颅椎交界处退行性关节炎-不断发展的认识。

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Atul Goel , Nasser M.F. El–Ghandour , Abhidha Shah , Apurva Prasad , Ravikiran Vutha , Siddharth Gautam , Tejas Vaja , Arjun Dhar
{"title":"颅椎交界处退行性关节炎-不断发展的认识。","authors":"Atul Goel ,&nbsp;Nasser M.F. El–Ghandour ,&nbsp;Abhidha Shah ,&nbsp;Apurva Prasad ,&nbsp;Ravikiran Vutha ,&nbsp;Siddharth Gautam ,&nbsp;Tejas Vaja ,&nbsp;Arjun Dhar","doi":"10.1016/j.jocn.2025.111638","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The report analyzes the outcome of atlantoaxial stabilization in patients presenting with clinical symptoms and with radiological features that were attributed to atlantoaxial instability related degenerative alterations at craniovertebral junction.</div></div><div><h3>Material and methods</h3><div>During the period January 2009 to December 2024, 95 patients presented with clinical symptoms that indicated mild to severe myelopathy and on imaging were identified to have degenerative alterations at the craniovertebral junction. Apart from validated parameters of abnormal alterations in atlantodental interval, atlantoaxial instability was diagnosed based on high level of clinical suspicion and physical alterations in the region of craniovertebral junction that included abnormal bone and osteophyte formation or soft tissue alterations in the vicinity of the odontoid process and atlantoaxial articulation, joint space reduction and alterations in alignment of facets of atlas and axis. The height of occipital condyle- atlas facet- axis facet complex was assessed and compared with a ‘normal’ cohort of individuals between ages of 30–50 years. All patients underwent atlantoaxial stabilization using the described techniques. No bone or soft tissue decompression was done. The clinical outcome was assessed on the standard parameters of VAS, Goel’s clinical grade and JOA score. Additionally, patient self-assessment questionnaire was used to evaluate the result of surgery.</div></div><div><h3>Results</h3><div>On dynamic head flexion–extension imaging, 47 patients had completely reducible and 26 patients partially reducible) atlantoaxial instability, 30 patients had fixed or irreducible atlantoaxial instability and 16 patients had no abnormal alteration in the atlantodental interval. Two patients had vertical mobile and partially reducible atlantoaxial dislocation. Twenty-four patients had varying degree of basilar invagination. Fifty-one patients had osteophytes in the paraodontoid region that included apical region (46 patients), lateral to odontoid process (14 patients), retroodontoid region (34 cases) and around the facets (57 cases). The height of occipital condyle- atlas facet- axis facet complex ranged from 20 mm to 32 mm (average 27 mm) when compared to 30 mm to 43 mm (average 39 mm) in the control group. During the average follow-up period of 26 months, all patients improved in their clinical symptoms following surgery. No patient needed any additional surgery to the craniovertebral junction or to the cervical spine.</div></div><div><h3>Conclusions</h3><div>Chronic weakness of the muscles of the nape forms the basis of atlantoaxial instability that leads to secondary degenerative ‘alterations’. Atlantoaxial stabilization can lead to gratifying clinical outcome.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111638"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Craniovertebral junction degenerative arthritis- evolving understanding\",\"authors\":\"Atul Goel ,&nbsp;Nasser M.F. El–Ghandour ,&nbsp;Abhidha Shah ,&nbsp;Apurva Prasad ,&nbsp;Ravikiran Vutha ,&nbsp;Siddharth Gautam ,&nbsp;Tejas Vaja ,&nbsp;Arjun Dhar\",\"doi\":\"10.1016/j.jocn.2025.111638\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>The report analyzes the outcome of atlantoaxial stabilization in patients presenting with clinical symptoms and with radiological features that were attributed to atlantoaxial instability related degenerative alterations at craniovertebral junction.</div></div><div><h3>Material and methods</h3><div>During the period January 2009 to December 2024, 95 patients presented with clinical symptoms that indicated mild to severe myelopathy and on imaging were identified to have degenerative alterations at the craniovertebral junction. Apart from validated parameters of abnormal alterations in atlantodental interval, atlantoaxial instability was diagnosed based on high level of clinical suspicion and physical alterations in the region of craniovertebral junction that included abnormal bone and osteophyte formation or soft tissue alterations in the vicinity of the odontoid process and atlantoaxial articulation, joint space reduction and alterations in alignment of facets of atlas and axis. The height of occipital condyle- atlas facet- axis facet complex was assessed and compared with a ‘normal’ cohort of individuals between ages of 30–50 years. All patients underwent atlantoaxial stabilization using the described techniques. No bone or soft tissue decompression was done. The clinical outcome was assessed on the standard parameters of VAS, Goel’s clinical grade and JOA score. Additionally, patient self-assessment questionnaire was used to evaluate the result of surgery.</div></div><div><h3>Results</h3><div>On dynamic head flexion–extension imaging, 47 patients had completely reducible and 26 patients partially reducible) atlantoaxial instability, 30 patients had fixed or irreducible atlantoaxial instability and 16 patients had no abnormal alteration in the atlantodental interval. Two patients had vertical mobile and partially reducible atlantoaxial dislocation. Twenty-four patients had varying degree of basilar invagination. Fifty-one patients had osteophytes in the paraodontoid region that included apical region (46 patients), lateral to odontoid process (14 patients), retroodontoid region (34 cases) and around the facets (57 cases). The height of occipital condyle- atlas facet- axis facet complex ranged from 20 mm to 32 mm (average 27 mm) when compared to 30 mm to 43 mm (average 39 mm) in the control group. During the average follow-up period of 26 months, all patients improved in their clinical symptoms following surgery. No patient needed any additional surgery to the craniovertebral junction or to the cervical spine.</div></div><div><h3>Conclusions</h3><div>Chronic weakness of the muscles of the nape forms the basis of atlantoaxial instability that leads to secondary degenerative ‘alterations’. Atlantoaxial stabilization can lead to gratifying clinical outcome.</div></div>\",\"PeriodicalId\":15487,\"journal\":{\"name\":\"Journal of Clinical Neuroscience\",\"volume\":\"142 \",\"pages\":\"Article 111638\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0967586825006113\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825006113","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

