Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ATLAS AND AXIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed1998

Cartilaginous development of the human craniovertebral junction as visualised by a new three-dimensional computer reconstruction technique.

Serial transverse histological sections of the human craniovertebral junction (CVJ) of 4 normal human embryos (aged 45 to 58 d) and of a fetus (77 d) were used to create 3-dimensional computer models of the CVJ. The main components modelled included the chondrified basioccipital, atlas and axis, notochord, the vertebrobasilar complex and the spinal cord. Chondrification of the component parts of CVJ had already begun at 45 d (Stage 18). The odontoid process appeared to develop from a short eminence of the axis forming a third occipital condyle with the caudal end of the basioccipital. The cartilaginous anterior arch of C1 appeared at 50-53 d (Stages 20-21). Neural arches of C1 and C2 showed gradual closure, but there was still a wide posterior spina bifida in the oldest reconstructed specimen (77 d fetus). The position of the notochord was constant throughout. The normal course of the vertebral arteries was already established and the chondrified vertebral foramina showed progressive closure. The findings confirm that the odontoid process is not derived solely from the centrum of C1 and that there is a 'natural basilar invagination' of C2 during normal embryonic development. On the basis of the observed shape and developmental pattern of structures of the cartilaginous human CVJ, we suggest that certain pathologies are likely to originate during the chondrification phase of development.

Basilar Artery↗
PubMed1986

[Diagnosis of instability of the upper cervical spine by functional computed tomography].

The evaluation by means of functional x-rays, of rotatory instability of the upper cervical spine as a result traumatic or inflammatory destruction of the ligamentous apparatus, is unsatisfactory. Functional CT of the upper cervical spine allows measurement of the segmental rotatory movements. 9 healthy adults and 30 patients were examined after neck injury via functional CT's. A rotation between occiput and atlas greater than 9 degrees, between atlas and axis over 50 degrees, the left-right difference at the level C0/C1 greater than 6 degrees and at the level C1/C2 over 10.5 degrees point to a suspicion of hypermobility or instability.

Adolescent↗
PubMed2006

One stage reduction and fixation for atlantoaxial spondyloptosis: Report of four cases.

We report four patients having an extremely rare and hitherto unreported clinical condition of spondyloptosis of the atlas over axis. Between the year 1999 and 2004, four patients with spondyloptosis were retrospectively analysed. The age of the patients ranged from 12 to 31 years. In three patients, the aetiology of spondyloptosis was probably congenital in nature and in one case it was secondary to rheumatoid disease. The patients presented with varying degrees of neck pain and spastic quadriparesis. All patients were successfully treated by atlantoaxial joint distraction, reduction of the dislocation and direct lateral mass plate and screw fixation by techniques described earlier by the senior author. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments is possible and probably an ideal treatment of cases with atlantoaxial spondyloptosis.

Adolescent↗
PubMed1993

Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature.

We report a case of tuberculous vertebral osteomyelitis of the first and second cervical vertebrae with extensive adjacent soft-tissue involvement and extension into the mediastinum and bilateral flanks. The clinical presentation of tuberculous vertebral osteomyelitis depends on the vertebrae involved. The characteristic syndrome, Pott's disease, reflects the consequence of infection of the lower thoracic and lumbar spine, the most common site of tuberculous vertebral osteomyelitis. Cervical involvement is unusual: tuberculosis affects the cervical vertebrae in approximately 0.03% of all cases. Tuberculosis of the atlas and axis is even more rare. Characteristic symptoms reported on presentation include fever, weight loss, night sweats, and neck pain and stiffness. Patients may have no neurological manifestations, but findings can range from single nerve-root compression to quadriplegia. Abscess may extend into the retropharynx, mediastinum, and posterior triangles and along the epidural space. Computerized tomography and magnetic resonance imaging are the most useful imaging procedures. Therapy should consist of administration of antimycobacterial antibiotics and--if indicated by the degree of subluxation, by neurological signs, or by cervical instability--surgical debridement and stabilization.

