Atlantoaxial fixation for craniovertebral anomaly associated with absent posterior elements of the axial vertebra: report of 3 cases

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This is a report of 3 relatively rare clinical cases in which the absence of posterior elements of the axis was associated with basilar invagination and multiple other craniovertebral junction musculoskeletal and neural abnormalities. Atlantoaxial fixation resulted in remarkable clinical recovery in all 3 cases. C2–3 fixation was not done, and bone decompression was not done. On the basis of their experience, the authors conclude that atlantoaxial fixation is a satisfactory form of surgical treatment in patients having an association of basilar invagination with absent posterior elements of axis.

Article Information

Correspondence Atul Goel: K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India. atulgoel62@hotmail.com.

INCLUDE WHEN CITING Published online July 12, 2019; DOI: 10.3171/2019.5.SPINE19185.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Images and a 3D model obtained in a 17-year-old male patient. A: CT scan with the neck in flexion, showing basilar invagination and assimilation of the atlas. The spinous process of C2 is not visualized. B: CT scan obtained with the neck in extension, showing reduction of the vertical atlantoaxial dislocation. C: Sagittal CT scan with the cut passing through the facets, showing the type A atlantoaxial “facetal” dislocation. D: Sagittal T2-weighted MR image showing basilar invagination and external syringomyelia. A large C3 spinous process mimicking a C2 spinous process can be seen. E: 3D model showing complex craniovertebral anomaly. There is an absence of posterior elements of C1 and C2. The stubby C3 spinous process is visualized. F: Postoperative CT scan showing reduction of basilar invagination and fixation. G: Postoperative CT scan showing the implant. Screws are seen in the C1 and C2 facets. H: Postoperative CT scans with the cut passing through the facets obtained 6 months postoperatively, showing evidence of bone fusion. Figure is available in color online only.

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    Case 2. Images and 3D model obtained in a 16-year-old male patient. A: Sagittal T2-weighted MR image showing severe cord indentation, external syringomyelia, and external syringobulbia. B: Sagittal CT scan showing assimilation of atlas and basilar invagination. C: Sagittal CT scan passing through the facets, showing severe atlantoaxial “facetal” malalignment. D: 3D reconstruction showing an absence of the posterior C2 elements. The X indicates the large spinous process of C3 that mimics the spinous process of C2. E: Postoperative CT scan showing reduction of basilar invagination. F: Postoperative cuts through the facets, showing screws in facet of atlas and facet of axis. Figure is available in color online only.

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    Case 3. Images and 3D model obtained a 37-year-old female patient. A: Sagittal T2-weighted MR image showing basilar invagination and severe cord indentation. B: Sagittal CT scan showing basilar invagination and assimilation of the atlas. C: 3D model showing assimilation of atlas, bifid posterior arch of C2, and the large and bulbous spinous process of C3. D: Postoperative CT scan showing reduction of basilar invagination. E: Postoperative CT scan with the cuts passing through the facets. The image shows metal implant and bone fusion of the region. F: Postoperative CT scans obtained 14 months postoperatively, showing evidence of fusion in the posterior elements. G: CT scan with the cut passing through the facets obtained 14 months postoperatively, showing evidence of fusion. H: 3D CT scan obtained 14 months postoperatively, showing fusion of the posterior elements. Figure is available in color online only.

References

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