Radiological features and internal fixation strategies of atlantoaxial dislocation combined with atlas occipitalization
Background Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery. Objective Based on comprehensive preoperative...
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| Veröffentlicht in: | European spine journal Jg. 34; H. 4; S. 1284 - 1294 |
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01.04.2025
Springer Nature B.V |
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| Abstract | Background
Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery.
Objective
Based on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation.
Methods
Imaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software.
Results
There were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17–71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm.
Conclusion
Comprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions. |
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| AbstractList | BackgroundPatients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery.ObjectiveBased on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation.MethodsImaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software.ResultsThere were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17–71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm.ConclusionComprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions. Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery. Based on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation. Imaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software. There were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17-71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm. Comprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions. Background Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery. Objective Based on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation. Methods Imaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software. Results There were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17–71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm. Conclusion Comprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions. Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery.BACKGROUNDPatients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery.Based on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation.OBJECTIVEBased on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation.Imaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software.METHODSImaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software.There were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17-71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm.RESULTSThere were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17-71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm.Comprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions.CONCLUSIONComprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions. |
| Author | Zhao, Shuli Xu, Hao Zeng, Minghui Liu, Jiang Jia, Li Pang, Qi Zhang, Rui |
| Author_xml | – sequence: 1 givenname: Jiang surname: Liu fullname: Liu, Jiang organization: Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China – sequence: 2 givenname: Li surname: Jia fullname: Jia, Li organization: Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China – sequence: 3 givenname: Minghui surname: Zeng fullname: Zeng, Minghui organization: Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China – sequence: 4 givenname: Hao surname: Xu fullname: Xu, Hao organization: Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China – sequence: 5 givenname: Shuli surname: Zhao fullname: Zhao, Shuli organization: Department of Radiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China – sequence: 6 givenname: Rui surname: Zhang fullname: Zhang, Rui organization: Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University – sequence: 7 givenname: Qi surname: Pang fullname: Pang, Qi email: sjjzwklj@163.com organization: Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University |
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| Keywords | Atlanto-axial joint CT angiography High-riding vertebral artery Pedicle screw Atlas occipitalization Dislocation |
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Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and... Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone,... BackgroundPatients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and... |
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| SubjectTerms | Adolescent Adult Aged Angiography Arteries Atlanto-Axial Joint - diagnostic imaging Atlanto-Axial Joint - injuries Atlanto-Axial Joint - surgery Bone surgery Cervical Atlas - abnormalities Cervical Atlas - diagnostic imaging Cervical Atlas - surgery Computed tomography Dislocation Female Humans Joint Dislocations - diagnostic imaging Joint Dislocations - surgery Klippel-Feil syndrome Klippel-Feil Syndrome - diagnostic imaging Klippel-Feil Syndrome - surgery Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Neurosurgery Original Article Patients Spinal Fusion - methods Spine (cervical) Subarachnoid space Surgery Surgical Orthopedics Veins & arteries Vertebrae Vertebral Artery - diagnostic imaging Young Adult |
| Title | Radiological features and internal fixation strategies of atlantoaxial dislocation combined with atlas occipitalization |
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