Adult↗
PubMed2006

Atlantoaxial subluxation in different intraoperative head positions in patients with rheumatoid arthritis.

BACKGROUND: Disorders of the cervical spine are often observed in patients with rheumatoid arthritis (RA). However, the best head position for RA patients with atlantoaxial subluxation in the perioperative period is unknown. This study investigated head position during general anesthesia for the patients with RA and proven atlantoaxial subluxation. METHODS: During anesthesia of patients with RA and proven atlantoaxial subluxation, the authors used fluoroscopy to obtain a lateral view of the upper cervical spine in four different positions: the mask position, the intubation position, the flat pillow position, and the protrusion position. Copies of the still fluoroscopic images were used to determine the anterior atlantodental interval, the posterior atlantodental interval, and the angle of atlas and axis (C1-C2 angle). RESULTS: The anterior atlantodental interval was significantly smaller in the protrusion position (2.3 mm) than in the flat pillow position (5.1 mm) (P < 0.05). The posterior atlantodental interval was significantly greater in the protrusion position (18.9 mm) than in the flat pillow position (16.2 mm) (P < 0.05). The C1-C2 angle was, on average, 9.3 degrees greater in the protrusion position than in the flat pillow position (P < 0.05). CONCLUSION: This study showed that the protrusion position using a flat pillow and a donut-shaped pillow during general anesthesia reduced the anterior atlantodental interval and increased the posterior atlantodental interval in RA patients with atlantoaxial subluxation. This suggests that the protrusion position, which involves support of the upper cervical spine and extension at the craniocervical junction, might be advantageous for these patients.

Adult↗
PubMed1998

Compression of the upper cervical spinal cord causing symptoms of brainstem compromise. A case report.

STUDY DESIGN: A case is reported in which a flexion-induced compression of the upper cervical spinal cord caused symptoms of brainstem compromise in the absence of radiographic evidence of osseous instability. OBJECTIVES: A 41-year-old woman developed postoperative cervical instability with flexion-induced neurologic symptoms referable to the brainstem. The instability was caused by direct compression at the third cervical vertebral body, which in turn was caused by differential movements between the neuraxis and skeletal elements in the upper cervical spine. SUMMARY OF BACKGROUND DATA: Pathologic processes at the craniocervical junction may cause brainstem compromise with neurologic symptoms. The mechanism of brainstem involvement is usually either vertebrobasilar insufficiency or direct mechanical compression. In cases where the brainstem is compressed by skeletal elements, the compressing osseous structures usually are the walls of the foramen magnum or the odontoid process, or, less frequently, the atlas or axis vertebrae. Symptoms of brainstem dysfunction caused by dynamic compression at the level of the third cervical vertebra in the absence of hindbrain herniation are unusual and, to the best of the authors' knowledge, have not been described previously. METHODS: The patient underwent initial examination, evaluation, and periodic follow-up examination with magnetic resonance imaging from the time of her first visit until 26 months after the surgical treatment. The patient experienced postsurgical instability with dynamic compression by the C3 vertebral body, which caused brainstem compromise. Surgical treatment consisted of decompressive C3 corpectomy and fusion of C2 to C6, supplemented by anterior fixation. RESULTS: After undergoing surgical decompression of C3, reconstruction, and anterior internal fixation of C2 to C6, the patient had dramatic neurologic improvement. Diplopia, paresthesia, and nystagmus disappeared immediately after surgery. Swallowing difficulties, hoarseness, and vertigo improved gradually. At follow-up examination 26 months after surgery, the patient was asymptomatic. Magnetic resonance imaging showed good position of the construct, with no evidence of compression of the spinal cord or brainstem. CONCLUSIONS: Instability of the cervical spine may result in symptoms of brainstem dysfunction, even in the absence of hindbrain herniation. This instability is explained by the differential movement between the bony structures and neuraxis in the upper cervical region. Diagnosis and adequate management of this instability alleviates the neurologic symptoms and prevents possible hazardous complications.

