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At least 379 records · Page 21Linked to original sources
PubMed2002

Congenital reducible atlantoaxial dislocation: classification and surgical considerations.

BACKGROUND: Reducible atlanto-axial dislocation (AAD) may cause severe motor and respiratory compromise due to recurrent spinal cord and/or brain stem impingement. To the best of the authors' knowledge, this is the first study concentrating on the classification, the protocol of the surgical management and the outcome of congenital, reducible AAD. METHODS: 109 patients with congenital, reducible AAD underwent posterior stabilization. Their preoperative disability was graded as: I (n=11, 10.09%) no functional disability (a history of minor trauma led to quadriparesis that subsequently improved); II (n=31, 28.44%) independent for activities of daily living with minor disability; III (n=42, 38.53%) partially dependent on others for their daily needs; and, IV (n=25, 22.93%) totally dependent. They were classified into 4 groups depending upon their association with: a normal odontoid and posterior arch of atlas (n=27); a dysplastic odontoid and normal posterior arch (n=25); an assimilated posterior arch (n=49); and, Arnold Chiari malformation type I (n=8). Nine patients with a dysplastic odontoid had a "hypermobile" AAD with an unrestricted backward and forward movement of the axis relative to the atlas in flexion as well as in extension of the neck, respectively. The surgical procedures included Brooks' (n=12) or modified Brooks' C1-2 fusion (n=39); Goel's C1-2 fusion (3); Ransford's contoured rod fusion (n=7); Jain's occipitocervical fusion (n=47); and, transoral decompression and Jain's occipitocervical fusion (n=1). There were 6 peri-operative mortalities in the series. FINDINGS: At follow-up (ranging from 3 months to 6 years; n=86), 64 patients had shown improvement by one grade or more; 8 patients, who had a history of transient quadriparesis but were without neurological deficits at presentation, remained in grade I; 11 had achieved stabilization of neurological functions; while 3 had deteriorated despite adequate radiological reduction of AAD and fusion of the construct. A follow-up of 6 months or more was available in 79 of these 86 patients, in whom a dynamic intrathecal CT scan showed a good osseous union. INTERPRETATION: The patients with congenital reducible AAD, depending on their surgical management, may be classified into four groups. Some patients with a dysplastic odontoid have a "hypermobile" AAD and require special care during intubation, positioning and stabilization. An assimilated posterior arch is often associated with asymmetrical lateral occipito-C1-C2 joint synostosis rendering transarticular screw placement difficult. The various causes of failure of constructs are discussed.

Adolescent↗
PubMed2001

Atlantoaxial cartilaginous exostosis causing spinal cord compression in a mature Bernese mountain dog.

Cartilaginous exostosis developed in the atlantoaxial region of a three-and-a-half-year-old Bernese mountain dog. The dog exhibited ataxia in the hindlimbs and flailing movements in the forelimbs. On survey radiographs of the cervical spine there was a focal calcified mass between the dorsal arch of the atlas and the spinous process of the axis. Lumbar myelography revealed severe dorsal spinal cord compression. The mass was removed surgically and the dog made a complete recovery. Histopathology of the excised mass was consistent with a diagnosis of cartilaginous exostosis.

Animals↗
PubMed1995

Specification of multiple vertebral identities by ectopically expressed Hoxb-8.

We have recently generated Hoxb-8 gain-of-function mutant embryos, using a Hoxb-8 transgene driven by a retinoic acid receptor beta 2 promoter to extend the expression domain to more anterior regions of the embryo (Charité et al. [1994] Cell 78:589-601). Here we describe the phenotype in the axial skeleton of transgenic embryos. The severity of the phenotype was variable, and cervical vertebrae and the base of the skull were affected in different ways. We observed fusion of the anterior arch of the atlas to the dens of the axis, partial splitting of the vertebral body and the neural arch of the axis, and abnormal morphology of the basioccipital and exoccipital bones. The basioccipital bone projected into the atlas, sometimes fusing to the dens of the axis; the exoccipitial bones appeared to be transformed towards neural arch-like structures. A novel pattern of posterior homeotic transformations was observed, involving cervical vertebrae C3 to C7: the ventral aspect of vertebrae C5 to C7 could acquire different morphologies characteristic of more posterior vertebrae: C5 could be transformed into C6, C7, or T1, C6 into C7 or T1, and C7 into T1. Phenotypes of different severity could be arranged into a phenotypic series, starting with the transformation of C7 to T1 and involving transformation of increasingly more anterior vertebrae into increasingly more posterior identities; no vertebra acquired a more posterior morphology than that of the vertebra immediately caudal to it. Ribs appeared to be formed relatively independently of rib heads; cervical ribs (but not rib heads) could be observed as anterior as C3. The results suggest that higher levels of ectopically expressed Hoxb-8 result in specification of more posterior vertebral identities.

