Highlights
- •The characteristics of patients with C1 stenosis (CIS) were compared with subaxial stenosis (SAS).
- •Patients with CIS were significantly older and their height and weight were significantly lower than SAS patients.
- •The atlas size of CIS group was significantly smaller than patients with SAS.
- •The atlas size of CIS group was also statistically smaller than asymptomatic controls.
- •Small atlas size can be associated with symptomatic spinal canal stenosis at the C1 level.
Abstract
Narrow cervical spinal canal is an important risk factor for the development of cervical
myelopathy. Patients with this disease often present with congenital narrowness of
the cervical spinal canal. While there are studies on patients with subaxial spinal
canal stenosis (SAS), few examined the coexistence of congenital narrow spinal canal
in patients with cervical myelopathy at the C1 level. We investigated the characteristics
of patients with C1 stenosis (C1S) with special reference to the size of the atlas.
Thirteen patients (8 men, 5 women, mean age 76 years) with C1S were retrospectively
analyzed and their clinical characteristics and radiological findings were compared
with 27 SAS patients and with 26 age-, sex-, and body habitus-matched asymptomatic
individuals. Of the 13 C1S patients, 6 presented with a retro-odontoid pseudotumor, 5 with atlantoaxial subluxation, and 2 with ossification or
calcification of the transverse ligament; they were significantly older and shorter,
and their body weight was significantly lower than in SAS patients (p < 0.001). Their
average C1 anteroposterior- and spinal canal diameter was 26.9 ± 2.4 mm and 12.8 ± 4.1 mm,
respectively and significantly smaller than in patients with subaxial stenosis (p = 0.004).
These measurements were also statistically smaller than in the controls, even after
matching for age, gender, height, and body weight (p < 0.05). In patients with C1S,
the atlas size was significantly smaller than in SAS patients and asymptomatic controls,
indicating an association between a small atlas size and symptomatic spinal canal
stenosis at the C1 level.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cervical myelopathy: current diagnostic and treatment strategies.Spine J. 2003; 3: 68-81
- Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels.Internat Orhopaedics (SICOT). 2011; 35: 1517-1522
- Does developmental canal stenosis influence surgical results of bilateral open-door laminoplasty for cervical spondylotic myelopathy?.J Neurosurg Spine. 2008; 9: 358-362
- Roentgenological study of anterior-posterior diameter in developmental canal stenosis of cervical spine.Nihon Seikeigeka Gakkai Zasshi. 1987; 61: 455-465
- Roentgenological study of the sagittal diameter of the cervical spinal canal in normal adult Japanese.Neruorl Med Chir (Tokyo). 1998; 38: 83-89
- Narrow cervical canal in 1211 asymptomatic healthy subjects: the relationship with spinal cord compression on MRI.Eur Spine J. 2016; 25: 2149-2154
- Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: radiographic data from over 1200 asymtomatic subjects.Eur Spine J. 2012; 21: 1492-1498
- Prevalence of cervical spine stenosis. Anatomic study in cadavers.J Bone Joint Surgery. 2007; 89: 376-380
- Radiographic analysis of the cervical spine in patients with retro-odontoid pseudotumors.Spine. 2009; 34: E110-E114
- C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases.Eur Spine J. 2013; 22: 1119-1126
- Retro-odontoid pseudotumor without atlantoaxial subluxation.J Clin Neurosci. 2009; 17: 649-652
- Defining of hypoplasia of the atlas.Spine. 2014; 39: E1243-E1247
- Cervical myelopathy accompanied with hypoplasia of the posterior arch of the atlas.J Spinal Disord Tech. 2009; 22: 228-232
- Clinical biomechanics of the spine.JB Lippincott, Philadelphia1978
- What is the most representative parameter for describing the size of the atlas? CT morphometric analysis of the atlas with special reference to atlas hypoplasia.Neurol Med Chir (Tokyo). 2017; 57: 461-466
- Atlas hypoplasia and ossification of the transverse atlantal ligament: a rare cause of cervical myelopathy.Case Rep Neurol Med. 2012; 2012: 893284
- Atlas hypoplasia as a cause of high cervical myelopathy.J Neurosurg. 1993; 79: 917-919
- Hypoplasia of the atlas associated with ankylosing spinal hyperostosis: a case report.Spine Spinal Cord. 1995; 8: 825-828
- Cervical cord compression due to a hypoplastic atlas.J Neurosurg (Spine 1). 2001; 94: 133-136
- Ossification of the posterior atlantoaxial membrane associated with atlas hypoplasia A case report.Medicine. 2016; 95 (e5563): 48
- A case of cervical myelopathy with developmental canal stenosis at the level of the atlas.Kobe J Med Sci. 1998; 44: 135-140
- Cervical myelopathy caused by hypoplasia of the atlas: two case reports and review of the literature.Neurosurgery. 1998; 43: 629-633
- Atlas hypoplasia associated with non-traumatic retro-odontoid mass.Neurol Med Chir (Tokyo). 2006; 46: 202-205
- Cervical myelopathy caused by anomalies at the level of atlas.Spine. 2010; 35: E77-E79
- Spinal canal stenosis at the level of the atlas: case report.Surg Neurol. 1994; 41: 238-240
- Cervical myelopathy caused by hypoplasia of the atlas and ossification of the transverse ligament.Neurol Med Chir (Tokyo). 2003; 43: 55-59
- Myelopathy due to hypoplasia of the atlas.Clin Orthopaed Rel Res. 1997; 338: 90-93
Article info
Publication history
Published online: August 27, 2018
Accepted:
August 13,
2018
Received:
April 18,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