目的:本报告分析了寰枢椎稳定患者的临床症状和影像学特征,这些患者归因于寰枢椎不稳定相关的颅椎交界处退行性改变。材料和方法:在2009年1月至2024年12月期间,95例患者表现出轻度至重度脊髓病的临床症状,影像学上发现颅椎交界处有退行性改变。除了寰牙间隙异常改变的有效参数外,寰枢椎不稳定的诊断是基于高度的临床怀疑和颅椎交界处区域的物理改变,包括齿状突和寰枢关节附近的异常骨和骨赘形成或软组织改变,关节间隙缩小以及寰枢关节面和轴的对齐改变。评估枕髁-寰椎关节突-轴关节突复合体的高度,并与年龄在30-50岁之间的“正常”人群进行比较。所有患者均采用上述技术进行寰枢椎稳定。未进行骨或软组织减压。采用VAS标准参数、Goel临床分级和JOA评分评价临床结局。采用患者自我评估问卷对手术效果进行评估。结果:动态头屈伸成像显示47例寰枢椎完全可复位,26例寰枢椎部分可复位,30例寰枢椎固定或不可复位,16例寰枢椎间段未见异常改变。2例患者有垂直可移动和部分可复位的寰枢脱位。24例患者有不同程度的颅底凹陷。51例患者在齿旁区出现骨赘,包括齿顶区(46例)、齿突外侧区(14例)、齿突后区(34例)和齿突周围区(57例)。与对照组30 ~ 43 mm(平均39 mm)相比,枕髁-寰椎关节突-轴关节突复合体的高度为20 ~ 32 mm(平均27 mm)。在平均随访26个月期间,所有患者术后临床症状均有改善。没有患者需要对颅椎交界处或颈椎进行任何额外的手术。结论:颈背肌肉的慢性无力是导致继发性退行性“改变”的寰枢椎不稳定的基础。寰枢椎稳定可导致令人满意的临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Craniovertebral junction degenerative arthritis- evolving understanding

Objective

The report analyzes the outcome of atlantoaxial stabilization in patients presenting with clinical symptoms and with radiological features that were attributed to atlantoaxial instability related degenerative alterations at craniovertebral junction.

Material and methods

During the period January 2009 to December 2024, 95 patients presented with clinical symptoms that indicated mild to severe myelopathy and on imaging were identified to have degenerative alterations at the craniovertebral junction. Apart from validated parameters of abnormal alterations in atlantodental interval, atlantoaxial instability was diagnosed based on high level of clinical suspicion and physical alterations in the region of craniovertebral junction that included abnormal bone and osteophyte formation or soft tissue alterations in the vicinity of the odontoid process and atlantoaxial articulation, joint space reduction and alterations in alignment of facets of atlas and axis. The height of occipital condyle- atlas facet- axis facet complex was assessed and compared with a ‘normal’ cohort of individuals between ages of 30–50 years. All patients underwent atlantoaxial stabilization using the described techniques. No bone or soft tissue decompression was done. The clinical outcome was assessed on the standard parameters of VAS, Goel’s clinical grade and JOA score. Additionally, patient self-assessment questionnaire was used to evaluate the result of surgery.

Results

On dynamic head flexion–extension imaging, 47 patients had completely reducible and 26 patients partially reducible) atlantoaxial instability, 30 patients had fixed or irreducible atlantoaxial instability and 16 patients had no abnormal alteration in the atlantodental interval. Two patients had vertical mobile and partially reducible atlantoaxial dislocation. Twenty-four patients had varying degree of basilar invagination. Fifty-one patients had osteophytes in the paraodontoid region that included apical region (46 patients), lateral to odontoid process (14 patients), retroodontoid region (34 cases) and around the facets (57 cases). The height of occipital condyle- atlas facet- axis facet complex ranged from 20 mm to 32 mm (average 27 mm) when compared to 30 mm to 43 mm (average 39 mm) in the control group. During the average follow-up period of 26 months, all patients improved in their clinical symptoms following surgery. No patient needed any additional surgery to the craniovertebral junction or to the cervical spine.

Conclusions

Chronic weakness of the muscles of the nape forms the basis of atlantoaxial instability that leads to secondary degenerative ‘alterations’. Atlantoaxial stabilization can lead to gratifying clinical outcome.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Clinical Neuroscience
Journal of Clinical Neuroscience 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
402
审稿时长
40 days
期刊介绍: This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信