[Axo-atlanto-occipital union; and radiological study].
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Axis, Cervical Vertebra↗
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[Atlanto-odontoid disjunction; its mechanism seen by tomography in three cases of sub-occipital Pott's disease].
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Axis, Cervical Vertebra↗
[Grisel's syndrome].
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Axis, Cervical Vertebra↗
Occipitoatlantoaxial malformation in two non-Arabian horses.
Occipitoatlantoaxial malformation was diagnosed in a 19-month-old mare of Appaloosa breeding and in a 3-year-old Quarter Horse gelding. Both horses had abnormal head and neck carriage since birth, but neurologic deficits did not become evident clinically until the horses reached 2 and 3 years of age, respectively. Palpation and manipulation of the base of the skull and cervical area proved to be useful diagnostically. Movement could not be elicited at the atlantooccipital joint but, in comparison with clinically normal horses, the range of dorsoventral motion at the atlantoaxial joint was increased. Alternate subluxation and relocation of this joint generated audible clicking sounds. Radiography revealed symmetric atlantooccipital fusion, with modification of the atlas, atlantoaxial joint, and axis. These findings were confirmed at necropsy.
Abnormalities, Multiple↗
An anatomic and morphometric study of C2 nerve root ganglion and its corresponding foramen.
STUDY DESIGN: Exposing and measuring the dorsal root ganglion of the second cervical spinal nerve (C2 ganglion) and the second intervertebral space, which is present between posterior arch of atlas (APA) and lamina of axis (LA). OBJECTIVES: This study aims to investigate the shape, size, and relation of the C2 ganglion with the adjacent structures that limits the corresponding intervertebral space and the alterations of relation between C2 ganglion and APA and between C2 ganglion and LA with the movements of the head bilaterally. SUMMARY OF BACKGROUND DATA: In previous studies, the position and the heights of the C2 ganglion have been described. But the shape of the C2 ganglion and its relation to APA and LA by the movement of the head had not been considered previously. METHODS: Upper cervical spines of 20 cadavers were dissected posteriorly. The muscles attaching to the atlas and axis were resected to ease the head movements. The heights of the C2 ganglion and space were measured in anatomic position and in hyperextension with opposite rotation position of the head. Originally in this study, plastic dough casts were used to obtain reliable outcomes. RESULTS: The shape of the ganglions was defined in three types: 70% were oval, 20% were spindle-like, and 10% were spherical. The height of the C2 ganglion was 4.97 +/- 0.92 mm on the right side and 4.6 +/- 0.84 mm on the left side. The height of the intervertebral space in anatomic position and in hyperextension with rotation to the opposite position of the head were, respectively, 9.74 +/- 1.77 mm and 7.48 +/- 1.44 mm on the right side and 9.64 +/- 1.47 mm and 7.12 +/- 0.96 mm on the left side. There was no bone contact or impact to the ganglion in each position of the head. CONCLUSION: The C2 ganglions are confident in their place between APA and LA. No bone contact to the C2 ganglion was detected in either normal limited or in forced head motions.
Adult↗
[Surgical treatment of atlanto-axial dislocation. An introduction of two new methods].
In the past fourty-two months we have operatively treated twenty cases of several types of atlanto-axial dislocation (AAD) including an atlanto-axial deformity. A transoral retropharyngeal approach to the anterior arch of the atlas and the body of the axis was performed in two cases of AAD with dens fracture, 2 traumatic pure anterior AAD with relatively narrow spinal canal and 1 os odontoideum. The operative method we have devised is a modification of the transoral micro-surgical odontoid resection. In hyperextended position the fractured dens or os odontoideum comes to the position nearest to the anterior arch of the atlas and a distance between the atlas and the axis almost disappears. In this position a Halo device is installed and the anterior arch of the atlas, the dens and the body of the axis are fixed by an autograft all together. The articular joints between the atlas and the axis are also fixed by small grafts. The "three points fixation" of the atlanto-axial vertebrae may be a better and safer operative technique for selected AADs. Another method for AAD is a posterior atlanto-axial fixation using a metal plate (Urlich Medical Instruments Co., West Germany). This technique is a modification of fixation with wire and methyl methacrylate. A strong point of this new method is that the laminae of the atlas, axis and C3 vertebra in some cases, are fixed not with wire but a plate. The wire is used only to fix the plate on the laminae, so that the wire is not snapped on elastic fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].
Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.
Adult↗
Reconstruction of the hypoplastic posterior arch of the atlas with calvarial bone grafts for posterior atlantoaxial fusion: technical report.
Posterior atlantoaxial fusion is a common procedure performed for instability at C1-C2. This operation requires intact posterior elements of both the atlas and the axis. When this is not the case, the incorporation of the occiput and the lower spinal segments is usually required for adequate posterior fusion, but such a procedure limits the mobility of the upper cervical spine. A technique for the reconstruction of the posterior arch of the atlas with calvarial bone is described in this report. This technique allowed the successful fusion of the C1 and C2 vertebrae in a patient with traumatic atlantoaxial subluxation who also had a congenital absence of the posterior arch of the atlas.
Atlanto-Axial Joint↗
[LUXATION FRACTURE BETWEEN ATLAS AND EPISTROPHEUS IN EARLY CHILDHOOD].
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Axis, Cervical Vertebra↗
[Treatment of subluxation of the atlas].
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Ascomycota↗
Occipital-axis posterior wiring and fusion for atlantoaxial dislocation associated with occipitalization of the atlas. Technical note.
The authors present their technique of occipital-axis posterior wiring and fusion for atlantoaxial dislocation associated with an occipitalized atlas. The technique consists of drilling a 3 x 1-cm horizontal groove in the occipital bone 1 cm posterior to the foramen magnum and building up a bony bridge along the posterior margin of the foramen magnum. This bony bridge is referred to as an "artificial atlas." Conventional wiring and fusion is performed between the artificial atlas and the C-2 lamina, interposing a strut bone graft. Since the compression force on tightening the wire is vertical, a very high degree of stability for the occipital-C-2 complex is achieved, facilitating early mobilization without postoperative redislocation.
Atlanto-Axial Joint↗
[Studies of gene networks and singal transduction of kidney deficiency syndrome by syndrome differentiation through drug effects].
Three kinds of networks were summarily described in this review including the small intracellular molecular networks, the middle-scale networks of hypothalamus-pituitary-adrenal-thymus (HPAT) axis and the large network, neuroendocrine-immune (NEI) network, covering the whole organism and linking multiple systems together. The hypothesis was expressed that the "disease" or "syndrome" formed in the human body by the intervention from outside world is based on the changes of multi-molecular network. In this paper, the pattern and ability of signal transduction channel and the methods of studying changes in it were also described, and raised, herefrom, "to determine syndrome by drug effects (DSDE)" is the intervention means for studying syndrome in the light of systemic biological methods. We found Kidney-yang deficiency syndrome covered the NEI network and the regulating center located in hypothamus with Compound Bushen Recipe (CBR, Kidney-tonifying recipe). By intervention with EF, an effective component of CBR, it was found that EF can activate the immune system and the three networks, including growth axis, sex hormone axis and lymphocyte apoptosis network in HPAT axis through the downward pathway of NEI network to play its efficiency of molecular network. There are many regulation patterns of EF on networks. For example, in the network mechanism of lymphocyte apoptosis and proliferation, EF can reconstruct the balance of the opposite apoptosis related genes and proliferation related genes; EF can assemble and integrate co-stimulating molecules, transform growth factors (TGF), and several oncogenes to form an upstream factor network for initiating the proliferation and anti-apoptosis promotion; EF can simultaneously up-regulate the two opposite genes expression of IkappaB and NFkappaB in NIK/IKK/IkappaB/Rel/NFkappaB signal transduction channel, which could not only control the rising of NFkappaB in a moderate range, but also guarantee its predominant status to exert its hinge role in molecule regulating network, by which gene network regulation atlas in HPAT axis of Kidney-deficiency syndrome was observed.
Animals↗
[Computed tomography in developmental anomalies of craniocervical junction].
