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 343 records · Page 19Linked to original sources
PubMed1998

Odontoid process and C1-C2 corrective osteotomy through a posterior approach: technical case report.

OBJECTIVE AND IMPORTANCE: To demonstrate a new posterior approach to the anterior elements of the atlas and the axis including the odontoid process. CLINICAL PRESENTATION: A 36-year-old woman presented with ankylosing spondylitis and severe flexion deformity of the cervical spine. She had sustained a trauma 5 years previously, causing the inability to look forward or to open the jaw adequately. An examination demonstrated fixed flexion and rotation of the cervical spine, with no neurological deficit. Radiologically, there was fusion of C1, C2, and the clivus. TECHNIQUE: The upper cervical vertebrae were exposed via a midline posterior incision, the posterior arch of C1 was excised, and the vertebral arteries were mobilized. A wedge osteotomy was performed through the lateral masses of C1 and subsequently through the odontoid. The head was repositioned, and C1-C2 lateral mass screws and a Ransford loop were inserted. CONCLUSION: It is possible to gain sufficient surgical access to the odontoid process via a posterior approach. The technique described is of benefit when the alternative anterior approaches to the upper cervical spine are technically difficult or impossible.

Adult↗
PubMed1991

Cineradiographic motion analysis of atlantoaxial instability in os odontoideum.

Cineradiography was used to study six patients with os odontoideum. Atlantoaxial kinematics was analyzed with the relative motion of the atlas on the axis. In all cases, the tracing of the anterior arch was straight in the sagittal plane, whereas the posterior arch moved in two different configurations: straight and S-shaped. In cases of S-shaped configurations, the anterior translation occurred in the neutral position. Such translation could threaten the stability of the atlantoaxial complex fixed with posterior wiring because circumferential wires allow the laminas to rotate in the sagittal direction. In patients with os odontoideum, pathomechanics of the atlantoaxial joint should be examined with cineradiography in order biomechanically to determine the soundest fixation.

Adolescent↗
PubMed1996

Fatal transdental posterior rotary subluxation of the cervical spine. A case report.

STUDY DESIGN: The cervical spine of an 86-year-old man known to have a fracture of the odontoid process was removed at autopsy and dissected. OBJECTIVES: To establish the cause of death, which was not apparent. SUMMARY OF BACKGROUND DATA: Ruptures of the vertebral arteries in patients with fractures of the odontoid process are rare. Only a few reports are published in the literature. Those that address postmortem findings in patients with fractures of the odontoid process do not make any reference to associated capsular and ligamentous injuries and the resultant instabilities. METHODS: Because of legal constraints, the cervical spine was removed en bloc 1 week after the patient's death and carefully dissected. RESULTS: In addition to the known bony injury, rupture of the left vertebral artery, epidural hematoma, disruption of the posterior atlantoaxial ligaments, hemorrhage into the anterior ligamentous structures, rupture of the capsule of the right atlantoaxial joint, and stretching of the capsule of the left joint were found to be present. Displacement of the spinal cord by an epidural hematoma secondary to rupture of the left vertebral artery was recorded as the apparent cause of death. The rupture had obviously been caused by the abnormal rotation of the atlas on the axis in a clockwise direction. CONCLUSIONS: Both the fatal outcome and the pathologic examination showed that established management concepts, particularly screw fixation of a fractured odontoid process, should be reconsidered in light of the potential occurrence of transdental posterior rotary subluxation. Because the incidence of capsular, ligamentous, and vascular injuries associated with fractures of the odontoid process is still poorly understood, more autopsies would be needed. The case also raises the question of whether, in an elderly patient like ours, a fracture of the odontoid process should prompt immediate surgical stabilization.

Aged↗
PubMed1998

Atlantoaxial rotatory dislocation. A case report.

STUDY DESIGN: Report of a child who sustained an acute atlantoaxial rotatory dislocation, associated with fractures of the clavicle and the temporal bone, and rupture of the alar ligament demonstrated by magnetic resonance imaging. OBJECTIVE: To describe the radiographic and pathoanatomic characteristics of the injury process. SUMMARY OF BACKGROUND DATA: Only five cases of traumatic atlantoaxial rotatory dislocation associated with fracture of the clavicle have been reported previously. This is the first report of a ruptured alar ligament demonstrated on magnetic resonance imaging in a patient with atlantoaxial rotatory dislocation associated with fractures of the clavicle and the temporal bone. METHODS: Computed tomography revealed the Type 1 rotatory dislocation described by Fielding and Hawkins, and magnetic resonance imaging delineated the ruptured alar ligament. RESULTS: Traction in a halter, followed by 6 weeks of immobilization with a cervical collar, was successful in the management of the injury. CONCLUSION: Concomitant fractures of the right temporal bone and the right clavicle may yield excessive left rotation of the atlas on the axis, resulting in the rupture of the right alar ligament. Awareness of this condition allows early diagnosis and effective conservative treatment.

Accidents, Traffic↗
PubMed2005

Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report.

