Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease
Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2015-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
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| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=2;spage=51;epage=55;aulast=Goel |
| _version_ | 1819092811097571328 |
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| author | Atul Goel |
| author_facet | Atul Goel |
| author_sort | Atul Goel |
| collection | DOAJ |
| description | Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior) atlantoaxial′facetal′ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA) scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months), all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ′frequently′ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy. |
| first_indexed | 2024-12-21T23:01:33Z |
| format | Article |
| id | doaj.art-37fba13547f74deb9d4c7c9f1d768ca9 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-21T23:01:33Z |
| publishDate | 2015-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-37fba13547f74deb9d4c7c9f1d768ca92022-12-21T18:47:18ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372015-01-0162515510.4103/0974-8237.156039Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic diseaseAtul GoelAim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior) atlantoaxial′facetal′ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA) scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months), all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ′frequently′ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=2;spage=51;epage=55;aulast=GoelAtlantoaxial dislocationcervical spondylosisfacetal instabilitysegmental arthrodesis |
| spellingShingle | Atul Goel Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease Journal of Craniovertebral Junction and Spine Atlantoaxial dislocation cervical spondylosis facetal instability segmental arthrodesis |
| title | Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease |
| title_full | Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease |
| title_fullStr | Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease |
| title_full_unstemmed | Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease |
| title_short | Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease |
| title_sort | posterior atlantoaxial facetal instability associated with cervical spondylotic disease |
| topic | Atlantoaxial dislocation cervical spondylosis facetal instability segmental arthrodesis |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=2;spage=51;epage=55;aulast=Goel |
| work_keys_str_mv | AT atulgoel posterioratlantoaxialfacetalinstabilityassociatedwithcervicalspondyloticdisease |