Adult↗
PubMed1993

Extracranial meningioma in the parapharyngeal space.

A case of extracranial meningioma in the parapharyngeal space is reported. A 24 year old woman presented with swelling and tenderness of the parapharyngeal region. A tumor was palpable in this region, and the tumor was surgically removed. Macroscopically the tumor occurred from the portion between the axis and atlas. Histologically the tumor cells, which had oval nuclei and a slightly eosinophilic cytoplasm, proliferated in fibrous connective tissues to form small nests. As the cell borders were not clear, the tumor structure appeared to be syncytium-like. Immunohistochemically the tumor cells were positive for anti-vimentin antibodies, anti-S-100 protein antibodies and anti-epithelial membrane antigen (EMA) antibodies in part. Electron microscopically the tumor cells had complex interdigitations of their adjacent plasma membranes. These were studded with many desmosomes. Bundles of intermediate filaments were visible in the cytoplasm. On the basis of the clinical, histological, immunohistochemical and electron microscopical features, the tumor was diagnosed as extracranial meningotheliomatous meningioma. The parapharyngeal space is an extremely rare location for extracranial meningioma, and our case is the first in Japan as far as we know.

Adult↗
PubMed1984

Vertical dislocation of the C1 and C2 vertebrae in rheumatoid arthritis.

In a retrospective analysis of 450 patients with rheumatoid arthritis the cervical films were reviewed to detect vertical dislocation of the C1 and C2 vertebrae. A frequency of 10 per cent was found among all patients and of 24 per cent among those with cervical arthritis. The authors' method of measuring vertical dislocation at conventional radiography turned out to be superior to the method of McGregor , especially in cases with severe dislocation. The vertical dislocation was shown to be preceded by a horizontal dislocation and the appearance of vertical dislocation diminished or abolished the horizontal dislocation. Progression occurred in many cases and was combined with erosions of the atlas and axis. In more than half of the patients there was also contemporaneously a subaxial dislocation. Neurologic symptoms were more often occurring in patients with a severe vertical dislocation and in patients with spinal stenosis at the C1 level.

Adult↗
PubMed2006

Catastrophic cervical spine injuries in high school and college football players.

BACKGROUND: Catastrophic cervical spine injuries in football are rare but tragic events. PURPOSE: To update the incidence of catastrophic cervical injuries in scholastic football players and identify new injury patterns. STUDY DESIGN: Descriptive epidemiology study. METHODS: The authors retrospectively reviewed 196 incidents of catastrophic high school and collegiate football injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). RESULTS: There were 15.08 direct catastrophic cervical spine injuries in scholastic football participants per year, an incidence of 1.10 and 4.72 injuries per 100 000 high school and 100 000 college participants, respectively. Seventy-six athletes had quadriplegia (5.85 per year), 0.50 per 100 000 high school players and 0.82 per 100 000 college players. Spear tackling by players on defense continued to be the predominant mechanism of injury causing quadriplegia. Five athletes had a Brown-Séquard-like syndrome; only 1 made a full recovery. One athlete with Brown-Séquard-like syndrome and permanent neurologic symptoms reported a cervical cord neurapraxia event before the study period. Forty-three athletes (3.31 per year) had diagnosed cervical cord neurapraxia. In addition to hyperflexion and hyperextension injuries, axial forces were found to cause cervical cord neurapraxia. Sixteen of the 43 athletes returned to football after a cervical cord neurapraxia episode, and none of the 16 suffered a permanent quadriplegic event. Nine athletes sustained an isolated injury at the C1 or C2 level, and 7 sustained a combined injury at the C1, or C2 level and at a subaxial level. CONCLUSION: The total number of quadriplegic events for high school and college football players is approximately 6 per year, with a higher incidence at the college level. Cervical cord neurapraxia can be caused by hyperflexion, hyperextension, and axial compression forces. Upper level cervical injuries involving the atlas and axis can occur in football players and may be associated with noncontiguous subaxial injuries.