We reviewed 27 patients with developmental anomalies in craniovertebral junction, and special attention was paid to computed tomography (CT) findings in congenital atlantoaxial dislocation (AAD), basilar invagination and Chiari malformations. In ADD, CT clearly demonstrated the relationships of the atlas to the axis in axial plane. Four major types were distinguished; anteroposterior (6 cases), transverse (0 case), anteroposterior-transverse (4 cases) and rotatory (5 cases) dislocations. It was feasible by CT to analyse the pathomechanics in each individual with AAD. Soft tissue wad was shown on the posterior aspect of the odontoid in 7 out of 15 patients with AAD. Those two features, pathomechanics of AAD and intraspinal soft tissue wad, were felt to be important for patient's symptomatology. Basilar invagination presented in no patient as a single deformity and was always associated with other bony and neural abnormalities in 14 patients. Basilar invagination might be suggested of its existence in such a case as CT showing; (1) the odontoid at or above the level of the foramen magnum, (2) distinctive margin of the foramen magnum above the bottom of the posterior fossa, and (3) the posterior arch of the atlas at the same level as foramen magnum. Nevertheless, it is essential to confirm occipital hypoplasia by using either reformatting CT images in coronal and sagittal plane or conventional tomography; whereas high resolutional CT machine provides new dimension for demonstration of bony details. In Chiari malformations, plain CT scanned by high resolutional machine often makes it possible to delineate caudal migration of the cerebellar tonsils, so that it may be a choice of examination as a screening of the anomaly. In addition, metrizamide CT clearly demonstrated caudal migration both of cerebellar tonsils and medulla oblongata. Therefore, CT apparently exceeds other diagnostic modalities in evaluating this anomaly.
Adolescent↗
Inflammatory atlanto-axial subluxation (Grisel's syndrome) in children: clinical diagnosis and management.
BACKGROUND: Grisel's syndrome is a uni- or bilateral subluxation of the atlas on the axis associated with an inflammatory condition of the head or neck. This uncommon entity usually affects children. The condition seems to be secondary to hyperemia and laxity of the atlanto-axial joints. PATIENTS AND METHODS: We report clinical and neuroimaging findings, treatment modalities, and outcomes in 4 children with atlanto-axial rotatory subluxation (AARS) associated with a previous upper respiratory tract infection treated at our Unit during the last 7 years. RESULTS: All children presented with neck pain, head tilt, and reduced neck motion. In 3 patients, the condition was secondary to otitis media and in the remaining patient to viral pharyngitis. The diagnosis was established by clinical signs and symptoms and confirmed by neuroimaging studies, especially by computerized tomography and 3-D reconstructions. Early detection and treatment resulted in a good outcome in all patients. None of the patients required surgical treatment. CONCLUSIONS: Grisel's syndrome must be suspected in children with painful torticollis associated with an upper tract respiratory infection. The best results are obtained with early conservative treatment, which prevents chronic changes leading to persistent neck pain and deformity, namely atlanto-axial rotatory fixation (AARF). We emphasize the fact that the diagnosis of Grisel's syndrome is mainly clinical, while the diagnostic confirmation of AARF can only be attained by special neuroimaging techniques.
Anti-Inflammatory Agents↗
Variations of cervical vertebrae after expression of a Hox-1.1 transgene in mice.
To understand the function of murine homeobox genes, a genetic analysis is mandatory. We generated gain-of-function mutants by introducing genomic sequences of the Hox-1.1 gene under the control of a chicken beta-actin promoter into mice. Our previous data had shown that these transgenic mice are nonviable after birth and are born with craniofacial abnormalities. In a subsequent detailed analysis of severely affected animals, malformations of the basioccipital bone, the atlas, and the axis were observed. Manifestation of an additional vertebra, a proatlas, occurred at the craniocervical transition. The dominant interference of the Hox-1.1 transgene with developmental programs seems to occur around day 9 of gestation, the time of neural crest migration and somite differentiation. We discuss the resulting phenotype with respect to a developmental control function of Hox-1.1.
Animals↗
Anatomical, biomechanical, and practical considerations in posterior occipitocervical instrumentation.
