{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:27Z","timestamp":1787840547475,"version":"build-2784847793"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The maintenance of spinal anatomy and posture is a dynamic process governed by vertebral bodies, intervertebral discs, facet joints, ligaments, and paraspinal musculature. This flexibility allows the spine to compensate for deformities and maintain sagittal balance. Surgical correction of atlantoaxial dislocation involves rigid fixation of the atlas and axis (C1\u2013C2) and disruption of posterior extensor muscles, which may induce compensatory changes in the subaxial cervical spine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim and Objectives:<\/jats:title>\n                    <jats:p>This study aims to analyze changes in the sagittal alignment of the subaxial cervical spine in patients with craniovertebral junction (CVJ) anomalies following posterior atlantoaxial fusion, and to examine the progression of these changes in relation to neurological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Thirty patients with CVJ anomalies who underwent posterior C1\u2013C2 fixation were analyzed. Clinical parameters, including age, gender, etiology, tone, power, and modified Japanese Orthopaedic Association Score, were assessed. Radiological evaluation focused on the C2\u2013C7 Cobb angle measured on lateral cervical spine radiographs preoperatively, immediately postoperatively, and 6 months follow up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Atlantoaxial fixation resulted in a significant reduction in subaxial cervical lordosis. The mean preoperative C2\u2013C7 angle was 16.96\u00b0\u00b0 \u00b1 4.07\u00b0, which decreased to 12.22\u00b0\u00b0 \u00b1 4.8\u00b0\u00b0 immediate postoperatively. At 6 months, the angle further reduced to 11.03\u00b0 \u00b1 4.3\u00b0\u00b0. Despite radiological changes, no clinical deterioration was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Posterior atlantoaxial fixation offers robust clinical and radiological outcomes in CVJ anomalies. While a reduction in subaxial lordosis is observed postoperatively, it does not correlate with adverse neurological outcomes in the short term.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_8_26","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T13:00:23Z","timestamp":1773838823000},"page":"174-180","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Subaxial sagittal shifts postatlantoaxial fusion \u2013 Radiological assessment and clinical analysis"],"prefix":"10.4103","volume":"17","author":[{"given":"Deepak Kumar","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveenkumar Nagendra","family":"Sangolli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet Kumar","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishan Kumar","family":"Vashisth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"R1-20260319","doi-asserted-by":"crossref","first-page":"697","DOI":"10.3171\/2011.1.SPINE10612","article-title":"Ligaments of the craniocervical junction","volume":"14","author":"Tubbs","year":"2011","journal-title":"J Neurosurg Spine"},{"issue":"Suppl 1","key":"R2-20260319","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1227\/01.neu.0000462075.73701.d2","article-title":"The craniovertebral junction area and the role of the ligaments and membranes","volume":"76","author":"Debernardi","year":"2015","journal-title":"Neurosurgery"},{"key":"R3-20260319","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s002340100648","article-title":"MRI assessment of normal ligamentous structures in the craniovertebral junction","volume":"43","author":"Krakenes","year":"2001","journal-title":"Neuroradiology"},{"key":"R4-20260319","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1002\/ca.20559","article-title":"3D morphometry of the transverse and alar ligaments in the occipito-atlanto-axial complex: An in vitro analysis","volume":"20","author":"Cattrysse","year":"2007","journal-title":"Clin Anat"},{"key":"R5-20260319","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/00000658-191002000-00004","article-title":"IV. Traumatic lesions of the atlas and axis","volume":"51","author":"Mixter","year":"1910","journal-title":"Ann Surg"},{"key":"R6-20260319","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4103\/0028-3886.53260","article-title":"Basilar invagination, Chiari malformation, syringomyelia: A review","volume":"57","author":"Goel","year":"2009","journal-title":"Neurol India"},{"key":"R7-20260319","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1055\/s-0042-1758843","article-title":"Surgical, clinical, and radiological outcomes analysis of craniovertebral junction anomalies cases: An institutional experience","volume":"17","author":"Prajapati","year":"2022","journal-title":"Asian J Neurosurg"},{"key":"R8-20260319","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s00381-008-0605-9","article-title":"Craniovertebral junction database analysis: Incidence, classification, presentation, and treatment algorithms","volume":"24","author":"Menezes","year":"2008","journal-title":"Childs Nerv Syst"},{"key":"R9-20260319","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2176\/nmc.45.512","article-title":"Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: Preliminary report of 12 cases","volume":"45","author":"Goel","year":"2005","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"R10-20260319","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s00381-008-0602-z","article-title":"Specific