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Atul Goel - One of the best experts on this subject based on the ideXlab platform.
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Rotatory Atlantoaxial Dislocation presenting as spinal kyphoscoliosis
Journal of craniovertebral junction & spine, 2021Co-Authors: Atul Goel, Abhidha Shah, Ravikiran Vutha, Survendrakumar Rajdeo RaiAbstract:A 16-year-old male presented with primary complaint of worsening dorsal spinal kyphoscoliosis (SKS) for 3 years. More recently, he developed spasticity in legs, breathlessness on mild exertion, and sleep apneas. Apart from SKS, investigations revealed rotatory Atlantoaxial Dislocation. Atlantoaxial fixation resulted in rapid recovery from all symptoms including from spinal deformity. Observations in this patient suggest that rotatory Dislocation can be a cause of spinal deformity.
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Torticollis and rotatory Atlantoaxial Dislocation: A clinical review.
Journal of craniovertebral junction & spine, 2019Co-Authors: Atul GoelAbstract:Rotatory Atlantoaxial instability can manifest as an acute episode following subtle or minor injury or even following a gentle tap on head in young children and can manifest as a painless deformity of the head. Goel technique of direct surgical opening of the Atlantoaxial facet joint, manual manipulation of the facets can lead to reduction of rotatory Atlantoaxial Dislocation and recovery from torticollis. Torticollis can be a protective natural phenomenon in response to Atlantoaxial instability and related basilar invagination. Only Atlantoaxial fixation can lead to immediate postoperative reduction of torticollis. Spasmodic torticollis related to muscle hyperactivity is unrelated to Atlantoaxial instability.
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Original Article Craniovertebral realignment for basilar invagination and Atlantoaxial Dislocation secondary to rheumatoid arthritis
2015Co-Authors: Atul Goel, Praveen Sharma, Prof Atul GoelAbstract:Objective: We present our experience of treating nine con-secutive cases of rheumatoid arthritis involving the craniovertebral junction by Atlantoaxial joint manipulation and attempts towards restoration of craniovertebral region align-ments. Material and results: Between November 2001 and March 2004, nine cases of rheumatoid arthritis involving the craniovertebral junction were treated in our department of neurosurgery. Six patients had basilar invagination and ‘fixed’ Atlantoaxial Dislocation and three patients had a retroodontoid process pannus and mobile and incompletely reducible Atlantoaxial Dislocation. The patients ranged from 24 to 74 years in age. Six patients were males and three were females. Neck pain and spastic quadriparesis were the most prominent symptoms. Surgery involved attempts to reduce the Atlantoaxial Dislocation and basilar invagina-tion by manual distraction of the facets of the atlas and axis. Reduction of the Atlantoaxial Dislocation and of basilar in-vagination and stabilization of the region was achieved by placement of bone graft and metal spacers within the joint and direct inter-articular plate and screw method of Atlantoaxial fixation. Following surgery all the patients showed symptomatic improvement and restoration of craniovertebral alignments. Follow-up ranged from four to 48 months (average 28 months). Conclusion: Manipula-tion of the Atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of rheumatoid arthritis involving the craniovertebral junction leads to re-markable and sustained clinical recovery
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Vertical mobile and reducible Atlantoaxial Dislocation. Clinical article.
Journal of neurosurgery. Spine, 2009Co-Authors: Atul Goel, Abhidha Shah, Sanjay RajanAbstract:Object The authors' experience with treatment of 8 patients with “vertical mobile and reducible” Atlantoaxial Dislocation is reviewed. The probable pathogenesis, radiological and clinical features, and management issues in such cases are discussed. Methods Between January 2006 and March 2008, 8 patients who presented with vertical mobile and reducible Atlantoaxial Dislocations were treated at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. The vertical Atlantoaxial Dislocation/basilar invagination reduced completely on extension of the neck, with no need of any cervical traction. According to the extent of superior migration of the odontoid process, and measurements based on the vertical Atlantoaxial instability index, the Dislocation was graded as mild, moderate, or severe. All patients were treated using the C-1 lateral mass and C-2 pars plate and screw method of fixation. Results The study group was composed of 5 male and 3 female patients (mean age 24 years, age range...
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Atlantoaxial joint jamming as a treatment for Atlantoaxial Dislocation: a preliminary report: Technical note
Journal of neurosurgery. Spine, 2007Co-Authors: Atul GoelAbstract:In this report the author describes an alternative technique of Atlantoaxial fixation that involves blocking or "jamming" of movements of the Atlantoaxial joint. The technique involves forcible impaction of spiked titanium metal spacers and bone grafts within the distracted Atlantoaxial facet joints. Between January 2003 and January 2006, four patients underwent this method of fixation at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. All four patients had posttraumatic mobile and reducible Atlantoaxial Dislocation. The mean follow-up period was 16 months (range 5-35 months). Successful Atlantoaxial stabilization along with ultimate bone fusion was achieved in all patients and was documented on dynamic radiographs. There were no neurological, vascular, or infection-associated complications. The author concludes that the described method of Atlantoaxial fixation provides an alternative treatment strategy. "Joint jamming" as a stand-alone method or in combination with other fixation methods may provide firm stabilization in cases of Atlantoaxial Dislocation.
