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Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations.
World J Orthop. 2017 Mar 18; 8(3):271-277.WJ

Abstract

AIM

To evaluate the role of dynamic computed tomography (CT) scan imaging in diagnosing craniovertebral junction (CVJ) instability in patients with congenital CVJ malformations.

METHODS

Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study. Measurements of the following craniometrical parameters were taken in flexed and extended neck position: Atlanto-dental interval (ADI), distance of the odontoid tip to the Chamberlain's line, and the clivus-canal angle (CCA). Assessment of the facet joints congruence was also performed in both positions. Comparison of the values obtained in flexion and extension were compared using a paired Student's t-test.

RESULTS

A total of ten patients with a mean age of 37.9 years were included. In flexion imaging, the mean ADI was 1.76 mm, the mean CCA was 125.4° and the mean distance of the odontoid tip to the Chamberlain's line was + 9.62 mm. In extension, the mean ADI was 1.46 mm (P = 0.29), the mean CCA was 142.2° (P < 0.01) and the mean distance of the odontoid tip to the Chamberlain's line was + 7.11 mm (P < 0.05). Four patients (40%) had facetary subluxation demonstrated in dynamic imaging, two of them with mobile subluxation (both underwent CVJ fixation). The other two patients with a fixed subluxation were not initially fixed. One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan. Patients with basilar invagination had a lower CCA variation compared to the whole group.

CONCLUSION

Craniometrical parameters, as well as the visualization of the facets location, may change significantly according to the neck position. Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability. Future studies addressing the relationship between craniometrical changes and neck position are necessary.

Authors+Show Affiliations

Otávio Turolo da Silva, Enrico Ghizoni, Helder Tedeschi, Andrei Fernandes Joaquim, Department of Neurology, Division of Neurosurgical, State University of Campinas, Campinas 13083-887, Brazil.Otávio Turolo da Silva, Enrico Ghizoni, Helder Tedeschi, Andrei Fernandes Joaquim, Department of Neurology, Division of Neurosurgical, State University of Campinas, Campinas 13083-887, Brazil.Otávio Turolo da Silva, Enrico Ghizoni, Helder Tedeschi, Andrei Fernandes Joaquim, Department of Neurology, Division of Neurosurgical, State University of Campinas, Campinas 13083-887, Brazil.Otávio Turolo da Silva, Enrico Ghizoni, Helder Tedeschi, Andrei Fernandes Joaquim, Department of Neurology, Division of Neurosurgical, State University of Campinas, Campinas 13083-887, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28361020

Citation

da Silva, Otávio Turolo, et al. "Role of Dynamic Computed Tomography Scans in Patients With Congenital Craniovertebral Junction Malformations." World Journal of Orthopedics, vol. 8, no. 3, 2017, pp. 271-277.
da Silva OT, Ghizoni E, Tedeschi H, et al. Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations. World J Orthop. 2017;8(3):271-277.
da Silva, O. T., Ghizoni, E., Tedeschi, H., & Joaquim, A. F. (2017). Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations. World Journal of Orthopedics, 8(3), 271-277. https://doi.org/10.5312/wjo.v8.i3.271
da Silva OT, et al. Role of Dynamic Computed Tomography Scans in Patients With Congenital Craniovertebral Junction Malformations. World J Orthop. 2017 Mar 18;8(3):271-277. PubMed PMID: 28361020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of dynamic computed tomography scans in patients with congenital craniovertebral junction malformations. AU - da Silva,Otávio Turolo, AU - Ghizoni,Enrico, AU - Tedeschi,Helder, AU - Joaquim,Andrei Fernandes, Y1 - 2017/03/18/ PY - 2016/10/09/received PY - 2016/11/18/revised PY - 2016/12/16/accepted PY - 2017/4/1/entrez PY - 2017/4/1/pubmed PY - 2017/4/1/medline KW - Basilar invagination KW - Chiari malformation KW - Craniovertebral junction KW - Dynamic imaging KW - Treatment SP - 271 EP - 277 JF - World journal of orthopedics JO - World J Orthop VL - 8 IS - 3 N2 - AIM: To evaluate the role of dynamic computed tomography (CT) scan imaging in diagnosing craniovertebral junction (CVJ) instability in patients with congenital CVJ malformations. METHODS: Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study. Measurements of the following craniometrical parameters were taken in flexed and extended neck position: Atlanto-dental interval (ADI), distance of the odontoid tip to the Chamberlain's line, and the clivus-canal angle (CCA). Assessment of the facet joints congruence was also performed in both positions. Comparison of the values obtained in flexion and extension were compared using a paired Student's t-test. RESULTS: A total of ten patients with a mean age of 37.9 years were included. In flexion imaging, the mean ADI was 1.76 mm, the mean CCA was 125.4° and the mean distance of the odontoid tip to the Chamberlain's line was + 9.62 mm. In extension, the mean ADI was 1.46 mm (P = 0.29), the mean CCA was 142.2° (P < 0.01) and the mean distance of the odontoid tip to the Chamberlain's line was + 7.11 mm (P < 0.05). Four patients (40%) had facetary subluxation demonstrated in dynamic imaging, two of them with mobile subluxation (both underwent CVJ fixation). The other two patients with a fixed subluxation were not initially fixed. One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan. Patients with basilar invagination had a lower CCA variation compared to the whole group. CONCLUSION: Craniometrical parameters, as well as the visualization of the facets location, may change significantly according to the neck position. Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability. Future studies addressing the relationship between craniometrical changes and neck position are necessary. SN - 2218-5836 UR - https://www.unboundmedicine.com/medline/citation/28361020/Role_of_dynamic_computed_tomography_scans_in_patients_with_congenital_craniovertebral_junction_malformations_ L2 - http://www.wjgnet.com/2218-5836/full/v8/i3/271.htm DB - PRIME DP - Unbound Medicine ER -
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