Vertical mobile and reducible atlantoaxial dislocation

Goel, Atul; Shah, Abhidha; Rajan, Sanjay

doi:10.3171/2009.3.spine08927

Cited by 77 publications

(40 citation statements)

References 12 publications

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“…There was evidence of vertical, mobile, and partially or completely reducible atlantoaxial dislocation (as described by us earlier in 2009) in 18 cases. 23 In patients having basilar invagination, there was occipitalization of the atlas in 33 cases and C2-3 fusion in 4 cases. Radiological images and operative observations revealed that the atlantoaxial joint was "open," functional, and unstable in all patients.…”

Section: Resultsmentioning

confidence: 99%

“…23 In several of these cases, the vertical dislocation was subtle but definite. Identification of such vertical dislocation seems to be an important additional parameter suggesting instability of the region and incompetence of the joints.…”

Section: Discussionmentioning

confidence: 99%

“…13,21 We introduced the term "'vertical" mobile and reducible atlantoaxial dislocation for basilar invagination. 23 Before the present study, until the year 2009, it appeared to us that in Group B basilar invagination, the atlantoaxial dislocation was fixed. Accordingly, posterior foramen magnum decompression was performed in these cases.…”

Section: Discussionmentioning

confidence: 99%

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Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

Goel

2015

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217

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OBJECT Understanding that atlantoaxial instability is the cause of Chiari malformation (CM), the author treated 65 patients using atlantoaxial stabilization. The results are analyzed. METHODS Cases of CM treated using atlantoaxial fixation during the period from January 2010 to November 2013 were reviewed and analyzed. Surgery was aimed at segmental arthrodesis. RESULTS The author treated 65 patients with CM in the defined study period. Fifty-five patients had associated syringomyelia. Forty-six patients had associated basilar invagination. Thirty-seven patients had both basilar invagination and syringomyelia. Three patients had been treated earlier using foramen magnum decompression and duraplasty. According to the extent of their functional capabilities, patients were divided into 5 clinical grades. On the basis of the type of facetal alignment and atlantoaxial instability, the patients were divided into 3 groups. Type I dislocation (17 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type II dislocation (31 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type III dislocation (17 patients) was the absence of demonstrable facetal malalignment and was labeled as “central” atlantoaxial dislocation. In 18 patients, dynamic images showed vertical, mobile and at-least partially reducible atlantoaxial dislocation. All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. One patient died, and death occurred in the immediate postoperative phase and was related to a vertebral artery injury incurred during the operation. One patient had persistent symptoms. In the rest of the patients there was gratifying clinical improvement. More remarkably, in 7 patients, the symptoms of lower cranial nerve paresis improved. No patient worsened in their neurological function after surgery. Reductions in the size of the syrinx and regression of the CM were observed in 6 of 11 cases in which postoperative MRI was possible. During the follow-up period, there was no delayed worsening of neurological function or symptoms in any patient. Sixty-three patients improved after surgery, and the improvement was sustained during the average follow-up period of 18 months. CONCLUSIONS On the basis of outcomes in this study, it appears that the pathogenesis of CM with or without associated basilar invagination and/or syringomyelia is primarily related to atlantoaxial instability. The data suggest that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and segmental arthrodesis. Except in cases in which there is assimilation of the atlas, inclusion of the occipital bone is neither indicated nor provides optimum stability. Foramen magnum decompression is not necessary and may be counter-effective in the long run.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

Goel

2015

SPI

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217

143

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“…11,13 Our experience in dealing with and manually handling unstable atlantoaxial and subaxial spinal facets is more than 25 years long. [1][2][3][4][5][6][7]10,[15][16][17][18][19][20][22][23][24][25][26][27][28][29][31][32][33][34][35][36] We have treated over 1300 cases by atlantoaxial fixation. 22,26 Because of this unique opportunity, we are able to identify the presence or absence of instability rather easily by assessing the local stability situation during an operation by manual bone handling.…”

Section: Responsementioning

confidence: 99%

Letter to the Editor: Chiari malformation Type 1 and atlantoaxial instability: a letter from the Pediatric Craniocervical Society

Brockmeyer¹,

Oakes²,

Rozzelle³

et al. 2015

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“…1 In most cases, the adoption of short posterior vertebral fixation techniques 2 (C1-C2) has replaced long occipital-cervical fixation (sub-axial) with good clinical outcomes and the preservation, in large part, of cervical mobility, although with an increased risk of neuro-vascular lesions, particularly of the vertebral artery. The need to extend the fixation to the occipital bone, which may increase the stability of the fixation and improve the clinical outcome, has also been questioned in pure atlantoaxial instabilities.…”

Section: Introductionmentioning

confidence: 99%

Odontoid Process Hypoplasia and Bipartite Atlas Associated With Atlanto-Axial Instability

2016

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Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.Keywords: Congenital abnormalities; Cervical atlas; Cervical vertebrae; Odontoid process. RESUMO O tratamento cirúrgico da patologia da charneira crânio-cervical tem evoluído consideravelmente nos últimos anos com a implementação de técnicas de fixação curta em detrimento de longas fixações occipito-cervicais (sub-axiais). Frequentemente é difícil e por vezes enganador determinar as variações ósseas e vasculares (artéria vertebral high-riding p.e.) apenas pelas imagens convencionais em três planos ortogonais (axial, sagital e coronal). Os autores descrevem um caso clínico raro de malformação congénita da charneira crânio-cervical constituída por hipoplasia/agenésia da odontoide e atlas bipartido, associado a instabilidade atlanto-axial e diagnosticado tardiamente em doente com antecedentes reumáticos prévios. Descreve-se o processo diagnóstico, incluindo novas técnicas de imagiologia e de reconstrução multiplanar tridimensional. Discute-se a técnica cirúrgica utilizada e possíveis alternativas.Descritores: Anormalidades congênitas; Atlas cervical; vertebras cervicais; Processo odontoide. (axial, sagital y coronal). Los autores describen un caso clínico poco frecuente de malformación congénita de la unión craneocervical que consiste en la hipoplasia/agenesia de la apófisis odontoides y atlas bipartito, asociado con la inestabilidad atlantoaxial, diagnosticado tardiamente en pacientes con enfermedades reumatológicas previas. Los autores relatan el proceso de diagnóstico, incluyendo nuevas técnicas de imagen y la reconstrucción multiplanar tridimensional. Los autores también discuten la técnica quirúrgica y las posibles alternativas. RESUMEN El tratamiento quirúrgico de la patología de la región craneocervical ha evolucionado considerablemente en los últimos años con la aplicación de técnicas de fijación cortas en lugar de fijación occipito-cervical larga (sub-axial). A menudo es difícil y hasta engañoso determinar las características óseos y vasculares (arteria vertebral high-riding, por ejemplo) usando sólo imágenes convencionales en tres planos ortogonales

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Vertical mobile and reducible atlantoaxial dislocation

Cited by 77 publications

References 12 publications

Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

Letter to the Editor: Chiari malformation Type 1 and atlantoaxial instability: a letter from the Pediatric Craniocervical Society

Odontoid Process Hypoplasia and Bipartite Atlas Associated With Atlanto-Axial Instability

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