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Biomedical subjects

J W Fielding

Publications and source records attributed to J W Fielding.

At least 127 records · Page 7Linked to original sources
PubMed1978

Acquired os odontoideum. A case report.

A 7-year-old boy presented with os odontoideum after a 5 story fall at 19 months of age, at which time roentgenograms documented a normal odontoid. Current flexion-extension films revealed a marked altlantoaxial instability related to the acquired "os." The treatment consisted of an atlantoaxial arthrodesis. Acquired os odontoideum is a recognized, though uncommon entity in which it is hypothesized that trauma produces vascular insufficiency, with subsequent resorption of the central portion of the odontoid, resulting in the classical features of os odontoideum. It is often associated with instability, with potential danger to the spinal cord. Instability in cases of os odontoideum is a positive indication for atlantoaxial arthrodesis.

Axis, Cervical Vertebra↗
PubMed1978

Congenital anomalies of the odontoid process.

Anomalous development of the odontoid is uncommon, and its clinical significance lies in its potential for producing serious neurologic sequelae due to atlantoaxial instability. Although there are several recognized variations (aplasia, hypoplasia, and os odontoideum), clinically they share the same signs and symptoms, and the treatment is identical. Symptoms are usually due to instability of the atlantoaxial joint, with compression of the spinal cord and anteriorly against the axis or posteriorly from the ring of the atlas. Patients may present with no symptoms, with persistent neck complaints, with transient or permanent neurologic deficits, or with sudden death. Symptoms from cranial nerve irritation seldom occur, but occasionally symptoms of cerebral and brain stem ischemia are noted as a result of compression of the vertebral arteries in the area of the atlas. If the condition is suspected, the diagnosis usually can be confirmed on lateral flexion-extension roentgenograms. Special techniques are often required, particularly lateral laminagrams, and flexion-extension stress roentgenograms are necessary to determine the presence and degree of atlantoaxial instability. The role of prophylactic surgical stabilization is not yet established. If instability greater than 5 mm. is demonstrated or the patient has clinical findings of neurologic compromise, surgical fusion should be performed.

Axis, Cervical Vertebra↗
PubMed1978

Atlantoaxial rotary deformities.

Persistent torticollis in younger patients, particularly after trivial trauma or an upper respiratory tract infection, suggests a diagnosis of atlantoaxial rotary fixation. The diagnosis can be confirmed by cineroentgenography. Anterior displacement of the atlas, indicating a deficient transverse ligament, should be ruled out by flexion-extension lateral roentgenograms. If conservative management fails to achieve reduction or is followed by a recurrence of the deformity, arthrodesis is indicated.

Adolescent↗
PubMed1978

Fractures of the odontoid: a laboratory and clinical study of mechanisms.

Previous reports and a study of the mechanism of injury in 25 cases of fracture of the odontoid suggest that the fracture usually results from a high velocity force directed to the head, producing flexion, extension, or rotation of the upper cervical spine. In a laboratory biomechanical study using cadaver preparations, fractures of the odontoid were produced in 20 specimens from the upper cervical spine, which were loaded in failure in forward and lateral modes.

Adolescent↗
PubMed1977

Osteoid osteoma of the cervical spine.

Four cases of cervical osteoid osteoma occurred predominantly in the adolescent age group with either pain, pain with scoliosis, or radicular pain usually without neurological signs. The initial X-rays did not demonstrate the lesions but a high index of suspicion led to additional roentgenographic as well as tomography examinations and eventually an accurate diagnosis. The lesions were located in the posterior elements in all 4 cases. Treatment consisted of excision in 3 cases and excision and fusion in one case and resulted in cure with no recurrence.

Adolescent↗
PubMed1977

Pregnancy after jejuno-ileal bypass.

The clinical details of two patients who have conceived after jejuno-ileal bypass for gross refractory obesity are presented. One was a twin pregnancy which yielded a stillborn and a normal baby. The other yielded a normal baby. The management of pregnancy in patients with small bowel bypass is discussed.

Adult↗
PubMed1977

Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint).

In seventeen cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and seven young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the thirteen patients treated by atlanto-axial arthrodesis, eleven had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining four patients, one treated conservatively had not been followed for long enough to evaluate the result, two declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.

Adolescent↗
PubMed1976

Spine fusion for atlanto-axial instability.

A follow-up study was done on fifty-seven spine fusions for atlanto-axial instability, classified as Type I - deficient odontoid (twenty-eight patients), Type II - deficient ligaments (twenty-three patients), and Type III - rotatory fixation (six patients). The average age of the patients at the time of the fusion was thirty years, and half had had significant trauma. Symptoms had been present for an average of 12.3 months before fusion. Preoperatively pain was the predominant complaint in twenty-nine; neurological complaints, in twenty-four; and instability in the rest. Of the forty-six Gallie fusions, there was one non-union and of the eleven occipitocervical fusions, two non-unions. Follow-up averaging 4.2 years revealed resolution of symptoms in almost all patients.

Adolescent↗