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The cranial and spinal meninges are complex protective structures surrounding the central nervous system (CNS), consisting of the brain and spinal cord. These meninges consist of the dura mater, the arachnoid mater, and the pia mater. They protect the CNS, provide structural support, and aid in circulating cerebrospinal fluid (CSF).
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The human skull is composed of several bones that come together to protect the brain and support the structures of the face. The junctions where these bones meet are called sutures.
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The lateral view of the cranium is dominated by temporal, sphenoid, and ethmoid bones.
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Craniovertebral junction degenerative arthritis- evolving understanding.

Atul Goel1, Nasser M F El-Ghandour2, Abhidha Shah3

  • 1Department of Neurosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai, India; Department of Neurosurgery, K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, India; Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|September 19, 2025
PubMed
Summary
This summary is machine-generated.

Atlantoaxial stabilization effectively treats degenerative changes at the craniovertebral junction, improving patient myelopathy symptoms. This surgical intervention leads to gratifying clinical outcomes without the need for further procedures.

Keywords:
Atlantoaxial instabilityBasilar invaginationRetroodontoid pannus

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Area of Science:

  • Neurosurgery
  • Orthopedics
  • Degenerative Spine Disease

Background:

  • Degenerative alterations at the craniovertebral junction can cause atlantoaxial instability and myelopathy.
  • Chronic nape muscle weakness is implicated as a primary cause of secondary degenerative changes.
  • Accurate diagnosis requires clinical suspicion alongside imaging parameters like the atlantodental interval.

Purpose of the Study:

  • To analyze the outcomes of atlantoaxial stabilization in patients with symptomatic atlantoaxial instability.
  • To evaluate the effectiveness of surgical stabilization for degenerative craniovertebral junction alterations.
  • To assess clinical improvement using validated scoring systems and patient self-assessment.

Main Methods:

  • Ninety-five patients with myelopathy and craniovertebral junction degenerative alterations underwent atlantoaxial stabilization.
  • Diagnosis was based on clinical symptoms, imaging, and assessment of the occipital condyle-atlas facet-axis facet complex height.
  • Clinical outcomes were evaluated using VAS, Goel's clinical grade, JOA score, and patient questionnaires post-surgery.

Main Results:

  • All patients showed improvement in clinical symptoms after an average follow-up of 26 months.
  • Imaging revealed various degrees of atlantoaxial instability, including reducible and fixed forms, with associated osteophyte formation.
  • The height of the occipital condyle-atlas facet-axis facet complex was significantly reduced compared to controls.

Conclusions:

  • Atlantoaxial stabilization is a successful treatment for instability-related degenerative alterations at the craniovertebral junction.
  • The procedure leads to significant clinical improvement and gratifying outcomes for patients.
  • No additional surgeries were required for the craniovertebral junction or cervical spine post-stabilization.