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Craniovertebral Junction

Craniovertebral Junction

The Department of Spine Surgery at Vimhans Nayati Hospital is a centre of excellence backed by state-of-the-art surgical modalities. The department is backed by the expertise of a highly specialised team of doctors and surgeons who work in close coordination to offer the best treatment and care to the patients. Our area of expertise includes both conventional as well as minimally invasive surgery and we specialise in treating a wide range of craniovertebral junction anomalies.

Craniovertebral junction surgery is an umbrella term used for various surgical procedures that aim at addressing congenital and acquired anomalies of the craniovertebral junction. This consists of the occiput, the foramen magnum and the first two cervical vertebrae. Such problems are usually diagnosed by magnetic resonance imaging (MRI) or computed tomography (CT) scan

Common indications of Craniovertebral junction surgery

  • Assimilation or Occipitalization of atlas – One of the most common osseous congenital abnormalities affecting the craniovertebral junction, the condition is marked by the partial or complete fusion of the atlas with the occipital bone, which can significantly reduce the diameter of the foramen magnum. While some patients do not experience any symptom at all, others may experience symptoms and complications arising due to neural compression. The problem is usually detected and assessed using radiological imaging modalities like magnetic resonance imaging or MRI. The treatment varies from one patient to another depending upon the type of variation.
  • Basilar invagination – Also known as a basilar impression, it is a craniovertebral junction abnormality marked by the projection of the odontoid process tip into the foramen magnum. The condition may be congenital or acquired.

Cause of congenital basilar malformation include:

  • Osteogenesis imperfecta
  • Klippel-Feil syndrome
  • Achondroplasia
  • Chiari I malformation/Chiari II malformation
  • Cleidocranial dysostosis

Causes of acquired basilar malformation include:

  • Rheumatoid arthritis
  • Paget disease
  • Hyperparathyroidism
  • Rickets
  • Atlantoaxial subluxation - The condition is marked by the misalignment of the 1st and 2nd cervical vertebrae that causes impairment in the movement of the neck. Atlantoaxial subluxation may be acquired as the result of an injury or trauma sustained in an accident or triggered by an underlying disease like rheumatoid arthritis, ankylosing spondylitis and idiopathic juvenile arthritis. Although the condition is very rare and usually asymptomatic, in some cases, it can trigger symptoms like persistent neck pain, headaches and spinal cord compression.
  • Klippel-Feil malformation – It is a craniovertebral junction anomaly marked by the fusion of the cervical vertebrae. The condition is congenital, i.e. present since birth and is usually characterized by an evidently short neck and limited neck movement. In some cases, the fusion can lead to severe nerve damage and spinal stenosis which can further aggravate and damage the spinal cord. The condition is usually detected and evaluated with the help of skull x-rays, magnetic resonance imaging (MRI) scan and computed tomography (CT) scan.

Major symptoms associated with Klippel-Feil malformation include:

  • Curtailed movement of back and neck
  • Chronic headaches
  • Persistent muscle pain
  • Facial asymmetry
  • Involuntary movements
  • Tingling sensation
  • Osteoarthritis of the affected joint

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