The Journal of Spinal Surgery

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VOLUME 6 , ISSUE 2 ( April-June, 2019 ) > List of Articles

Original Article

Do Effective Canal Diameter and Atlantodental Interval have a Role in the Assessment of Postoperative Early Clinical and Radiological Status in Craniovertebral Junction Disorders?

Satyajit Rabha, Andi S Ramesh, Vadivel RR Kumar, Rajalakshmi Rajasegaran

Keywords : Atlantoaxial dislocation, Compressive myelopathy, Neck pain, Nurick grade

Citation Information : Rabha S, Ramesh AS, Kumar VR, Rajasegaran R. Do Effective Canal Diameter and Atlantodental Interval have a Role in the Assessment of Postoperative Early Clinical and Radiological Status in Craniovertebral Junction Disorders?. J Spinal Surg 2019; 6 (2):35-39.

DOI: 10.5005/jp-journals-10039-1209

License: CC BY-NC 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Introduction: Surgery at the level of the craniovertebral junction (CVJ) is complex and technically challenging due to the presence of vital anatomical structures and complex congenital anomalies. The type of surgical procedure depends on the primary pathology. However, the aim of these surgical procedures is to relieve the compression at the level of the medulla and achieve anatomical stabilization. Objective: The objective of this study was to assess the early postoperative clinical and radiological outcome following stabilization of the CVJ in patients with atlantoaxial dislocation (AAD). Materials and methods: It is a retrospective descriptive study. All consecutively operated patients of AAD having complete clinical and radiological medical records in the institute were included in this study. Patients who had undergone transoral odontoidectomy were excluded. Atlantodental interval more than 3 mm in adults and 5 mm in children was considered as AAD. Three parameters were studied: Nurick grade, atlantodental interval (ADI), and effective canal diameter (ECD) at the level of C1. Clinical and radiological improvement was assessed by the Wilcoxon signed-rank sum test and the paired t test, respectively. A correlation among the duration of symptoms, Nurick grade, and changes in ECD and ADI was assessed by the Pearson correlation coefficient test. Results: Twenty-five patients who had complete clinical and radiological records were included in this study. There was no significant neurological improvement in the immediate (within 7 days) postoperative period. However, statistically significant improvement was observed in ECD and ADI. There was no significant correlation among the duration of symptoms, Nurick grade, and changes in ECD and ADI. Conclusion: ECD and ADI may serve as useful parameters to assess the radiological improvement in the early postoperative period of patients with AAD.

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  1. Klimo Jr P, Rao G, et al. Congenital anomalies of the cervical spine. Neurosurg Clin N Am 2007;18(3):463–478. DOI: 10.1016/
  2. Wasserman BR, Moskovich R, et al. Rheumatoid arthritis of the cervical spine–clinical considerations. Bull NYU Hosp Jt Dis 2011;69(2):136–148.
  3. Dvorak J, Schneider E, et al. Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 1988;6(3):452–461. DOI: 10.1002/jor.1100060317.
  4. Wang S, Wang C, et al. Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine (Phila Pa 1976) 2013;38(21):E1348–1356. DOI: 10.1097/BRS.0b013e3182a1e5e4.
  5. Yang SY, Boniello AJ, et al. A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 2014;4(3):197–210. DOI: 10.1055/s-0034-1376371.
  6. Di Lorenzo N, Fortuna A, et al. Craniovertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 1982;57(5):603–608. DOI: 10.3171/jns.1982.57.5.0603.
  7. Sumi M, Kataoka O, et al. Atlantoaxial dislocation. A follow-up study of surgical results. Spine (Phila Pa 1976) 1997;22(7):759–763.
  8. Arunkumar MJ, Rajshekhar V. Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery. J Neurosurg 2002;97(2):166–171.
  9. Goel A, Kulkarni AG, et al. Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2005;2(4):505–509. DOI: 10.3171/spi.2005.2.4.0505.
  10. Bahadur R, Goyal T, et al. Transarticular screw fixation for atlantoaxial instability – modified Magerl's technique in 38 patients. J Orthop Surg Res 2010;5:87. DOI: 10.1186/1749-799x-5-87.
  11. Dunn RN, Stander H. Atlantoaxial fusion: Magerl transarticular vs Harms instrumentation techniques. SA Orthopaedic J 2014;13(2):31–34.
  12. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95:87–100.
  13. De la Garza-Ramos R, Ramhmdani S, et al. Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment. World Neurosurg 2017;105:314–320. DOI: 10.1016/j.wneu.2017.05.166.
  14. Jain VK. Atlantoaxial dislocation. Neurol India 2012;60(1):9–17. DOI: 10.4103/0028-3886.93582.
  15. Mummaneni PV, Haid RW. Atlantoaxial fixation: overview of all techniques. Neurol India 2005;53(4):408–415.
  16. Tan M, Jiang X, et al. Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases. Eur Spine J 2011;20(12):2187–2194. DOI: 10.1007/s00586-011-1865-8.
  17. Jain N, Verma R, et al. CT and MR imaging of odontoid abnormalities: a pictorial review. Indian J Radiol Imaging 2016;26(1):108–119. DOI: 10.4103/0971-3026.178358.
  18. Oda T, Yonenobu K, et al. Diagnostic validity of space available for the spinal cord at C1 level for cervical myelopathy in patients with rheumatoid arthritis. Spine (Phila Pa 1976) 2009;34(13):1395–1398. DOI: 10.1097/BRS.0b013e3181a2b486.
  19. Berquist TH. Imaging of the postoperative spine. Radiol Clin North Am 2006;44:407–418. DOI: 10.1016/j.rcl.2006.01.002.
  20. Matveeva N, Janevski P, et al. Morphometric analysis of the cervical spinal canal on MRI. Prilozi 2013;34(2):97–103.
  21. Sardhara J, Behari S, et al. Syndromic vs nonsyndromic atlantoaxial dislocation: do clinico-radiological differences have a bearing on management? Acta Neurochir (Wien) 2013;155(7):1157–1167. DOI: 10.1007/s00701-013-1717-x.
  22. Mehrotra A, Srivastava A, et al. Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies. Asian J Neurosurg 2016;11(4):396–401. DOI: 10.4103/1793-5482.144149.
  23. Song G-C, Cho K-S, et al. Surgical treatment of craniovertebral junction instability: clinical outcomes and effectiveness in personal experience. J Korean Neurosurg Soc 2010;48(1):37–45. DOI: 10.3340/jkns.2010.48.1.37.
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