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

JOURNAL TITLE: The Journal of Spinal Surgery

Author
1. Andi S Ramesh
2. Satyajit Rabha
3. Rajalakshmi Rajasegaran
4. Vadivel RR Kumar
ISSN
2349-0462
DOI
10.5005/jp-journals-10039-1209
Volume
6
Issue
2
Publishing Year
2019
Pages
5
Author Affiliations
    1. Department of Neurosurgery, Jorhat Medical College, Jorhat, Assam, India
    1. Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
    1. Department of Neurosurgery, Apollo Proton Cancer Centre, Tharamani, Chennai, Tamil Nadu, India
    1. Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
  • Article keywords
    Atlantoaxial dislocation, Compressive myelopathy, Neck pain, Nurick grade

    Abstract

    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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