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Cervical Alignment of Patients with Basilar Invagination: A Radiological Study.

Jun-Yu Lin1,2, Ming-Gui Bao1, Shao-Yi Lin1

  • 1Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Orthopaedic Surgery
|February 14, 2022
PubMed
Summary

Patients with basilar invagination (BI) exhibit a stiffer cervical spine compared to healthy individuals, particularly in the upper cervical region. This stiffness is associated with a more pronounced inverse relationship between upper and lower cervical spine curvatures.

Keywords:
Basilar invaginationC0-C2 angleCervical alignmentCervical curvatureDynamic X-ray images

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Area of Science:

  • Orthopedics and Spine Surgery
  • Radiology
  • Biomechanics

Background:

  • Basilar invagination (BI) is a complex craniovertebral junction anomaly.
  • Understanding cervical spine alignment and motion is crucial for managing BI.
  • Limited data exists on the dynamic range of motion (ROM) in BI patients.

Purpose of the Study:

  • To investigate and compare cervical alignment and relative range of motion (ROM) in patients with basilar invagination (BI) versus asymptomatic individuals.
  • To analyze the correlation between upper and lower cervical curvatures in both groups.

Main Methods:

  • Dynamic X-ray imaging (neutral, extension, flexion) of 40 BI patients and 80 controls.
  • Measurement of various cervical angles including Skull-C2/Skull-BV, C0-C2/C0-BV, and C2-C7/BV-C7.
  • Calculation of total, extension, and flexion ROMs for each angle and correlation analysis.

Main Results:

  • BI patients showed altered neutral position angles (smaller C0-C2/C0-BV, larger C2-C7/BV-C7 angles) compared to controls.
  • A significant negative correlation between upper and lower cervical curvatures was observed in BI patients across all positions.
  • BI patients demonstrated reduced total and extension ROMs in upper cervical segments and increased total ROM in the lower cervical segment (C2-C7/BV-C7 wall angle).

Conclusions:

  • The cervical spine in BI patients is significantly stiffer than in asymptomatic individuals, especially in the upper cervical region.
  • The inverse relationship between upper and lower cervical curvatures is more pronounced in BI patients, indicating altered biomechanical coupling.
  • These findings highlight distinct cervical spine biomechanics in BI, potentially impacting clinical management and surgical planning.