STUDY DESIGN: Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain. OBJECTIVE: To report this rare case that was successfully treated with long-term traction and a brace. SUMMARY OF BACKGROUND DATA: AARF is a rare kind of subluxation that is a pathologic fixation of the atlas on the axis. It is most common in pediatric patients and is usually reduced easily with conservative treatments only in the acute stage. However, previously reported chronic AARFs have usually been treated with operative reductions. Although high success rates have been achieved with operative reduction in chronic cases of AARF, even successful operative reduction may result in significant neck motion limitation. METHODS: A 9-year-old girl had torticollis of more than 3 months duration develop as a result of an upper respiratory infection. Dynamic computerized tomography showed consistent fixation of the atlantoaxial joint consistent with type 1 AARF according to the classification of Li and Pang. The patient was treated with halter traction of 5-lb weight for 6 weeks, and with a brace for 4 months and collar for 2 months. RESULTS: We successfully treated this patient with chronic AARF only with cervical traction. She had full recovery of neck motion and normal atlantoaxial angle on follow-up computerized tomography after 6 months. CONCLUSION: From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.

Atlanto-Axial Joint↗
PubMedDate not supplied

Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts.

Atlantoaxial instability can lead to severe, permanent neurologic compromise and death if not treated by cervical fusion. However, identification of atlantoaxial subluxation can be difficult owing to the often confusing signs and symptoms. We describe a patient with unexplained transient repeated cerebral and cerebellar signs who had 10 mm of translation of the atlas on the axis owing to os odontoideum with infarcts in the cerebellum and occipital parietal lobes. These correlated with angiographically documented vertebral artery narrowing at the level of the axis and the subsequent low flow to the posterior cerebellum. After stabilization and fusion of the cervical spine, the patient regained normal neurologic function and has remained symptom-free at 2 years of follow-up.

Atlanto-Axial Joint↗
PubMed2004

The accessory atlantoaxial ligament.

OBJECTIVE: The stability of the joints connecting the cranium to the upper cervical spine is of vital importance. The ligaments of this region, for the most part, have been thoroughly investigated, with the exception of the accessory atlantoaxial ligament. METHODS: Ten cadaveric specimens were examined to observe the anatomy of this ligament. RESULTS: This ligament was found in all specimens, and in each, it not only connected the atlas to the axis but also continued cephalically to the occipital bone. The approximate dimensions of this structure were 3 cm x 5 mm. Functionally, this ligament became maximally taut with a rotation of the head of 5 to 8 degrees. Laxity was observed with cervical extension, and maximal tautness was seen at 5 to 10 degrees of cervical flexion. CONCLUSION: The accessory atlantoaxial ligament seems to participate in craniocervical stability and perhaps should be renamed the accessory alar ligament or accessory atlantoaxialoccipital ligament; both of these terms better denote its anatomic characteristics. Perhaps in the future, better magnetic resonance imaging techniques and machines will be able to identify this structure so as to appreciate its integrity after upper cervical spine trauma.

Aged↗
PubMed1990

One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation.

An operation which combined anterior transoral decompression with posterior occipitocervical fixation was used in 68 rheumatoid patients with irreducible anterior neuraxial compression at the craniocervical junction. Fibre-optic laryngoscopy with nasotracheal intubation was less hazardous than tracheostomy. The patients underwent surgery in the lateral position to allow access both to the mouth and to the back of the neck without moving the head. Specially designed instruments allowed visualisation from the front without dividing the soft palate. Posterior stabilisation was achieved by a preformed contoured loop fixed to the occiput, the atlas and the axis by sublaminar wires. The procedure allowed immediate mobilisation and had a very low morbidity in such ill patients.

Arthritis, Rheumatoid↗
PubMed2003

Posterior atlantoaxial dislocation without fracture. Case report.

Posterior dislocation of the atlas onto the axis without related fracture of the odontoid process is a very rare traumatic condition of which five cases have been previously reported. The authors present a sixth case in which management was different from the others. The patient was successfully treated by open reduction of the dislocation and C1-2 transarticular screw fixation. The rarity of the lesion, the differences in diagnostic studies, and the successful treatment by safe intraoperative reduction and fixation are factors of interest in this case.

Atlanto-Axial Joint↗
PubMed2000

Upper cervical spine surgery in rheumatoid arthritis: retrospective study of 30 patients followed for two years or more after Cotrel-Dubousset instrumentation.

PURPOSE: To evaluate the efficacy of upper cervical spine surgery in symptomatic atlantoaxial instability due to rheumatoid arthritis (RA). MATERIAL AND METHODS: Thirty RA patients (29 women and one man) with a mean age of 56 years were studied retrospectively. Symptomatic forward slippage of the atlas on the axis with a synovial pannus surrounding the odontoid and magnetic resonance imaging evidence of spinal cord compression was present in all 30 patients; 18 patients had vertical translocation of the odontoid and 14 had basilar invagination. Surgery, performed between 1991 and 1997, consisted of occipitocervical fusion in 18 patients and atlantoaxial fusion in 12. Cotrel-Dubousset instrumentation was performed in all 30 patients. RESULTS: Mean follow-up was four and a half years. All patients were satisfied with the procedure and exhibited marked functional gains and objective neurological improvement (by one class in the Ranawat scheme). Stable fusion was documented in all 30 patients. CONCLUSION: Cervical instrumentation and bone grafting seems to provide functional and neurological gains in carefully selected RA patients with atlantoaxial instability and spinal cord compression. Long term follow-up suggests that the benefits are sustained and that morbidity is low.

Adult↗