Adolescent↗
PubMed2003

Paleopathological features of the cervical spine in the early middle ages: natural history of degenerative diseases.

OBJECTIVE: Trauma and degenerative joint disease are the most common pathological conditions observed in archaeological skeletal remains. We describe the prevalence of different types of cervical bone diseases observed in the early Middle Ages (6th to 8th centuries AD). METHODS: Human skeletons were excavated from Germanic row graves in southwestern Germany. One hundred ninety-six cervical spines thus obtained were examined for bone disease. The degenerative changes were classified into Grades 1 (marginal osteophytes), 2 (uneven joint surfaces), and 3 (osseous ankylosis). Cervical spinal canal stenosis was defined as anteroposterior diameters of <11 mm and intervertebral foraminal stenosis as <3.0 mm in the smallest diameter. RESULTS: Of the skeletons, 27.5% demonstrated degenerative changes of the cervical spine. The mean age of the skeletons at the time of death was 33.4 years, compared with 43.7 years for those with degenerative disease. Degenerative changes of the vertebral bodies (usually Grades 1 and 2) were most common in the C5-C6 (12.4%, P < 0.05) and C6-C7 (15.3%, P < 0.05) segments. The medial (6.1%) and lateral (0.6%) atlantoaxial joints were rarely involved in degenerative disease. The facet joints from C3-C4 to C6-C7 demonstrated degenerative changes (usually Grades 1 and 2) in 8.0 to 11.8% of cases. The C2-C3 facet joints were significantly involved in degenerative disease in 19.7% of cases (P < 0.05), one-fourth of which demonstrated osseous ankylosis. We observed cervical spinal canal stenosis in 5 skeletons (2.6%) and osseous intervertebral foraminal stenoses in 12 (6.1%). Isolated cases of other pathological processes, i.e., spondylitis ankylopoietica, occipitalization of the atlas and axis, and an odontoid fracture with pseudoarthrosis, were also recorded. CONCLUSION: In the early Middle Ages, the prevalence of degenerative cervical spine disease was the same as that observed today. The C2-C3 facet joints demonstrated high rates of degenerative disease.

Adolescent↗
PubMed1987

The differing effects of occipital and trunk somites on neural development in the chick embryo.

In all higher vertebrate embryos the sensory ganglia of the trunk develop adjacent to the neural tube, in the cranial halves of the somite-derived sclerotomes. It has been known for many years that ganglia do not develop in the most cranial (occipital) sclerotomes, caudal to the first somite. Here we have investigated whether this is due to craniocaudal variation in the neural tube or crest, or to an unusual property of the sclerotomes at occipital levels. Using the monoclonal antibody HNK-1 as a marker for neural crest cells in the chick embryo, we find that the crest does enter the cranial halves of the occipital sclerotomes. Furthermore, staining with zinc iodide/osmium tetroxide shows that some of these crest-derived cells sprout axons within these sclerotomes. By stage 23, however, no dorsal root ganglia are present within the five occipital sclerotomes, as assessed both by haematoxylin/eosin and zinc iodide/osmium tetroxide staining. Moreover, despite this loss of sensory cells, motor axons grow out in these segments, many of them later fasciculating to form the hypoglossal nerve. The sclerotomes remain visible until stages 27/28, when they dissociate to form the base of the skull and the atlas and axis vertebrae. After grafting occipital neural tube from quail donor embryos in place of trunk neural tube in host chick embryos, quail-derived ganglia do develop in the trunk sclerotomes. This shows that the failure of occipital ganglion development is not the result of some fixed local property of the neural crest or neural tube at occipital levels. We therefore suggest that in the chick embryo the cranial halves of the five occipital sclerotomes lack factors essential for normal sensory ganglion development, and that these factors are correspondingly present in all the more caudal sclerotomes.

