Evaluating Atlantoaxial Dislocation Based on Cartesian Coordinates: Proposing a New Definition and Its Impact on Assessment of Congenital Torticollis

Sardhara, Jayesh; Behari, Sanjay; Sindgikar, Pavaman; Srivastava, Arun Kumar; Mehrotra, Anant; Das, Kuntal Kanti; Bhaisora, Kamlesh Singh; Sahu, Rabi Narayan; Jaiswal, Awadhesh Kumar

doi:10.1093/neuros/nyx196

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…Whether an occipitocervical or a C1-2 fusion is performed, after three months, the stability will be provided not by the construct alone but by the concomitant and adequate bony fusion brought about by decortication of the vertebral surfaces, and by the placement of adequate onlay and strut bone grafts in the region as well as within and around the C1-2 facet joints. [35][36][37][38][39][40][41]…”

Section: E Fmentioning

confidence: 99%

Is Cervical Stabilization for All Cases of Chiari-I Malformation an Overkill? Evidence Speaks Louder Than Words!

et al. 2019

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Chiari I malformation is characterized by the downward displacement of cerebellar tonsils through the foramen magnum. While discussing the treatment options for Chiari I malformation, the points of focus include: (1) Has the well-established procedure of posterior fossa decompression become outdated and has been replaced by posterior C1-2 stabilization in every case? (2) In case posterior stabilization is required, should a C1-2 stabilization, rather than an occipitocervical fusion, be the only procedure recommended? The review of literature revealed that when there is bony instability like atlantoaxial dislocation (AAD), occipito-atlanto-axial facet joint asymmetry or basilar invagination (BI) associated with Chiari I malformation, one should address the anterior bony compression as well as perform stabilization. This takes care of the compromised canal at the foramen magnum and re-establishes the cerebrospinal fluid flow along the craniospinal axis; and also provides treatment for CVJ instability. In the cases with a pure Chiari I malformation without AAD or BI and with completely symmetrical C1-2 joints, however, posterior fossa decompression with or without duroplasty is sufficient to bring about neurological improvement. The latter subset of cases with pure Chiari I malformation have, thus, shown significant (> 70%) rates of neurological improvement with posterior fossa decompression alone. A C1-2 posterior stabilization is a more stable construct due to the strong bony purchase provided by the C1-2 lateral masses and the short lever arm of the construct. However, in the cases with significant bleeding from paravertebral venous plexus; a very high BI, condylar hypoplasia and occipitalized atlas; gross C1-2 rotation or vertical C1-2 joints with unilateral C1 or C2 facet hypoplasia, as well as the presence of subaxial scoliosis; maldevelopment of the lateral masses and facet joints (as in very young patients); or, the artery lying just posterior to the C1-2 facet joint capsule (being endangered by the C1-2 stabilization procedure), it may be safer to perform an occipitocervical rather than a C1-2 fusion.

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Section: E Fmentioning

confidence: 99%

Is Cervical Stabilization for All Cases of Chiari-I Malformation an Overkill? Evidence Speaks Louder Than Words!

et al. 2019

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“…The involvement of the upper cervical spine in the restrictions of the cervical rotation should be considered in this speci c population. This manual approach would be a less dangerous and aggresive therapy than quick chiropractic manipulations [66] or surgery procedures [41] described in studies with samples probably sharing biomechanical conditions with our sample of study. Funding: This study was not funded.…”

Section: Discussionmentioning

confidence: 99%

“…For example, atlantoaxial rotatory xation (AARF) [35] has been linked to torticollis in several studies [36][37][38]. Several imaging studies have also described a link between CMT and the C1-C2 joint subluxation, which causes C1 to be in a more ventral position, rotated or sidebent [39][40][41]. In the sample for the study carried out by Sardhara et al (2017), 52% of the patients ranging from 5 to 64 years of age had evident clinical torticollis and an even higher percentage of the subjects with torticollis were associated with greater degrees of C1 displacement in all planes.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Pediatric Integrative Manual Therapy In Cervical Movement Limitation In Infants With Positional Plagiocephaly: A Randomized Controlled Trial

Pastor-Pons

Hidalgo-García

Lucha-López

et al. 2020

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Background: Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods: 34 children with PP and less than 28 week old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d. Results: All randomized subject were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41º) than the control group (6.13 ± 17.69º) (p< 0.05). Both groups improved the neuromotor development but no statistical significant differences were found. No harm was reported during the study.Conclusion: The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program.

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“…Atlantoaxial rotatory fixation (AARF) [62] has been linked to torticollis [27]. Several imaging studies have also described a link between CMT and the C1-C2 joint subluxation, which causes C1 to be in a more ventral position, rotated or sidebent [30,32]. In the sample for the study carried out by Sardhara et al [32], 52% of the patients ranging from 5 to 64 years of age had evident clinical torticollis and an even higher percentage of the subjects with torticollis were associated with greater degrees of C1 displacement in all planes.…”

Section: Intervention Studymentioning

confidence: 99%

“…Nevertheless, the biomechanical factors that contribute to the restriction of cervical rotation AROM of the child, and later to CMT and PP are not fully understood. Moreover, the etiology of these conditions is not entirely clear and it is associated with multiple factors including delivery traumatisms [24], pre-and peri-birth compartment syndrome [1], alterations in the development of the sternocleidomastoid muscle [25] causing its stiffness and restriction of motion [26] and joint dysfunctions [27][28][29][30][31][32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial

et al. 2021

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Background Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d. Results All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. Conclusion The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032. Registration date: September 1, 2018.

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Evaluating Atlantoaxial Dislocation Based on Cartesian Coordinates: Proposing a New Definition and Its Impact on Assessment of Congenital Torticollis

Abstract: Three-dimensional assessment of AAD including evaluation of culpable C1-2 facet joints addresses anomalous displacements in 3 Cartesian planes. This provides targets for adequate cervicomedullary decompression-stabilization, and helps in the management of accompanying torticollis.

Cited by 18 publications

References 22 publications

Is Cervical Stabilization for All Cases of Chiari-I Malformation an Overkill? Evidence Speaks Louder Than Words!

Is Cervical Stabilization for All Cases of Chiari-I Malformation an Overkill? Evidence Speaks Louder Than Words!

Efficacy of Pediatric Integrative Manual Therapy In Cervical Movement Limitation In Infants With Positional Plagiocephaly: A Randomized Controlled Trial

Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial

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