):46. Epub 2022 Jan 18.

College of Veterinary Medicine, Research Institute for Veterinary Science, Seoul National University, Gwanak-ro, Gwanak-gu, 08826, Seoul, South Korea.

Background: Atlantoaxial instability (AAI) is primarily a congenital neurological disorder affecting young toy-breed dogs. So far, most studies have focused on bones and ligaments related to AAI, and there are no studies on the suboccipital muscles (SOMs) that occupy a large area from the occipital bone to C2 in dogs. This study evaluated the cross-sectional area (CSA) and fat infiltration of the SOMs using magnetic resonance imaging (MRI), specifically, T1-weighted images, in normal dogs (≤ 5 kg) and AAI dogs. Read More