Jingzhu Duan - One of the best experts on this subject based on the ideXlab platform.
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anterior submandibular retropharyngeal odontoid osteotomy and posterior Atlantoaxial fusion for irreducible Atlantoaxial Dislocation associated with odontoid fracture malunion
European Spine Journal, 2018Co-Authors: Jingzhu DuanAbstract:Purpose To report a case of complex odontoid fracture malunion accompanied by Atlantoaxial Dislocation which was treated with a new surgical approach.
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Anterior submandibular retropharyngeal odontoid osteotomy and posterior Atlantoaxial fusion for irreducible Atlantoaxial Dislocation associated with odontoid fracture malunion.
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2017Co-Authors: Jingzhu DuanAbstract:To report a case of complex odontoid fracture malunion accompanied by Atlantoaxial Dislocation which was treated with a new surgical approach. A 53-year-old female was admitted due to progressive symptoms with a stiff limp and unsteady gait. Preoperative examination, diagnostic radiography, computed tomography, and magnetic resonance imaging were performed following admission. The examinations showed odontoid fracture malunion, an old right axial zygapophyseal fracture, Atlantoaxial Dislocation, and spinal cord injury. Anterior submandibular retropharyngeal odontoid osteotomy and posterior Atlantoaxial fusion were then performed. Good reduction of the Atlantoaxial Dislocation was gained. The cervical spinal cord compression was significantly relieved and neurological function was also significantly improved. Anterior submandibular retropharyngeal odontoid osteotomy and posterior Atlantoaxial fusion fixation is an effective method for treating IAAD associated with odontoid fracture malunion, it avoids the adverse effects of anterior transoral odontoid osteotomy and provides a new option for the treatment of odontoid fracture malunion associated with Atlantoaxial Dislocation.
Chao Wang - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of Atlantoaxial Dislocation combined with high riding vertebral artery using c2 translaminar screws
World Neurosurgery, 2019Co-Authors: Yongqiang Wang, Chao Wang, Ming YanAbstract:Objective Atlantoaxial stabilization procedures in high-riding vertebral artery (HRVA) cases are challenging. C2 translaminar screws are rigid and pose no risk to the vertebral artery. The aim of this study was to present clinical outcomes of Atlantoaxial Dislocation combined with HRVA using C2 translaminar screws. Methods Cases of Atlantoaxial Dislocation combined with HRVA surgically treated in our institution from 2007 to 2015 were retrospectively reviewed. Atlantodental interval and clivus-axial angle were measured. The Japanese Orthopaedic Association scale was used to evaluate neurologic status. Results There were 58 patients enrolled: 15 with instability and 43 with Dislocation, 13 of which were irreducible. Incidence of bilateral HRVA was 5.2%. C1-C2 fixation was performed in 26 cases; atlantodental interval decreased from 9.9 ± 3.7 mm to 1.0 ± 1.7 mm (P Conclusions Surgical results of C2 translaminar screws are unsatisfactory, with high reDislocation and reoperation rates in Atlantoaxial Dislocation cases. New treatment methods should be investigated to facilitate clinical outcomes. Extending fixed segments should be considered.
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does Atlantoaxial Dislocation influence the subaxial cervical spine
European Spine Journal, 2013Co-Authors: Shenglin Wang, Peter G Passias, Libin Cui, Ming Yan, Haitao Zhou, Chao WangAbstract:Introduction Previous studies have reported that the alignments of the occipital-cervical and subaxial spine were closely interrelated in asymptomatic individuals; however, none have focused on a population with Atlantoaxial Dislocation.
