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Craniovertebral Junction Instability: A Review of Facts about Facets.

Goel A - Asian Spine J (2015)

Bottom Line: The facets of atlas and axis form the primary site of movements at the craniovertebral junction.All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint.Direct manipulation and fixation of the facets forms the basis of treatment for instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.

ABSTRACT
Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability.

No MeSH data available.


Related in: MedlinePlus

Images of a 32-year-old male. (A) T2-weighted magnetic resonance imaging shows group A basilar invagination. Chiari malformation is observed. Ill-defined cord changes are observed in the spinal cord at C3 spinal level. (B) Computed tomography (CT) scan showing basilar invagination. Assimilation of atlas and C2-3 fusion can be observed. (C) Sagittal image with the section passing through the facets. Facets of C1 and C2 are in severe mal-alignment. (D) Postoperative image following surgery that involved distraction, reduction and fixation of the atlantoaxial joint. Please note the reduction of basilar invagination. (E) CT scan image showing realignment of the facets.
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Figure 2: Images of a 32-year-old male. (A) T2-weighted magnetic resonance imaging shows group A basilar invagination. Chiari malformation is observed. Ill-defined cord changes are observed in the spinal cord at C3 spinal level. (B) Computed tomography (CT) scan showing basilar invagination. Assimilation of atlas and C2-3 fusion can be observed. (C) Sagittal image with the section passing through the facets. Facets of C1 and C2 are in severe mal-alignment. (D) Postoperative image following surgery that involved distraction, reduction and fixation of the atlantoaxial joint. Please note the reduction of basilar invagination. (E) CT scan image showing realignment of the facets.

Mentions: The facets of atlas and axis are located in the lateral gutter of the region. The region is loaded with a large plexus of veins. Venous bleeding can sometimes be quite significant and can adversely affect the conduct of the operation. Understanding of the bone anatomy in its three dimensional perspective is crucially important. The vertebral artery has multiple twists and turns especially in the craniovertebral junctional region. These loops have a dynamic relationship with the bones and grooves and participate in movements of head and neck [12]. The relationship of the vertebral artery to the facet of axis, arch of atlas and in the region lateral to the facet joint needs to be understood, appropriately evaluated and the artery needs to be precisely handled during the conduct of surgery. The course of the artery in relationship to the facet of C2, makes it vulnerable during screw implantation. Appropriate evaluation of the traverse of the artery on the basis of computer-based imaging can assist in providing safety during surgery. Neuronavigation systems can be helpful in this regard, but are not essential during surgery.


Craniovertebral Junction Instability: A Review of Facts about Facets.

Goel A - Asian Spine J (2015)

Images of a 32-year-old male. (A) T2-weighted magnetic resonance imaging shows group A basilar invagination. Chiari malformation is observed. Ill-defined cord changes are observed in the spinal cord at C3 spinal level. (B) Computed tomography (CT) scan showing basilar invagination. Assimilation of atlas and C2-3 fusion can be observed. (C) Sagittal image with the section passing through the facets. Facets of C1 and C2 are in severe mal-alignment. (D) Postoperative image following surgery that involved distraction, reduction and fixation of the atlantoaxial joint. Please note the reduction of basilar invagination. (E) CT scan image showing realignment of the facets.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522459&req=5

Figure 2: Images of a 32-year-old male. (A) T2-weighted magnetic resonance imaging shows group A basilar invagination. Chiari malformation is observed. Ill-defined cord changes are observed in the spinal cord at C3 spinal level. (B) Computed tomography (CT) scan showing basilar invagination. Assimilation of atlas and C2-3 fusion can be observed. (C) Sagittal image with the section passing through the facets. Facets of C1 and C2 are in severe mal-alignment. (D) Postoperative image following surgery that involved distraction, reduction and fixation of the atlantoaxial joint. Please note the reduction of basilar invagination. (E) CT scan image showing realignment of the facets.
Mentions: The facets of atlas and axis are located in the lateral gutter of the region. The region is loaded with a large plexus of veins. Venous bleeding can sometimes be quite significant and can adversely affect the conduct of the operation. Understanding of the bone anatomy in its three dimensional perspective is crucially important. The vertebral artery has multiple twists and turns especially in the craniovertebral junctional region. These loops have a dynamic relationship with the bones and grooves and participate in movements of head and neck [12]. The relationship of the vertebral artery to the facet of axis, arch of atlas and in the region lateral to the facet joint needs to be understood, appropriately evaluated and the artery needs to be precisely handled during the conduct of surgery. The course of the artery in relationship to the facet of C2, makes it vulnerable during screw implantation. Appropriate evaluation of the traverse of the artery on the basis of computer-based imaging can assist in providing safety during surgery. Neuronavigation systems can be helpful in this regard, but are not essential during surgery.

Bottom Line: The facets of atlas and axis form the primary site of movements at the craniovertebral junction.All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint.Direct manipulation and fixation of the facets forms the basis of treatment for instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.

ABSTRACT
Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability.

No MeSH data available.


Related in: MedlinePlus