BACKGROUND CONTEXT: Patients with cervical myelopathy secondary to craniocervical instability commonly present with spinal cord compression secondary to a combination of static forces and gross instability. Craniocervical arthrodesis is therefore indicated in the treatment of the majority of these conditions. In order to facilitate arthrodesis, techniques for occipitocervical instrumentation have been developed. PURPOSE: To systematically review the anatomy, biomechanics, and practical considerations involved in posterior occipitocervical instrumentation. STUDY DESIGN: Retrospective literature review. PATIENT SAMPLE: Not applicable. OUTCOME MEASURES: Not applicable. METHODS: Retrospective literature review. RESULTS: The anatomic elements of the craniocervical junction include the occipital bone, occipital condyles, atlas (C1), and axis (C2). The occiput-C1 and C1-C2 motion segments possess unique mechanical properties. Occipitocervical instrumentation constructs are comprised of points of fixation and longitudinal elements, each with characteristic strengths and weaknesses. CONCLUSIONS: Analysis of the anatomy, available points of fixation, and the movements to be controlled leads to the choice of a longitudinal element which can control movement by incorporating the strongest points of fixation. By going through this process for each patient, an informed decision may be made regarding the optimal occipitocervical instrumentation construct.
Biomechanical Phenomena↗
Asymmetry of the odontoid-lateral mass interspaces: a radiographic finding of questionable clinical significance.
Asymmetry of the interspaces between the odontoid process and the lateral masses of the atlas is a finding occasionally noted on anteroposterior open-mouth radiographs obtained following trauma. Controversy exists as to the clinical significance of this finding in minimally symptomatic patients. Some believe this asymmetry is a normal variant, while others suggest that pathological rotation of the atlas on the axis may be present. This condition has been termed atlantoaxial rotatory subluxation (ARS), and when not corrected by 15 degrees head rotation, is said to be "fixed." Recent experience has shown that some patients with radiographic findings of ARS do not exhibit clinical signs or symptoms, leading us to question the significance of the radiographic diagnosis. A study was performed to evaluate the incidence of atlantoaxial asymmetry in normal subjects, the effect of rotation on the atlantoaxial relationship, and the ability to correct asymmetry by rotation. Eleven normal volunteers were evaluated with the following anteroposterior open-mouth views: without tilt or rotation (neutral); 15 degrees rotation in each direction; 15 degrees head and neck tilt to the right; right rotation with right tilt; and left rotation with right tilt. Six normals (54%) demonstrated atlantoaxial asymmetry in the neutral position despite proper positioning. No predictable change in the atlantoaxial relationship was produced by any of the manipulations described. Two normal subjects fulfilled the radiographic criterion for fixed atlantoaxial subluxation (asymmetry not corrected by rotation). We conclude that the radiographic finding of atlantoaxial asymmetry is common and not in itself abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Cervical signs and symptoms in patients with Meniere's disease: a controlled study.
This study compares the frequency of signs and symptoms from the cervical spine in 24 patients diagnosed with Meniere's disease and 24 control subjects from a population sample. From a previous controlled comparative study concerning signs and symptoms of craniomandibular disorders, 24 patients diagnosed with Meniere's disease (10 males and 14 females) and their 24 matched control subjects participated in this investigation on the state of the cervical spine. Symptoms of cervical spine disorders, such as head and neck/shoulder pain, were all significantly more frequent in the patient group than in the control group. Most of the patients (75%) reported a strong association between head neck movements in the atlanto-occipital and atlanto-axial joints and triggered attacks of vertigo. Also, 29% of the patients could influence their tinnitus by mandibular movements. Signs of cervical spine disorders, such as limitations in side-bending and rotation movements, were significantly more frequent in the patient group than in the control group. Tenderness to palpation of the transverse processes of the atlas and the axis, the upper and middle trapezius, and the levator scapulae muscle were also significantly more frequent in the patient group. The study shows a much higher prevalence of signs and symptoms of cervical spine disorders in patients diagnosed with Meniere's disease compared with control subjects from the general population.
Adult↗