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Purpose: Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. Methods: Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. Results: A total of 247 cases were examined (congenital scoliosis—229, congenital kyphosis—18). The average age was seven years (range 0.8 to 19 years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis—53.7%, congenital kyphosis—38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. Conclusion: This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction. [ABSTRACT FROM AUTHOR]

Purpose There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations. Materials and Methods All patients undergoing spine surgeries including craniovertebral junction (CVJ) surgeries from January 2021 to June 2022 were included in the study. Success rate of telemedicine was calculated using a simple formula: Success rate of telemedicine = successful telemedicine consultations / total number of telemedicine consultation × 100. Success rate was evaluated with respect to demographic features and underlying disease-related factors. Results Eighty-four patients formed the study group in which a total of 181 video teleconsultations were done. Overall success rate of telemedicine was 82.87%. Higher socioeconomic and educational statuses were related to higher success rates of tele-consultations (p < 0.05). Difficulty in assessing neurological condition using video call in follow-up cases of CVJ and issues related to Internet communication network leading to inability to video call and share image/videos were major causes of failures. Conclusion Telemedicine may prove an effective option for following up patients undergoing spine surgeries except CVJ, which is likely to improve further with improvements in Internet connectivity. [ABSTRACT FROM AUTHOR]

Recent years have witnessed a rapidly growing interest in CVJ bony abnormalities, and a qualitative and quantitative analysis of relevant literatures is necessary. This study aims to identify and summarize the published articles related to craniovertebral junction bony abnormalities, to analyze and visualize the current research trends and major contributors. We collected data from Web of Science, excluding certain article types. Two researchers screened articles for relevance. Data were organized with EndnoteX9, and analyzed using VOSviewer and CiteSpace for co-authorship, co-occurrence, keyword burst, and co-citation analyses to identify research trends and collaborations. A total of 2,776 articles were included, revealing an increasing trend in annual publications of CVJ bony abnormalities. The USA was the leading country. King Edward Memorial Hospital was the most prolific institution, and Seth GS Medical College had the most citations. The Spine is the most popular journal with the highest number of publications and citations. Professor Goel Atul from India emerged as the most influential pioneer in this field. Keyword analysis highlighted surgical techniques, diagnosis, and anatomy as the primary research hotspots and Fixation, Placement, and Basilar invagination gradually become the new research trend. However, there is a relative weakness in basic research and epidemiology. This study provides valuable insights into the current research trends and critical contributors in CVJ bony abnormalities, guiding evidence-based decisions and fostering international collaborations to advance knowledge in this field. [ABSTRACT FROM AUTHOR]

Background: It was found that goldsmiths were highly affected by improper body posture and workload. Twisting, bending over, and over-reaching are the results of poorly designed workstations; this will cause postural abnormality, and later on, this can lead to musculoskeletal-related disorders, in which forward head posture (FHP) is the most common postural abnormality. Therefore, to aware the workers about their musculoskeletal disorder as well as the analysis of the worker suffering from forward head posture (FHP). Materials and Methods: The study took place at the workplace of goldsmith workers in Nagpur, Maharashtra, for 1.5 years. With the confidence interval of 95%, an absolute precision of 15and based on a pilot study and literature reviews, the sample size was estimated to be 35.AGoniometer, camera(for photographic Images), laptop and twosided tape were used to determine the cranio-vertebral angle. Thirty-five goldsmiths participated in the study. The photographic method was used to evaluate cranio-vertebral angle, which helps to determine forward head posture. Result: In this study 35 goldsmith workers were evaluated with a mean age of 37±10 years, a mean working hour of 11±10 hours and a work experience of 18±9.8 years. Out of 35 goldsmiths 25 showed the prevalence of forward head posture, or 71.42% of them had forward head posture. Conclusion: Based on the results the present study which was conducted on goldsmith workers concluded that prevalence of forward head posture was 71.42% among the population. [ABSTRACT FROM AUTHOR]

