Treatment of Basilar Invagination by Joint Remodeling and Cage Implantation Combined with Intraoperative Cervical Traction
Bibliographic record
Abstract
Abstract Objective:This study aimed to explore the clinical and imaging results of lateral atlantoaxial joint remodeling, cage placement, and intraoperative traction in the treatment of basilar invagination. Methods: The clinical data of 11 patients with basilar invagination treated by lateral atlantoaxial joint remodeling, cage placement, and intraoperative traction were analyzed retrospectively. The lateral atlantoaxial joint surface was remodeled to form an inclined surface between the joints, and a cage was then placed. The combined use of these techniques corrects the clivus canal angle and simultaneously moves the dentate process downward, thus reducing the compression on the ventral surface of the brainstem. The Chamberlain line invasion, atlas-dens interval, and clivus-canal angle were measured using a preoperative and postoperative CT scan. In addition, pB-C2 and cervicomedullary angle (CMA) were measured on sagittal magnetic resonance imaging pre- and postoperatively. The clinical outcomes of all patients were assessed using the Japanese Orthopedic Association (JOA) scale. Wilcoxon test was used to compare the pre- and postoperative measurements. Results:Clinical symptoms of all patients significantly improved. The mean JOA score increased from 11.73 ± 2.45 preoperatively to 15.09 ± 1.22 postoperatively (z = –2.956, P = 0.003). No vertebral artery or dura mater injury was observed. The ventral compression of the brainstem was relieved after the operation. The mean pB-C2 decreased from 10.85 ± 2.96 postoperatively to 7.13 ± 1.38 preoperatively (z = –2.936, P = 0.003), and mean clivus-carnal angle and mean CMA increased from 137.25 ± 8.38 and 131.58 ± 9.17 preoperatively to 147.35 ± 7.55 (z = –2.934, P = 0.003) and 146.05 ± 6.36 (z = –2.934, P = 0.003) postoperatively, respectively. There were two cases of collapse of the C1 inferior articular process and one case of avulsion fracture of the C1 anterior arch. All patients achieved interarticular bone fusion. Conclusion: The cases demonstrated a safe and effective method for treating basilar invagination when atlantoaxial joint reduction is difficult during surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".