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Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations.
Spine (Phila Pa 1976). 2015 Nov; 40(22):1763-8.S

Abstract

STUDY DESIGN

This is a cross-sectional analysis of resonance magnetic images of 111 patients with craniocervical malformations and those of normal subjects.

OBJECTIVE

To test the hypothesis that atlas assimilation is associated with basilar invagination (BI) and atlas's anterior arch assimilation is associated with craniocervical instability and type I BI.

SUMMARY OF BACKGROUND DATA

Atlas assimilation is the most common malformation in the craniocervical junction. This condition has been associated with craniocervical instability and BI in isolated cases.

METHODS

We evaluated midline Magnetic Resonance Images (MRIs) (and/or CT scans) from patients with craniocervical junction malformation and normal subjects. The patients were separated into 3 groups: Chiari type I malformation, BI type I, and type II. The atlas assimilations were classified according to their embryological origins as follows: posterior, anterior, and both arches assimilation.

RESULTS

We studied the craniometric values of 111 subjects, 78 with craniocervical junction malformation and 33 without malformations. Of the 78 malformations, 51 patients had Chiari type I and 27 had BI, of whom 10 presented with type I and 17 with type II BI. In the Chiari group, 41 showed no assimilation of the atlas. In the type I BI group, all patients presented with anterior arch assimilation, either in isolation or associated with assimilation of the posterior arch. 63% of the patients with type II BI presented with posterior arch assimilation, either in isolation or associated with anterior arch assimilation. In the control group, no patients had atlas assimilation.

CONCLUSION

Anterior atlas assimilation leads to type I BI. Posterior atlas assimilation more frequently leads to type II BI. Separation in terms of anterior versus posterior atlas assimilation reflects a more accurate understanding of the clinical and embryological differences in craniocervical junction malformations.

LEVEL OF EVIDENCE

N/A.

Authors+Show Affiliations

*Post-graduation Program in Health Sciences, IAMSPE, São Paulo, Brazil†Hospital Universitário Presidente Dutra, - HUUFMA, São Luís, Brazil‡Hospital do Servidor Público do Estado de São Paulo, São Paulo, Brazil.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26165213

Citation

Ferreira, Edson Dener Zandonadi, and Ricardo Vieira Botelho. "Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations." Spine, vol. 40, no. 22, 2015, pp. 1763-8.
Ferreira ED, Botelho RV. Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations. Spine. 2015;40(22):1763-8.
Ferreira, E. D., & Botelho, R. V. (2015). Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations. Spine, 40(22), 1763-8. https://doi.org/10.1097/BRS.0000000000001045
Ferreira ED, Botelho RV. Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations. Spine. 2015;40(22):1763-8. PubMed PMID: 26165213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atlas Assimilation Patterns in Different Types of Adult Craniocervical Junction Malformations. AU - Ferreira,Edson Dener Zandonadi, AU - Botelho,Ricardo Vieira, PY - 2015/7/14/entrez PY - 2015/7/15/pubmed PY - 2016/10/14/medline SP - 1763 EP - 8 JF - Spine JO - Spine VL - 40 IS - 22 N2 - STUDY DESIGN: This is a cross-sectional analysis of resonance magnetic images of 111 patients with craniocervical malformations and those of normal subjects. OBJECTIVE: To test the hypothesis that atlas assimilation is associated with basilar invagination (BI) and atlas's anterior arch assimilation is associated with craniocervical instability and type I BI. SUMMARY OF BACKGROUND DATA: Atlas assimilation is the most common malformation in the craniocervical junction. This condition has been associated with craniocervical instability and BI in isolated cases. METHODS: We evaluated midline Magnetic Resonance Images (MRIs) (and/or CT scans) from patients with craniocervical junction malformation and normal subjects. The patients were separated into 3 groups: Chiari type I malformation, BI type I, and type II. The atlas assimilations were classified according to their embryological origins as follows: posterior, anterior, and both arches assimilation. RESULTS: We studied the craniometric values of 111 subjects, 78 with craniocervical junction malformation and 33 without malformations. Of the 78 malformations, 51 patients had Chiari type I and 27 had BI, of whom 10 presented with type I and 17 with type II BI. In the Chiari group, 41 showed no assimilation of the atlas. In the type I BI group, all patients presented with anterior arch assimilation, either in isolation or associated with assimilation of the posterior arch. 63% of the patients with type II BI presented with posterior arch assimilation, either in isolation or associated with anterior arch assimilation. In the control group, no patients had atlas assimilation. CONCLUSION: Anterior atlas assimilation leads to type I BI. Posterior atlas assimilation more frequently leads to type II BI. Separation in terms of anterior versus posterior atlas assimilation reflects a more accurate understanding of the clinical and embryological differences in craniocervical junction malformations. LEVEL OF EVIDENCE: N/A. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/26165213/Atlas_Assimilation_Patterns_in_Different_Types_of_Adult_Craniocervical_Junction_Malformations_ L2 - http://dx.doi.org/10.1097/BRS.0000000000001045 DB - PRIME DP - Unbound Medicine ER -