Background: The posterior cranial fossa (PCF) and the foramen magnum (FM) are the critical anatomical components of the craniovertebral junction region, which comprise and transmit numerous vital neurovascular structures. So, a fundamental knowledge of the basic radiological anatomy of PCF and FM is of paramount importance in the evaluation of associated pathologies and approaching these areas surgically. The aim of this study is to describe different linear and angular craniometric parameters of PCF, FM and surrounding territory based on reconstructed computed tomography (CT) images. Material and methods: This study was conducted in our tertiary care hospital in northern India from the period of January 2023 to June 2023 on 120 patients, and CT screening was done for the head and spine region following a history of head injury. Results: In this study, 120 patients were included, of whom 50.83% (n = 61) were females and 49.17% (n = 59) were males. Age ranged from 18 to 70 years with mean age of 43.5 ± 14.08 years. The mean values for linear craniometric parameters of PCF were statistically nonsignificant for different age groups. Statistically significant differences were found for twinning line (TL) (p < 0.0001), McRae's line (< 0.0001), clivus length (< p < 0.0001), internal occipital protuberence -opisthion line (p = 0.01), Klaus' index (p < 0.0001), height of posterior fossa (h) (p < 0.0001), h/TL (p = 0.028), when these values were compared for the genders. The measurements of FM transverse diameter, anteroposterior diameter and area were 27.12 ± 1.42 mm (range 23.6–30.1 mm), 30.99 ± 2.23 mm (range 27.6–35.8 mm) and 691.32 ± 30.35 mm2 (range 632.7–777.7 mm2). The values of clivus canal angle (p = 0.038) and clivoodontoid angle (p = 0.012) were statistically significant when compared for different age groups. The values of Boogard's angle (p = 0.021) and tentorial slope (p = 0.031) were statistically significant when these were compared for the genders. Conclusions: This study described almost all the linear and angular craniometric parameters used in the morphometric analysis of PCF and FM. The findings of this study provide valuable data regarding linear and angular craniometric parameters of PCF and FM which can redefine reference values. [ABSTRACT FROM AUTHOR]

Introduction: The occipital condyles are located lateral to anterior half of foramen magnum. Being the important component of craniovertebral region, occipital condyles are exposed to variety of clinical conditions. These clinical conditions may need surgical interventions for their treatment. In transcondylar approach to craniovertebral junction lesions partial occipital condylectmies are done commonly. It has been reported after such condylectomies that there have occurred post-operative atlanto occipital joint instability and hypoglossal nerve palsies. These post-operative complications have been attributed to population specific variations in the occipital condyles. Hence it is important to have meticulous knowledge of the occipital condyles. Aims: The aim of this study was to measure the morphometric parameters of the occipital condyles like length, width, height, anterior intercondylar distance (AID) and posterior intercondylar distance (PID) of the Indian population and to compare them with the other populations. Materials and Methods: The study was conducted in Government Medical College Srinagar, J&K, India, on 198 occipital condyles (76 occipital bones and 23 articulated skulls). Measurements were done with the help of Vernier's calliper. Mean and standard deviation of the morphometric parameters were analysed and comparison was done. Results: The length of occipital condyles on the right side was 22.86 + 3.05mm and on the left side it was 22.76 + 2.80 mm with the mean of 22.81 + 2.92mm. The width on the right side was 12.23 + 1.51mm while on the left side it was found to be 11.43mm + 1.36mm with the mean of 11.83 + 1.43mm. the height of the occipital condyles on the right side was found to be 9.37 + 1.29mm and on the left side it was 9.16 + 1.15mm with the mean of 9.27 + 1.22 mm. the mean anterior intercondylar distance (AID) was found to be 19.57 + 2.81mm while the mean value of posterior intercondylar distance (PID) was found to be 39.62 + 4.23mm. Conclusion: the mean values of all the parameters in the study showed side variations values were found more on the right side than that of left side. there was also difference in these values between the Indian and the other populations for successful surgeries on the occipital condyles, the surgeon must take care of these variations. The study thereby forms the morphometric reference to the surgeons to carry out successful surgeries. [ABSTRACT FROM AUTHOR]

Background/Aims Forward head posture is the most frequent postural deviation in typically healthy individuals and is associated with rounding of the shoulders. Prevention should be considered when it is at the asymptomatic stage by screening and early exercise intervention. The aim of the study was to examine the effects of Bruegger's exercises compared to deep cervical flexor training in asymptomatic participants with forward head posture. Methods This randomised controlled trial included 51 participants with asymptomatic forward head posture, who were allocated to one of three groups. One group undertook Bruegger's exercises with an elastic resistance band, another group performed deep cervical flexor training with a pressure biofeedback unit and the control group performed isometric neck exercises. Outcomes measured were the craniovertebral angle, the craniocervical flexion endurance test and the Pectoralis Minor Index, which were assessed at baseline on day 1 and at the end of the 3-week intervention. Follow-up assessment was undertaken for craniovertebral angle at 6 and 9 weeks from day 1 of the intervention. Statistical analysis included paired t-tests, the Wilcoxon signed-rank test, analysis of variance and the Kruskal–Wallis test. Results All three groups showed improvements in craniovertebral angle and the craniocervical flexion endurance test when compared between pre- and post-intervention. Only those in the Bruegger's exercises group showed an increase in the length of the pectoralis minor according to the Pectoralis Minor Index. Deep cervical flexor muscle endurance increased significantly (P<0.0002) for those in the Bruegger's exercises group and deep cervical flexor training group. At the end of the intervention (week 3) (P<0.0205) and follow up at week 9 (P<0.0029), individuals in the Bruegger's exercises group had maintained the craniovertebral angle correction for longer than those in the deep cervical flexor training and control group. Conclusions Bruegger's exercises with an elastic resistance band was found to be an effective intervention exercise to correct posture from head to scapula and can be included in the treatment of patients with postural head and neck issues. [ABSTRACT FROM AUTHOR]

