अमूर्त

Cause-effect association of high cervical disc disease with degeneration at craniovertebral junction.

Puram Saikiran, Mudumba Vijayasaradhi, Rajesh Alugolu, Abhishek Arora

Objective: To analyze the association of High Cervical Disc Degeneration (HCDD) to the presence of Cranio-Vertebral Junction (CVJ) ligamentous calcification.

Methods: The study included 100 consecutive symptomatic cervical PIVD patients who presented to neurosurgery OPD of NIMS, Hyderabad between October 2016 and October 2018. Of these, 70 had C3-4 PIVD (cases) and 30 had C5-6 PIVD (controls). VAS, FIM, mJOA, Nurick’s grades were used for clinical assessment. CT scan focusing at CVJ (occipital condyles to inferior body of C2), 1 mm sections with zero spacing with axial, coronal and sagittal reconstructions was performed. The incidence and patterns of ligamentous calcifications of apical, alar, transverse atlantal ligaments and anterior atlanto-occipital membrane were observed.

Results: The mean age of patients with C3-4 PIVD (cases) was 55.5 years (range: 30 to 80 years) while that of C5-C6 PIVD (controls) was 43.5 years (range: 25 to 65 years) (p<0.001). Amongst the 70 cases, 68 patients (97.1%) had CVJ ligamentous calcifications while only 1 (3.3%) of the 30 control patients had CVJ ligamentous calcification. The apical ligament was the most frequent to be calcified accounting for 31 (44.3%) cases. Alar ligament, anterior atlanto-occipital membrane calcification were noted in 3(4.3%) patients and 9(12.9%) patients in high cervical disc disease. A combination of alar and apical ligament calcification was noted in 2 (2.9%) patients, combination of apical and TAL ligament calcification was noted in 1 (1.4%) patient. In controls, 1 (3.3%) patient had calcification of the anterior atlanto-occipital ligament. Calcification of CV Junction ligament was more in cases than in controls (p<0.001). C3-4 PIVD patients presented with a poorer pre-op (58.6% in cases vs. 8% in controls) and post-op nurick’s grade. 43 (61.4%) patients of high cervical disc disease had T2 hyperintense signal changes on pre-operative MRI compared to 7 (23.3%) patients in low cervical disc disease group (p<0.001).

Conclusion: CVJ ligamentous calcifications have strong association with HCDD.