The mandible-C2 angle: a new radiographic assessment of occipitocervical alignment

Bellabarba, Carlo; Karim, Farhan; Tavolaro, Celeste; Zhou, Haitao; Bremjit, Prashoban; Nguyen, Quynh T.; Agel, Julie; Bransford, Richard J.

doi:10.1016/j.spinee.2020.07.003

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…Researchers reported several methods for measuring the O-C2 angle using the mandible. 12 , 15 ) Bellabarba et al reported that the mandible-C2 angle can provide reliable information on occipitocervical alignment comparable to the O-C2 angle. 12 ) However, intraoperative measurement of the specific angle seems to be challenging, as stated above.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 15 ) Bellabarba et al reported that the mandible-C2 angle can provide reliable information on occipitocervical alignment comparable to the O-C2 angle. 12 ) However, intraoperative measurement of the specific angle seems to be challenging, as stated above. Tan et al advocated the mandibular critical distance (MCD) as a sensitive parameter for occipitocervical alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Reduction in the ΔO-C2 angle by > 10° after OC fusion is considered the threshold for the occurrence of postoperative dysphagia. 2 , 10 , 12 ) Therefore, we analyzed the ΔGonion-C2 distance corresponding to an ΔO-C2 angle reduction of > 10°. Receiver operating characteristic (ROC) curves were constructed, and the corresponding area under the curve (AUC) was calculated.…”

Section: Methodsmentioning

confidence: 99%

“…The O-C2 angle is sometimes difficult to measure with standard intraoperative fluoroscopic imaging because of its poor image quality. [11][12][13] In addition, surgeons usually noticing subtle changes in the O-C2 angle intraoperatively difficult. Therefore, the development of a method to easily recognize occipitocervical malalignment is desirable.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study

Nagashima

Nishimura

AWAYA

et al. 2023

Neurol. Med. Chir.(Tokyo)

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The Occipito(O)-C2 angle reflects the correct craniocervical spine alignment; however, the poor image quality of standard intraoperative fluoroscopy at times lead to inaccurate measurements. Herein, we preliminarily investigated the relationship between the O-C2 angle and the Gonion-C2 distance, which is based on the positioning of the mandible and the cervical spine. We enrolled patients who underwent cervical spine radiography in neutral, flexion, and extension positions from January 2020 to October 2020. The difference by posture changes for each parameter was defined as the Δ value, and the Spearman's rank correlation coefficient was determined. Furthermore, we determined the cutoff value of the ΔGonion-C2 distance to predict a decrease of > 10°in the ΔO-C2 angle, which is reported to be related to dysphagia and dyspnea. Seventy-four patients were included. Spearman's rank correlations for the neutral, flexion, and extension positions were 0.630 (P < 0.001), 0.471 (P < 0.001), and 0.625 (P < 0.001), respectively, while the cutoff values of the ΔGonion-C2 distance for predicting > 10°in the ΔO-C2 angle were 9.3 mm for the neutral flexion change (sensitivity: 0.435, specificity: 0.882) and 8.3 mm for the extension-neutral change (sensitivity: 0.712, specificity: 0.909). The O-C2 angle and Gonion-C2 distances correlated; however, this correlation was weaker in the flexed position. Nevertheless, the ΔGonion-C2 distance can be used as a warning sign for postoperative complications after posterior occipital bone fusion surgery, because a decrease of > 10°in the ΔO-C2 angle can be predicted with high specificity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study

Nagashima

Nishimura

AWAYA

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Upper Cervical Trauma

Olinger

Bransford

2021

Orthopedic Clinics of North America

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Atlanto-occipital Dissociation

Sheppard,

Savage,

Moore

2024

Clinical Spine Surgery

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Atlanto-occipital dissociation (AOD) is an extremely common injury but often fatal. In a systematic review from 2010, AODs were present in almost 20% of blunt trauma fatalities. It is an injury many patients do not survive; therefore, few are treated, even at high volume trauma centers. In survivors, his injury is often missed or the diagnosis is often delayed. Mortality rates commonly reach beyond 60% when injury patterns go unrecognized. Approximately 50% of patients with AOD sustain blunt cerebrovascular injury and nearly 20% of patients present with traumatic brain injury (TBI) or stroke. This pathology was once considered uniformly fatal. However, over the last 20 years, significant advancements have been made both clinically and radiographically, to better identify and manage this injury pattern. Despite improvements in clinical comprehension and improved time to diagnosis, less than 75% of cases are currently recognized within 24 hours. Less than 40% of patients who suffer AOD are independent with functionality, without neurological impairment. This article reviews current literature regarding AOD in hopes to improve timing to diagnosis, subsequent prognosis, timing to fixation or stabilization, and postoperative recovery.

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The mandible-C2 angle: a new radiographic assessment of occipitocervical alignment

Cited by 4 publications

References 24 publications

Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study

Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study

Upper Cervical Trauma

Atlanto-occipital Dissociation

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