entities affecting the craniocervical region: Osteogenesis imperfecta and related osteochondrodysplasias: Medical and surgical management of basilar impression","volume":"24","author":"Menezes","year":"2008","journal-title":"Childs Nerv Syst"},{"key":"R11-20260319","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.4103\/1817-1745.85721","article-title":"Pediatric bony craniovertebral junction abnormalities: Institutional experience of 10 years","volume":"6","author":"Kale","year":"2011","journal-title":"J Pediatr Neurosci"},{"key":"R12-20260319","first-page":"489","article-title":"Atlantoaxial dislocation associated with the maldevelopment of the posterior neural arch of axis causing compressive myelopathy","volume":"52","author":"Behari","year":"2004","journal-title":"Neurol India"},{"key":"R13-20260319","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1227\/00006123-199510000-00012","article-title":"C1-C2 posterior cervical fusion: Long-term evaluation of results and efficacy","volume":"37","author":"Coyne","year":"1995","journal-title":"Neurosurgery"},{"key":"R14-20260319","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1097\/00006123-200212000-00004","article-title":"Atlantoaxial fixation using plate and screw method: A report of 160 treated patients","volume":"51","author":"Goel","year":"2002","journal-title":"Neurosurgery"},{"key":"R15-20260319","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1097\/00007632-200111150-00014","article-title":"Posterior C1-C2 fusion with polyaxial screw and rod fixation","volume":"26","author":"Harms","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"R16-20260319","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/BF01400872","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994","journal-title":"Acta Neurochir (Wien)"},{"key":"R17-20260319","doi-asserted-by":"crossref","first-page":"368","DOI":"10.4103\/jcvjs.jcvjs_128_22","article-title":"C2 Screw fixation techniques in atlantoaxial instability: A technical review","volume":"13","author":"Singh","year":"2022","journal-title":"J Craniovertebr Junction Spine"},{"key":"R18-20260319","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/197140090702000215","article-title":"Biomechanics of the spine III. The cranio-cervical junction","volume":"20","author":"Izzo","year":"2007","journal-title":"Neuroradiol J"},{"key":"R19-20260319","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/0021-9290(88)90204-7","article-title":"Moment-rotation relationships of the ligamentous occipito-atlanto-axial complex","volume":"21","author":"Goel","year":"1988","journal-title":"J Biomech"},{"key":"R20-20260319","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1007\/s00586-019-06083-1","article-title":"Sagittal balance of the spine","volume":"28","author":"Le","year":"2019","journal-title":"Eur Spine J"},{"issue":"Suppl 6","key":"R21-20260319","doi-asserted-by":"crossref","first-page":"S834","DOI":"10.1007\/s00586-013-3030-z","article-title":"Compensatory mechanisms contributing to keep the sagittal balance of the spine","volume":"22","author":"Barrey","year":"2013","journal-title":"Eur Spine J"},{"key":"R22-20260319","first-page":"213","article-title":"Sagittal plane alignment of the spine and gravity: A radiological and clinical evaluation","volume":"71","author":"Legaye","year":"2005","journal-title":"Acta Orthop Belg"},{"key":"R23-20260319","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"R24-20260319","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1007\/s00586-012-2167-5","article-title":"Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects","volume":"21","author":"Yukawa","year":"2012","journal-title":"Eur Spine J"},{"key":"R25-20260319","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/01.BRS.0000107225.97653.CA","article-title":"A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1-C2 fusion","volume":"29","author":"Yoshimoto","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"issue":"Suppl 1","key":"R26-20260319","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00586-009-0988-7","article-title":"Craniovertebral junction lesions: Our experience with the transoral surgical approach","volume":"18","author":"Mouchaty","year":"2009","journal-title":"Eur Spine J"},{"key":"R27-20260319","doi-asserted-by":"crossref","first-page":"116","DOI":"10.3171\/2014.10.SPINE14176","article-title":"Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation","volume":"22","author":"Goel","year":"2015","journal-title":"J Neurosurg Spine"},{"key":"R28-20260319","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/ijors.ijors_17_21","article-title":"Outcome analysis of surgeries around craniovertebral junction","volume":"29","author":"Ostagar","year":"2021","journal-title":"Int J Orthop Surg"}],"container-title":["Journal of Craniovertebral Junction and Spine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_8_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:24:48Z","timestamp":1787837088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_8_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jcvjs.jcvjs_8_26","relation":{},"ISSN":["0974-8237","0976-9285"],"issn-type":[{"value":"0974-8237","type":"print"},{"value":"0976-9285","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2026-01-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}