ArticleJournal of neurosurgery. Pediatrics2024
The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium.
Article in Journal of neurosurgery. Pediatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed.
- Cervicomedullary CSF space obliteration as a risk factor of reoperation in Chiari malformation type I.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Mini-open exoscopic surgery for C1 restenosis 7 years after decompression of Chiari malformation type 1 with atlas assimilation.Surgical neurology international · 2025Article
- Clinical features of atlas occipital assimilation: A retrospective study.Surgical neurology international · 2025Article
- Morphometric study of the atlantooccipital and the lateral atlantoaxial joints in small breed dogs with and without atlantoaxial instability.Frontiers in veterinary science · 2025Article
- Neonatal Necrotizing Enterocolitis: An Update on Pathophysiology, Treatment, and Prevention.Paediatric drugs · 2024Review
- Atlantal facet geometry in Chiari I malformation.Journal of craniovertebral junction & spineArticle
- An examination of atlanto-occipital curvature in adult Chiari malformation type 1 and control groups.Journal of craniovertebral junction & spineArticle
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Abstract
objectiveCongenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF).
methodsThe authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio.
resultsClinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle-C2 sagittal vertical alignment (C-C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95).
conclusionsThe authors' results indicate that the occipital condyle-atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.
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