PubMed · 15435352
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M R D'OSUALDO, A S CALVO. 1950-06-05. [Grisel's syndrome].. https://pubmed.ncbi.nlm.nih.gov/15435352/
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STUDY DESIGN: A case report and review of previous literature are presented. OBJECTIVE: The objective of this manuscript was to report a case of cervical myelopathy due to anomalous laminae of the axis in a patient with spina bifida. SUMMARY OF BACKGROUND DATA: In previous studies, few cases of invaginated anomalous laminae of the axis have been reported. Treatment was surgical removal of the invaginated laminae. METHODS: The patient's history, clinical examination, imaging findings, and treatment were reported. RESULTS: Characteristic findings were revealed from imaging studies, a multiplane reconstruction of the CT images, and a stereolithographic model of the cervical spine. The patient was treated with a posterior decompressive operation. The outcome was satisfactory, with an improvement in the patient's neurology. CONCLUSIONS: This is a report of a rare characteristic anomaly of the laminae of the axis. A multiplane reconstruction of the CT images and a stereolithographic model were useful for treatment of this case. Possible causes of this anomaly may be the failure of ossification or fusion of the embryological term.
BACKGROUND: Chronic low back pain (LBP), the leading symptom of ankylosing spondylitis (AS) and undifferentiated axial spondyloarthritis (SpA), precedes the development of radiographic sacroiliitis, sometimes by many years. OBJECTIVE: To assign disease probabilities and to develop an algorithm to help in the early diagnosis of axial SpA. METHODS: Axial SpA comprises AS and undifferentiated SpA with predominant axial involvement. Clinical features include inflammatory back pain (IBP), alternating buttock pain, enthesitis, arthritis, dactylitis, acute anterior uveitis, a positive family history, psoriasis, inflammatory bowel disease, and good response to NSAIDs. Associated laboratory findings include raised acute phase reactions, HLA-B27 association, and abnormalities on skeletal imaging. Sensitivities, specificities, and likelihood ratios (LRs) of these parameters were determined from published studies. A 5% prevalence of axial SpA among patients with chronic LBP was used. The probability of the presence of axial SpA, depending on the presence or absence of the above clinical features of SpA, was determined. A probability of > or = 90% was used to make a diagnosis of axial SpA. RESULTS: The presence of inflammatory back pain features increased the probability of axial SpA from the background 5% prevalence to 14%. The presence of 2-3 SpA features was necessary to increase the probability of axial SpA to 90%. The highest LRs were obtained for HLA-B27 and MRI. Diagnostic algorithms to be used in daily practice were suggested. CONCLUSIONS: This approach can help clinicians to diagnose with a high degree of confidence axial SpA at an early stage in patients with IBP who lack radiographic sacroiliitis.
OBJECT: The C-2 pedicle plays an important role regarding screw purchase for spinal fixation. The aim of this study was to measure the C-2 pedicle-related linear and angular parameters. METHODS: Seven parameters in 160 C-2 pedicles (80 dry vertebrae) were measured using a Vernier caliper (accurate to 0.1 mm) and goniometer. The Student t-test was used to determine statistical significance. The authors found that the C-2 isthmus (pars interarticularis) and the C-2 pedicle are distinct structures. The C-2 isthmus covers the pedicle. The isthmus is present between the superior and inferior articular processes, and the pedicle is the structure beneath the C-2 isthmus. It connects the lateral mass-inferior articular process to the body of the axis. The heights of the right and the left C-2 pediculoisthmic components (PICs) were 10.3 +/- 1.6 and 9.9 +/- 1.5 mm, respectively. The posterior part of the superior aspect of the PIC was wider than the anterior portion. The widths of the posterosuperior aspect of the PIC were 11.1 +/- 2 and 11 +/- 1.7 mm on the right and left sides, whereas the widths of the anterosuperior aspect of the PIC were 7.9 +/- 1.7 and 8.5 +/- 1.6 mm, respectively. The inferior widths of this component were 6.0 +/- 1.5 and 5.5 +/- 1.3 mm on the right and left side, respectively. The lengths of the component were 28.8 +/- 2.9 mm on the right and 28.8 +/- 3.4 mm on the left side. The PIC exhibits a lateral-to-medial and an inferior-to-superior angle. Its axial angles were 28.4 +/- 2.5 and 28.6 +/- 2.2 degrees on the right and left sides, respectively; its sagittal angles were 18.8 +/- 2.1 and 18.8 +/- 1.7 degrees, respectively. CONCLUSIONS: The C-2 pedicle can be seen in the inferior aspect of the vertebra, and it connects posterior vertebral elements (that is, the lateral mass and inferior articular process) to the axial body. The isthmus drapes the pedicle. The authors suggest that this be termed "the pediculoisthmic component."