Endoscopic spine surgeries provide distinct advantages and is therefore a viable alternative to open or microscopic techniques. Indian surgeons have shown their expertise from craniovertebral junction to lumbosacral spine with these techniques. Many novel approaches like endoscopic transcervical, partial corpectomy, and others have been designed, and many technological innovations for these surgeries have been made. With different training programs attracting both native and international surgeons, the future of endoscopic spine surgery is bright. [ABSTRACT FROM AUTHOR]

Objectives  Craniovertebral junction (CVJ) is a unique, mobile and complicated component of our spine which necessitates specific study pertaining to its structure as well as pathologies. This study aims to report the normative data detailing the CVJ anatomy among the rural population of Central India which would help us in understanding the joint dynamics. Materials and Methods  A retrospective observational study was undertaken in the Department of Neurosurgery and Radiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, from December 2018 to May 2019. A total of 255 head injury patients with a normal CT brain cervical spine were included in this study. Anterior and posterior atlantodental interval (AADI/PADI), clivus length (CL), foramen magnum diameter (FMD), Boogard's and basal angle (BOO & BA) were measured and analyzed. Statistical Analysis  Statistical analysis was done using Microsoft Excel 2016. A web-based, open source application known as OpenEpi.com (version 3.01) was used for applying unpaired t -test. Results  This study had a mean age of 42.9 years. The difference in mean value of AADI between male and female population was not found to be statistically significant, while in case of PADI, CL, FMD, BOO and BA, it was found to be significant (p < 0.05). On comparison of cases with age ≤ 20 years and > 20 years, we found the difference in values of ADI, CL and FMD to be statistically significant (p < 0.05). Conclusion  Although there are some similarities, namely, AADI measurements as compared with other studies, there are differences in cutoff values of other parameters. Being a major draining reference center for rural population in India, this data can be extrapolated to a similar population for reference. [ABSTRACT FROM AUTHOR]

Background: The available literature on the anatomy and imaging of the craniovertebral junction (CVJ) focusses on the osteometric indices described for the detection of abnormal relationships between the components of CVJ. However, a knowledge of the normal osteometry of this region in the Indian population is critically important for the operating surgeon as it may influence the surgical technique as well as the choice, size and configurations of the implants. It is also important to determine whether critical differences exist between the osteometric data of Indians and the rest of the world for this part of the anatomy. Accordingly, the present study is an attempt to quantitate the osteometric indices for the anatomically normal CVJ in Indian subjects.Materials and Methods: We retrospectively studied the imaging data of 49 consecutive adult patients (31 males, 18 females) who underwent a computed tomographic (CT) angiogram for suspected vascular conditions unrelated to the craniovertebral junction. Several parameters related to the atlanto-dental relationship, foramen magnum, atlas and axis vertebrae were recorded, including the dimensions of the commonly instrumented bony regions and also the indices related to the CVJ bony relationships. The data was also compared between the two genders, statistically through the Student's t-test using the statistical program "R".Results: No patient had an atlanto dens interval >2.5 mm. The mean distance of the odontoid tip from the McRae line in this series was 5.11 mm and no patient had the odontoid tip above the McRae line. Female subjects had significantly smaller diameters of C1 lateral masses and odontoid screw trajectory length when compared to males. Additionally, in the Indian population, the length range of odontoid screw trajectory and the thickness of the narrowest part of the C2 pedicles was smaller with respect to similar data from other geographical regions. However, the rest of the parameters resembled the data from studies conducted on populations with other ethnicities.Conclusion: The osteometric parameters of the CVJ in the Indian population are largely similar to those described globally. However, there are some important differences too which can influence the design of surgical implants suited to the Indian population. [ABSTRACT FROM AUTHOR]