Animals↗
PubMed1999

Bow hunter's stroke associated with atlantooccipital assimilation--case report.

A 39-year-old male presented with bow hunter's stroke manifesting as repeated vertebrobasilar ischemic attacks induced by head rotation 45 degrees to the left. Three-dimensional computed tomography angiography clearly showed the occluded right vertebral artery (VA) between the axis and atlas. Single photon emission computed tomography study showed diffuse hypoperfusion of the brain stem and bilateral cerebellar hemispheres, suggesting hemodynamic compromise of these regions. He refused surgery and was treated conservatively. The most likely mechanism is that the affected VA was fixed by the ossification of the atlantooccipital membrane, vascular groove, and transverse foramen of the atlas, and therefore became elongated and compressed by head-turning.

Adult↗
PubMed2005

Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: preliminary report of 12 cases.

Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. The mean duration of symptoms was 11 months. The atlantoaxial dislocation and basilar invagination were reduced by manual distraction of the facets of the atlas and axis, stabilization by placement of bone graft and metal spacers within the joint, and direct atlantoaxial fixation using an inter-articular plate and screw method technique. Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment.

Adolescent↗
PubMed1983

Os odontoideum. A cause of atlanto-axial instability.

Os odontoideum is a rare condition in which instability may damage the upper cervical cord. A delay in diagnosis is not uncommon. This paper describes a series of 11 patients with os odontoideum. The presenting symptoms were divided into three groups: posttraumatic neck-pain, gradually appearing signs of medullary compression and an asymptomatic group. Eight patients had atlanto-axial instability. Six had interlaminar fusion between atlas and axis. No serious complications were seen. Stability was obtained in all patients postoperatively. In case of significant instability, fusion is indicated. In patients with cerebral palsy a closer examination of the upper cervical cord is recommended.

Adult↗
PubMed1983

Atlantoaxial dislocation associated with neurofibromatosis. Report of three cases.

Atlantoaxial dislocation was found in three patients with neurofibromatosis. Roentgenographic findings included marked reduction of sagittal diameter at the C-1 vertebral level, and cervical spine abnormalities associated with mesodermal dysplasia, such as posterior scalloping of the cervical spinal bodies with dural ectasia and vertebral body deformity (vertebral body dysplasia). Although the relationship of the atlas and axis did not change with neck position, all three patients had progressive neurological deficits and were treated by decompressive surgery combined with fusion. The pathogenesis of atlantoaxial dislocation associated with neurofibromatosis is discussed.

Adult↗
PubMedDate not supplied

Cervical vertebral fractures in 56 dogs: a retrospective study.

The clinicopathological features of cervical fractures in 56 dogs were reviewed. "Hit by car" (HBC) was the most common inciting cause, and the axis and atlas were the vertebrae most frequently affected. Surgical treatment was associated with high (36%) perioperative mortality. However, all dogs that survived the perioperative period achieved functional recovery. Functional recovery was achieved in 25 (89%) of 28 nonsurgically treated dogs with adequate follow-up. Overall, severity of neurological deficits (nonambulatory status) and prolonged interval (five days or longer) from trauma to referral were associated with poorer outcome. Nonsurgical treatment is a viable therapeutic approach for many dogs with cervical fractures. Early neck immobilization and prompt referral are recommended, because delay in referral decreases the likelihood of functional recovery.

Accidents, Traffic↗
PubMed1999

[Little known sequelae of sprains of the cervical spine].

After cervical sprain not only pain and neuropsychological disturbances may occur, but also the following sequelae: cervical dystonia, and torticollis, dizziness, hearing loss for low frequencies, dysphonia and globus. Except for dystonia the symptoms often respond to manipulation of a blocked articulation between occiput and atlas or axis and the third cervical vertebra.

Cervical Vertebrae↗