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Radiological Evaluation of Craniocervical Region in Patients with Basilar Invagination

Ji, Wei, MD, PhD; Xu, Xiaolin, MD; Wu, Zenghui, MD, PhD; Liu, Xiang, MD; Kong, Ganggang, MD; Huang, Zucheng, MD, PhD; Chen, Jianting, MD

doi: 10.1097/BRS.0000000000002706

Study Design. A retrospective analysis of collected data.

Objective. Our study aims to present the morphology of cranial-cervical spinal canal in basilar invagination (BI) patients.

Summary of Background Data. BI is characterized by protrusion of the odontoid process into the foramen magnum (C0), leading to compression of the cervicomedullary junction. However, no study has ever clarified the anatomical diameters of spinal canal in patients with BI.

Methods. The study retrospectively examined computed tomography (CT)-based anatomical characteristics in a cohort of 84 patients with and without BI. We measured the anteroposterior diameter (APD) and transversal diameter (TVD) of spinal canal from C0 to C4, together with the area of vertebral canal (Area). Independent samples t test was used for statistical analysis.

Results. The APD in the BI group was shorter than the control group from C0 to C2 (C0: 27.98 vs. 35.11 mm, P < 0.001; C1: 11.87 vs. 16.91 mm, P < 0.001; C2: 12.91 vs. 14.84 mm, P < 0.001), but it became longer from C3 to C4. The TVD of the BI group was significantly wider from C0 to C3 (C0: 30.59 vs. 28.54 mm, P < 0.001; C1: 31.31 vs. 25.98 mm, P < 0.001; C2: 21.56 vs. 20.40 mm, P = 0.01; C3: 22.45 vs. 21.23 mm, P = 0.013), and it had no significance at C4. The Area showed no difference between the two groups from C1 to C2, but it turned larger at C3 and C4 in BI patients.

Conclusion. BI patients may have shorter APD from C0 to C2, which could be the leading cause of neurological compression, necessitating decompression on sagittal plane. Below the pathological levels, BI patients have larger spinal canal than general population.

Level of Evidence: 3

Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China

Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Guangzhou, China.

Address correspondence and reprint requests to Zenghui Wu, MD, PhD, Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, 111 Liuhua Road, Guangzhou 510010, China; Wei Ji, MD, PhD, Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510010, China; E-mail:

Received 23 January, 2018

Revised 15 April, 2018

Accepted 17 April, 2018

Wei Ji and Xiaolin Xu share the first authorship.

The National Natural Science Foundation of China (No.81702192), the Incubation Program for Distinguished Young Scholars of Nanfang Hospital, Southern Medical University, China (No. 2017J008), and the President Foundation of Nanfang Hospital, Southern Medical University, China (No.2016C021) funds were received in support of this work.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No relevant financial activities outside the submitted work.

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