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Cervical Fusion as a Protective Response to Craniovertebral Junction Instability: A Novel Concept
Atul Goel 대한척추신경외과학회 2018 Neurospine Vol.15 No.4
The author reviews the various types of cervical fusion that are associated with instability of the craniovertebral junction. Assimilation of the atlas, C2–3 fusion, the Klippel-Feil abnormality, and pancervical fusion are amongst the more common types of bone abnormalities. It is conceptualised that these types of cervical fusion are not related to any kind of embryological dysgenesis or fault, but instead emerge due to longstanding muscle spasms of the neck in response to atlantoaxial instability. Such bone fusions could be secondary protective responses to longstanding atlantoaxial instability.
Craniovertebral Junction Instability: A Review of Facts about Facets
Atul Goel 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4
Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability.
Atul Goel 대한척추신경외과학회 2019 Neurospine Vol.16 No.2
The author discusses the novel form of central or axial atlantoaxial instability and analyses its clinical significance. High degree of clinical and radiological understanding of the region is mandatory to diagnose and then treat such atlantoaxial instability. Evaluation of alignment of facets of atlas and axis and observations on direct manipulation of facets of atlas and axis forms the basis of diagnosis. The treatment of clinical entities like basilar invagination, Chiari formation, syringomyelia and myelopathy related to cervical spinal degeneration, spinal deformities, ossified posterior longitudinal ligament, and Hirayama disease can be influenced by the understanding of central or axial atlantoaxial instability.
Atul Goel 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3
Study Design: Four patients had C2–3 vertebral fusion and radiologically demonstrated cord compression at C3–4 level related to disc bulge with or without association of osteophytes and C1–2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. Purpose: The article evaluates the significance of atlantoaxial facetal instability in cases having C2–3 vertebral fusion and cord compression at the level of C3–4 disc. Overview of Literature: C2–3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2–3 vertebral fusion. Methods: Between June 2013 and November 2014 four patients having C2–3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3–4 disc space. Further investigations revealed C1–2 posterior facetal dislocation. Results: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. Conclusions: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2–3 fusion and high cervical (C3–4) disc related cord compression.
Giant Ventral Midline Schwannoma of Cervical Spine : Agonies and Nuances
Mahore, Amit,Chagla, Aadil,Goel, Atul The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.47 No.6
Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed.