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At least 253 records · Page 14Linked to original sources
PubMed1975

[Chronic tonsillitis and the upper cervical spine (author's transl)].

The authors investigated 46 patients with chronic tonsillitis. Only in 5 (11% blockage in the craniocervical junction were absent. The most frequently affected segment was between the occipital bone and the atlas (in 36 patients), between the atlas and axis in two and between the axis and C3 in three patients. In 28 treatment was only surgical. There blockage disappeared only in four, in two blockage developed operation. Five patients were treated before operation also by manipulation. There the blockage relapsed only once. In 10 treatment was by manipulation only. During the observation period (from 3-9 months) not a single relapse of blockage or tonsillitis was observed during the winter period.

Adolescent↗
PubMed1975

[Osteochondroma of the high cervical spine--a case report (author's transl)].

Osteochondroma is one of the most common benign bone tumors, but it is rare in the spine. A woman aged 54 was admitted for investigation of left nuchal pain with radiation to the occipital region for one and a half years duration. Physical and neurological examinations revealed no objective abnormalities. The cervical spine film showed the presence of a calcified mass in the left articulation between atlas and axis. Myelogram outlined a left sided filling defect at the level of a calcified mass. The tumor was totally removed using operating microscope technique through transcervical approach. This calcified mass was confirmed as the benign osteochondroma by histological examination. The patient became completely symptom-free after the operation.

Cervical Vertebrae↗
PubMed1992

[Instability and misdiagnosed or neglected dislocations of the upper cervical spine in children. Apropos of 20 cases].

Neglected instabilities or luxations of the upper cervical spine in children are rare if one discards conditions such as chondrodysplasia, Down Syndrome or others, were the spine is known to be at high risk of instability. We have studied twenty cases of neglected luxations and the delay in diagnosis is explained either by the asymptomatic character of some of these lesions, or by the difficulty in diagnosis. At the occipito-atlantal level we have reviewed: an instability in translation which required an occipito-axial fusion; two compensatory counter occipito-atlantal luxation of an atlanto-axial rotatory fixation. The diagnosis was best made with computed tomography scan and the treatment was not much different from the isolated atlanto-axial rotatory luxation. An instability in flexion extension, which was merely followed at regular intervals. At the atlanto-axial level 9 cases of sagittal instabilities in kyphosis and translation with a distance between atlas and axis of more than 5 mm were observed. These instabilities were most often associated with a malformation of the cranio-cervical junction; their treatment was usually surgical by means of an atlanto-axial or occipito-axial arthrodesis depending on the case. 9 other cases of atlanto-axial rotatory luxations were either isolated (7 cases) or associated with a counter occipito-atlantal rotatory subluxation (2 cases). Their diagnosis was made on routine X-rays, but the complete or incomplete aspect of the luxation, as well as its fixed aspect, was best appreciated with dynamic CT scan. Their treatment was always started with collar neck or halo traction in order to obtain, reduction of the dislocation, or at least the disparition of the torticollis and the head straight up on shoulders. The stability of the spine was achieved with a minerva cast jacket, halo cast or spine fusion depending on the case.

Adolescent↗
PubMed2004

Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis.

OBJECTIVE: We present our experience of treating nine consecutive cases of rheumatoid arthritis involving the craniovertebral junction by atlantoaxial joint manipulation and attempts towards restoration of craniovertebral region alignments. MATERIAL AND RESULTS: Between November 2001 and March 2004, nine cases of rheumatoid arthritis involving the craniovertebral junction were treated in our department of neurosurgery. Six patients had basilar invagination and 'fixed' atlantoaxial dislocation and three patients had a retroodontoid process pannus and mobile and incompletely reducible atlantoaxial dislocation. The patients ranged from 24 to 74 years in age. Six patients were males and three were females. Neck pain and spastic quadriparesis were the most prominent symptoms. Surgery involved attempts to reduce the atlantoaxial dislocation and basilar invagination by manual distraction of the facets of the atlas and axis. Reduction of the atlantoaxial dislocation and of basilar invagination and stabilization of the region was achieved by placement of bone graft and metal spacers within the joint and direct inter-articular plate and screw method of atlantoaxial fixation. Following surgery all the patients showed symptomatic improvement and restoration of craniovertebral alignments. Follow-up ranged from four to 48 months (average 28 months). CONCLUSION: Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of rheumatoid arthritis involving the craniovertebral junction leads to remarkable and sustained clinical recovery.

Adult↗
PubMed2004

[3D-CT investigation of craniofacial and cervical spine anomalies in congenital muscular torticollis].

PURPOSE: To investigate the accompanied craniofacial and cervical spine anomalies in congenital muscular torticollis (CMT) with three-dimensional computerized tomography (3D-CT). MATERIALS AND METHODS: We examined six cases of CMT. Cranial and cervical 3D CT was performed in all cases. Facial midline deviation angle (FDA), upper hemifacial width, lower hemifacial width (LHFW), length of hemimandible and zygomatic arcus, posterior hemicranial width (PHCW), anterior hemicranial width and cranial base midline deviation angle (CBDA) were measured on cranial 3D-CT images. Value of orbital index was calculated. Data achieved both ipsilaterally and contralaterally were compared with paired t-test. Atlanto-axial rotation angle (AARA) and atlantodental interval (ADI) values were measured on cervical 3D-CT images. RESULTS: Ages ranged between 2-26 years with a M/F ratio of 1/5. Facial asymmetry was diagnosed in all cases and LHFW was significantly undersized when compared to contralateral side (p < 0.05). FDA was measured 5.4+/-2.0 degrees on the average. Zygomatic arcus and hemimandible were significantly undersized on the side of torticollis (p < 0.05). Occipital plagiocephaly existed in all cases and PHCW was significantly extensive on torticollis side (p < 0.05). CBDA was measured 4.5+/-1.7 degrees on the average. Rotational movement of atlas over axis was observed in all cases where the AARA was 15.0+/-7.4 degrees. ADI was lesser than 3 mm in all cases. CONCLUSION: Even occipital plagiocephaly, maxillary and orbital deformity were commonly found in cases of CMT, most dominant asymmetry was observed in lower hemifacial region, zygomatic arcus and mandible by 3D-CT imaging. Rotational movement of first cervical vertebra over the second one was determined in all cases.

Adolescent↗
PubMed2006

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation.

OBJECTIVE: To design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP), introduce the operation procedure, and evaluate its preliminary clinical effects. METHODS: A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis. RESULTS: Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory. CONCLUSIONS: The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications.

Adolescent↗
PubMed1991

Instability of the cervical spine after decompression in patients who have Arnold-Chiari malformation.

Stability of the cervical spine was studied in two groups of children who had myelomeningocele. Group I consisted of twenty children who had an Arnold-Chiari Type-II malformation in whom a suboccipital craniectomy (partial occipital craniectomy through the suboccipital route) and cervical laminectomy was done to decompress the brain stem. The average duration of follow-up in this group (excluding one patient) was 4.7 years (range, 2.3 to 10.4 years) after the operation. Group II consisted of twenty children who had myelomeningocele but had not had an operation for decompression. Lateral radiographs of the cervical spine in flexion and extension showed no instability between the occiput and atlas or between the atlas and axis in either group. In contrast, translation between the second and third cervical vertebrae averaged four millimeters in Group I and one millimeter in Group II (p less than 0.01), and angulation between the third and fourth cervical vertebrae averaged 17 degrees in Group I and 6 degrees in Group II (p less than 0.01). Nineteen of the twenty patients in whom a suboccipital craniectomy and cervical laminectomy (Group I) had been done had instability of the cervical spine.

Arnold-Chiari Malformation↗
PubMed1987

The anterior retropharyngeal approach to the upper part of the cervical spine.

Since 1959, we have used a superior extension of the anterior approach to the cervical spine of Robinson and Smith in a consecutive series of seventeen patients. This approach provided anterior access to the neural elements from the clivus to the body of the third cervical vertebra, without the need for posterior dissection of the carotid sheath or entrance into the hypopharynx or oral cavity. It also provided adequate exposure for the insertion of iliac or fibular strut grafts, which was necessary in thirteen patients. The approach gave excellent exposure for anterior intralesional excision of a tumor in ten patients, marginal excision of an osteochondroma, two corpectomies of the second cervical vertebra combined with removal of the odontoid process, corpectomy of the second cervical vertebra for the treatment of fixed atlanto-axial subluxation, removal of a bullet anterior to the clivus, reduction of a dislocation of the second on the third cervical vertebra secondary to an unstable fracture of the pedicles of the second cervical vertebra, and anterior débridement for treatment of pyogenic vertebral osteomyelitis. In contrast to the reported results of transmucosal approaches to the atlas and axis, there were no infections or iatrogenic neurological deficits of the spine in the present series. Twelve patients who were followed for two years or more had a solid anterior fusion and no subsequent loss of cervical stability. Pain in the neck was relieved in all of the patients who had had a pathological or traumatic fracture.

Adolescent↗
PubMedDate not supplied

Assessment of craniocervical junction and atlantoaxial relation using metrizamide-enhanced CT in flexion and extension.

Metrizamide-enhanced computed tomographic (CT) myelography has made it easier to define the relation of the spinal cord to the vertebral canal. A flexion-extension metrizamide-enhanced CT technique has been developed to study the craniocervical junction that refines evaluation of the relation between the spinal cord and the foramen magnum, atlas, and axis. This technique was used to study 15 adults who had had a structurally normal examination of the upper cervical cord and foramen magnum. The average movement of the upper cervical cord was shown to be 1 mm. The advantages of the flexion-extension metrizamide-enhanced CT examination were evident in 10 other patients who had a variety of craniocervical junction pathologies.

Aged↗
PubMed1984

Neck manipulation causing stroke. Case reports.

Neck manipulation may cause injury to the vertebrobasilar arterial system with resultant brainstem ischaemia or infarction. This complication has been recognized for many years, and although rarely reported in the literature is a well-recognized problem encountered by neurologists. This article describes 3 patients with this condition seen at the Johannesburg Hospital. The probable pathogenesis is that a thrombus occurs at a site of vertebral artery injury created by sudden sharp neck movement chiefly between the axis and atlas. This thrombus may propagate or embolize. The therapeutic role of anticoagulants is discussed.

Adult↗
PubMed1983

Rugby injuries of the upper cervical spine. Case reports.

Fractures and dislocations of the upper cervical spine (atlas and axis) differ markedly from those of the lower cervical spine (C3 - C7) because of the unique anatomy and function of these two vertebrae. Case reports of 4 rugby players who sustained serious injuries of the upper cervical spine are presented. The role of the high tackle in causing these injuries is described and the association of head and upper cervical spinal trauma is emphasized. The radiological management of the player with suspected injury is outlined.

Adult↗
PubMed1994

Occipital condyle fractures: clinical presentation and radiologic detection.

PURPOSE: To describe the CT findings in occipital condyle fractures in patients suffering craniocervical trauma. METHODS: Six occipital condyle fractures in five patients were analyzed. Because of clinical or plain-film findings, the craniocervical junction in each patient was imaged using thin-section, high-resolution CT. Axial data were reformatted in the coronal plane or in both coronal and sagittal planes. Clinical and radiologic findings associated with occipital condyle fractures reported in the English medical literature were correlated with our cases to determine conclusive predictive features indicating condylar injury. RESULTS: Two avulsion (type III) fractures in two patients, two compression (type I) fractures in one patient, and two compression fractures in two patients were diagnosed by CT. Specific predictive features indicating occipital condyle fracture could not be confirmed. CONCLUSIONS: CT greatly facilitates diagnosing and typing of occipital condyle fractures. Nonspecific parameters promoting CT after trauma are unexplained persistent upper-neck pain with normal plain-film findings, lower cranial nerve palsies, spasmodic torticollis, retropharyngeal or prevertebral soft-tissue swelling, and fractures of the atlas or axis.

Cervical Vertebrae↗
PubMed1996

Anterior atlantoaxial subluxation in a patient with diffuse idiopathic skeletal hyperostosis.

We describe an 80-year-old woman with neck pain that radiated to the back and left side of her head. Radiographs of the cervical spine showed calcification and ossification of the anterior longitudinal ligament of the spine from the C3 to the C7 level, erosive destruction of the lateral masses of the atlas and axis, and anterior atlantoaxial subluxation (AAS). Diffuse idiopathic skeletal hyperostosis (DISH) was diagnosed. This is to the best of our knowledge the first reported case of DISH accompanied by AAS.

Aged↗
PubMed1998

Management of cervical disc herniation with upper cervical chiropractic care.

OBJECTIVE: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.

Adult↗
PubMed1997

[Internal fixation with U-shaped pin in the treatment of fracture-dislocation of the cervical spine].

Twenty cases with fracture-dislocation of the cervical spine were treated by U-shaped pin fixation. The U-shaped pin made of Steiman pin was used to hold sublaminar fixation of two segments above and below the vertebra of fracture. When atlas or axis was injured, a pair of small holes were drilled on the occipitale. The closed end of the U-Shaped pin was wired through the holes. Early postoperative ambulation was allowed without external fixation. 18 cases were followed up for 8-35 months. 5 cases of six patients with neurologic deficits recovered completely. The remaining one improved, no failure or loosening of the U-Shaped pin or wires was observed. Sound union of the bone grafts was obtained in all the patients. The results suggest that the operative procedure is simple, with sound fixation and satisfactory reduction and union of the fractures.

Adolescent↗
PubMed1976

Myelopathy in infancy complicating congenital atlantoaxial dislocation.

Two infants had congenital atlantoaxial dislocation associated with myelopathy. One of them, a 3-month-old girl, showed anterior dislocation of the atlas on the axis, and had extreme weakness of the extremities. Another patient, an 8-month-old boy, showed tetraplegia, and posterior dislocation with absent odontoid process was demonstrated radiologically. These cases add another cause to the varied etiologies of floppiness in early infancy.

Axis, Cervical Vertebra↗