Dataset Information

Quantitative Reduction of Basilar Invagination With Atlantoaxial Dislocation by a Posterior Approach.

ABSTRACT: OBJECTIVE:This study evaluated the feasibility and efficacy of quantitative reduction and fixation to treat basilar invagination (BI) with atlantoaxial dislocation (AAD). METHODS:Posterior occipitocervical angle (POCA), occiput-C2 angle (Oc-C2A), clivusaxial angle (CAA), and C2-7 angle (C2-7A) were considered for quantitative reduction. Twelve patients with BI complicated with AAD received posterior interarticular release and individualized cage implantation to restore vertical dislocation. The POCA was adjusted using cantilever technology to further reduce the horizontal dislocation and adjust lower cervical vertebral angle. All patients received a radiological follow-up for ?12 months. Improvements in spinal cord function were evaluated using Japanese Orthopedic Association (JOA) score. RESULTS:All the patients received successful quantitative reduction for BI-AAD, and bony fusion was achieved without spinal cord injury after surgery for 12 months. The JOA score was improved significantly to 15.2 ± 0.9 twelve months after surgery (p < 0.01). Radiological follow-up revealed that individualized cage and POCA play vital roles in quantitative correction: (1) distance of the dens above McRae's line and atlantodens interval were restored to normal level, respectively; (2) changes in Oc-C2 angle (?Oc-C2A), C2-7 angle (?C2-7A), clivus-axial angle (?CAA), and POCA (?POCA) were all caused by changes in axis tilt. Based on the changes of radiological parameter we deduced the formula for quantitative reduction by linear regression analysis: -?POCA = ?Oc-C2A = -?C2-7A = ?CAA. CONCLUSION:Quantitative posterior reduction by individualized cage and adjusting ?POCA is feasible for treating BI with AAD.

SUBMITTER: Guan J

PROVIDER: S-EPMC7538363 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Quantitative Reduction of Basilar Invagination With Atlantoaxial Dislocation by a Posterior Approach.

Guan Jian J Jian Fengzeng F Yao Qingyu Q Yuan Chenghua C Zhang Can C Ma Longbing L Liu Zhenlei Z Duan Wanru W Wang Xingwen X Bo Xuefeng X Chen Zan Z

Neurospine 20200930 3

<h4>Objective</h4>This study evaluated the feasibility and efficacy of quantitative reduction and fixation to treat basilar invagination (BI) with atlantoaxial dislocation (AAD).<h4>Methods</h4>Posterior occipitocervical angle (POCA), occiput-C2 angle (Oc-C2A), clivusaxial angle (CAA), and C2-7 angle (C2-7A) were considered for quantitative reduction. Twelve patients with BI complicated with AAD received posterior interarticular release and individualized cage implantation to restore vertical di ...[more]

PMID: 33022162

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Project description:Fibrous dysplasia (FD) is a mosaic disorder of benign fibro-osseous lesions, which may be associated with extraskeletal features as part of McCune-Albright syndrome (MAS). Cranial base abnormalities, including Chiari I malformation (CM1), in which the cerebellum extends below the foramen magnum, and secondary basilar invagination (BI), in which the odontoid prolapses into the posterior cranial fossa, are potentially serious complications of metabolic bone disorders. The purpose of this study was to determine the prevalence, natural history, and risk factors for CM1 and BI in patients with FD/MAS, and to determine mechanisms of cranial base deformities. Clinical and radiographic data from subjects in an FD/MAS natural history study were evaluated and compared to normal controls. In 158 patients with craniofacial FD, 10 (6.3%) cases of CM1 and 12 (7.6%) cases of BI were diagnosed. No cranial base abnormalities were identified in 10 control subjects. Craniomorphometric and volumetric analyses identified cranial constriction and cranial settling as the primary mechanisms of cranial base abnormalities, whereas intracranial hypertension was a contributing factor in a minority of subjects. Longitudinal analyses found progression of odontoid position with age, but no progression of tonsillar position. No endocrinopathies were associated with CM1. MAS endocrinopathies associated with BI included hyperthyroidism (odds ratio [OR] 12.0; 95% confidence interval [CI], 2.9 to 55.6; p?<?0.01), precocious puberty (OR 5.6; 95% CI, 1.2 to 26.0; p?<?0.05), and hypophosphatemia (OR 7.7; 95% CI, 1.9 to 27.0; p?<?0.01). Scoliosis was associated with both CM1 (OR 4.8; 95% CI, 1.1 to 22.8; p?<?0.05) and BI (OR?=?infinity; 95% CI, 4.7 to infinity; p?<?0.01). This study successfully characterized cranial base abnormalities in FD/MAS and the pathophysiological connection between them. These findings support routine screening for cranial base abnormalities in patients with craniofacial FD, as well as aggressive management of contributory risk factors. © 2018 American Society for Bone and Mineral Research.

Dataset Information

Quantitative Reduction of Basilar Invagination With Atlantoaxial Dislocation by a Posterior Approach.

Publications

Quantitative Reduction of Basilar Invagination With Atlantoaxial Dislocation by a Posterior Approach.

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