Tag: Distraction

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Distraction, Compression, Extension, and Reduction Combined With Joint Remodeling and Extra-articular Distraction: Description of 2 New Modifications for Its Application in Basilar Invagination and Atlantoaxial Dislocation: Prospective Study in 79 Cases

Distraction,_Compression,_Extension,_and_Reduction

Neurosurgery 77:67–80, 2015

Recent strategies for treatment of basilar invagination (BI) and atlantoaxial dislocation (AAD) are based on simultaneous posterior reduction and fixation.

OBJECTIVE: To describe new modifications of the procedure distraction, compression, extension, and reduction (DCER), ie, joint remodeling (JRM) and extra-articular distraction (EAD) in patients with “vertical” joints, and to quantify the improvement in joint indices, ie, sagittal inclination (SI), craniocervical tilt (CCT), and coronal inclination.

METHODS: Prospective study (May 2010 to September 2014). Joint indices measured included (normal values): SI (87.15 ± 5.65º), CCT (60.2 ± 9.2), and coronal inclination (110.3 ± 4.23). Surgical procedures included DCER alone (performed in SI ,100, group I) or JRM with DCER (in SI: 100-160, group II), or EAD with DCER in severe BI with almost vertical joints (SI >160º, group III).

RESULTS: Seventy-nine patients were selected (mean, 22.5 years of age). All conventional indices improved significantly (P < .001). CCT improved in all groups (P < .01); group I (n = 32): 54 ± 8.7 (preoperative 80.71 ± 12.72); group II (n = 40): 58 ± 7.0 (preoperative 86.5 6 14); group III (n = 7): 62 ± 10.0 (preoperative 104 6 11.2). SI improved in both group I and II, P < .01 (cannot be measured in group III). At long-term follow-up (n = 64, 29 ± 8 months, range 12-39 months), the Nurick grade improved to 1.5 ±0.52 (preoperative: 3.4 6 0.65; P < .001).

CONCLUSION: DCER seems to be an effective technique in reducing both BI and AAD. JRM and EAD with DCER are useful in moderate to severe BI and AAD (with SI .100). Joint indices provide useful information for surgical strategy and planning.

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Joint Indexes for the Craniovertebral Junction

New Indexes for the Craniovertebral Junction

Neurosurgery 10:621–630, 2014

Joint-distraction and intra-operative manipulation surgeries to correct basilar invagination (BI) and atlantoaxial dislocation (AAD) are becoming standard procedures. However, current data are unable to aid in the understanding of normal and abnormal morphology of the C1/C2 joints.

OBJECTIVE: To study various aspects of C1/C2 joint morphology to create normative and patient data on joint abnormalities that could provide the surgeon with objective data for surgical planning and approach.

METHODS: Seventy patients (age, 15-45 years) were compared with an equal number of age- and sex-matched control subjects (age, 21.9±8.2 years) with irreducible BI and AAD from a developmental origin (May 2010-July 2013). Joint anatomy was studied with the use of thin-slice computed tomography scans. The joint parameters studied included sagittal joint inclination, craniocervical tilt, coronal joint inclination, surface area, joint overlap index, and joint reciprocity. The severity of BI and the severity of AAD were compared.

RESULTS: Sagittal joint inclination and craniocervical tilt significantly correlated with both BI and AAD (P , .01). Coronal joint inclination correlated with BI (P = .2). The mean sagittal joint inclination value in control subjects was 87.15±5.65 and in patients with BI and AAD was 127.1±22.05. The mean craniocervical tilt value in controls was 60.2±9.2 and in patients with BI and AAD was 84.0±15.1. The mean coronal joint inclination value in control subjects was 110.3±4.23 and in patients with BI and AAD was 121.15±14.6.

CONCLUSION: This study has demonstrated for the first time the important role of joint orientation and its correlation with the severity of BI and AAD and has described new joint indexes.

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