Ming Yan - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of Atlantoaxial Dislocation combined with high riding vertebral artery using c2 translaminar screws
World Neurosurgery, 2019Co-Authors: Yongqiang Wang, Chao Wang, Ming YanAbstract:Objective Atlantoaxial stabilization procedures in high-riding vertebral artery (HRVA) cases are challenging. C2 translaminar screws are rigid and pose no risk to the vertebral artery. The aim of this study was to present clinical outcomes of Atlantoaxial Dislocation combined with HRVA using C2 translaminar screws. Methods Cases of Atlantoaxial Dislocation combined with HRVA surgically treated in our institution from 2007 to 2015 were retrospectively reviewed. Atlantodental interval and clivus-axial angle were measured. The Japanese Orthopaedic Association scale was used to evaluate neurologic status. Results There were 58 patients enrolled: 15 with instability and 43 with Dislocation, 13 of which were irreducible. Incidence of bilateral HRVA was 5.2%. C1-C2 fixation was performed in 26 cases; atlantodental interval decreased from 9.9 ± 3.7 mm to 1.0 ± 1.7 mm (P Conclusions Surgical results of C2 translaminar screws are unsatisfactory, with high reDislocation and reoperation rates in Atlantoaxial Dislocation cases. New treatment methods should be investigated to facilitate clinical outcomes. Extending fixed segments should be considered.
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does Atlantoaxial Dislocation influence the subaxial cervical spine
European Spine Journal, 2013Co-Authors: Shenglin Wang, Peter G Passias, Libin Cui, Ming Yan, Haitao Zhou, Chao WangAbstract:Introduction Previous studies have reported that the alignments of the occipital-cervical and subaxial spine were closely interrelated in asymptomatic individuals; however, none have focused on a population with Atlantoaxial Dislocation.
Wang Chao - One of the best experts on this subject based on the ideXlab platform.
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Does Atlantoaxial Dislocation influence the subaxial cervical spine?
european spine journal, 2013Co-Authors: Wang Shenglin, Passias, Peter G., Cui Libin, Li Gang, Yan Ming, Zhou Haitao, Wang ChaoAbstract:Previous studies have reported that the alignments of the occipital-cervical and subaxial spine were closely interrelated in asymptomatic individuals; however, none have focused on a population with Atlantoaxial Dislocation. From 2007 to 2011, 298 patients with Atlantoaxial Dislocation and atlas occipitalization were studied. Angles formed between Occiput-C2 and C2-C7 were measured. The relationship between the alignment of the occipital-cervical junction and the subaxial cervical spine was evaluated. The range of values for the angles measured was as followed: the Occiput-C2 angles were -35.2A degrees to 44.8A degrees, and the C2-C7 angles were -17.4A degrees to 77.8A degrees. Statistically significant negative correlations were observed between the Occiput-C2 and C2-C7 angles. Anterior Dislocations of the atlas are associated with diminished lordosis or even kyphosis of the occipital-cervical junction, and result in compensatory hyperlordosis of the subaxial cervical spine, collectively presenting as a "swan neck" deformity. Atlantoaxial Dislocation may influence the global cervical alignment.Clinical NeurologyOrthopedicsSCI(E)PubMed1ARTICLE71603-16072
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A novel surgical treatment of irreducible Atlantoaxial Dislocation
Chinese Journal of Orthopaedics, 2001Co-Authors: Wang Chao, Yan Ming, Zhou Hai-taoAbstract:Objective To explore a novel operative management for irreducible Atlantoaxial Dislocation. Methods Fifty-four patients, which as 32 males and 22 females aged from 7 to 63 years old with a mean of 32 years, were diagnosed with irreducible Atlantoaxial Dislocation, including 18 patients with os odontoideum, 22 occipitalization, 5 malunion of odontoid fracture and 9 relaxation of transverse ligament of atlas. Forty patients presented signs and symptoms of myelopathy or spinal cord injury. All of the patients underwent the operation of open reduction and release by transoral approach. The longus collies muscles, longus capitis muscles, anterior longitudinal ligament, Atlantoaxial articular capsules, the apical odontoid ligament and alar odontoid ligaments may be included, were transected, followed by arthrodesis via posterior approach in one stage. Different methods of posterior arthrodesis were conducted as followed: C1,2 transarticular screw fixation in 5 cases, occipitocervical fixation using pedicle screws of axis and occipitocervical plate in 37 cases, and C1,2 joint fixation with plates and screws in the lateral masses of the atlas and axis in 12 cases. Results A complete reduction was achieved in 41 cases, and the other 13 patients obtained partial reduction. Forty-eight patients were followed up from 4 to 40 months, 15.7 months at the average. All of them achieved solid arthrodesis. According to Odom's scoring system, among the 38 patients with preoperative upper cervical myelopathy, 15 patients were assessed as excellent, 14 good, 8 fair and 1 poor. During the operation, cerebral spinal fluid leakage occurred in 1 case, and pedicle screwing failed in 1 case. After the operation, respiratory failure was found in 1 case, nasal sound in 3 cases, dysphagia in 1 case. One patient became quadriplegia due to myelitis caused by septicemia at two weeks after the operation. The internal fixation loosened in 1 case at 2 months postoperatively. Conclusion Transorally surgical release for reduction and posterior arthrodeses could achieve satisfactory outcomes in patients with irreducible Atlantoaxial Dislocation.