Animals↗
PubMed2002

The atlanto-axial joint: physiological range of rotation on MRI and CT.

AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. In addition, an anatomical specimen of the atlanto-axial joint, fixed in varying degrees of rotation, was imaged using CT. RESULTS: At the extremes of physiological rotation in healthy subjects there is striking but incomplete loss of contact between the articular surfaces of the atlas (C1) and the axis (C2). The range of rotation to the right was 20-48.5 degrees (mean 32.4 degrees ) and to the left was 13-52.75 degrees (mean 34.2 degrees ). There was no significant difference between rotation to the right and left (P = 0.455). Total rotation was 45-88.5 degrees (mean 69.25 degrees ). The instantaneous axis of rotation was located within the odontoid peg. CONCLUSION: There is a wide range of atlanto-axial rotation in normal subjects. The instantaneous axis of rotation lies within the odontoid peg. The appearances of the rotated atlanto-axial joint are striking and may be misinterpreted as subluxation.

Adolescent↗
PubMed1999

Kinematic magnetic resonance imaging of the upper cervical spine using a novel positioning device.

STUDY DESIGN: The development of a novel positioning device for magnetic resonance imaging of the upper cervical spine and an evaluation of motion patterns of the craniovertebral junction in asymptomatic volunteers as a part of the whole cervical spine motion. OBJECTIVES: To design and construct a positioning device that enables magnetic resonance imaging of the cervical spine in rotation, lateral bending, flexion, and extension in a horizontally open magnetic resonance scanner, and to define reference values for movements of the occiput (C0), the atlas (C1), and the axis (C2) in asymptomatic volunteers. SUMMARY OF BACKGROUND DATA: In previously used devices, the direction of motion is limited usually to flexion-extension, or the position of the head and neck are adjusted without a positioning device using semihard wedges or pillows. METHODS: Magnetic resonance imaging of the upper cervical spine in 20 asymptomatic individuals (10 men and 10 women) was performed in a horizontally open 0.23-T magnetic resonance imager in progressive steps during rotation, lateral bending, and flexion-extension using axial, coronal, and sagittal imaging planes, respectively. The positions of C0, C1, and C2 were measured, and pattern of motions between segments analyzed. Lateral displacement of the atlas during lateral bending and cranial migration distance during flexion-extension were assessed. RESULTS: The nonferromagnetic positioning device was designed and constructed. The motion patterns of the craniovertebral junction during rotation did not differ between the men and women, but in lateral bending there was a small difference between genders at C1-C2. In men, the position of C1 during flexion-extension was consistently more extended in relation to C0 and C2 than in women. CONCLUSIONS: The new positioning device allows magnetic resonance imaging of the upper cervical spine during flexion, extension, rotation, and lateral bending. To assess the relationship between C0-C1 and C1-C2 in flexion and extension, separate reference values for men and women are recommended.

Adolescent↗
PubMed1982

Roentgenographic measurement of atlas laterality and rotation: a retrospective pre- and post-manipulation study.

Case records (523) were chosen at random from the files of J.F. Grostic, D.C. (deceased) for retrospective determination of the effects of chiropractic adjustments on atlas positioning relative to the occiput and axis. For each patient the recorded degrees of (1) atlas rotation and (2) laterality, both before and soon after spinal manipulative therapy, were extracted from the x-ray reports. Frequency histograms were made of pre- and post-adjustment degrees of laterality and rotation and the relative change of values analyzed statistically. Before manipulation, nine patients had zero atlas rotation and none were zero with respect to laterality. The mean deviation from zero degrees of "misalignment," was 2.75 and 2.63 respectively for rotation and laterality. After manipulation the corresponding values were 1.43 and 140, which is a statistically significant change. The numbers of patients who had zero rotations and laterality after adjustment were 156 and 151 respectively. In 63 patients the post-adjustment values were zero for both parameters. Under the circumstances presented in this retrospective study, these data tend to show that spinal manipulative therapy altered the position of atlas in the postulated direction.

Atlanto-Occipital Joint↗
PubMed2004

Kinematics of the upper cervical spine in rotation: in vivo three-dimensional analysis.

STUDY DESIGN: Kinematics of the upper cervical spine during head rotation were investigated using three-dimensional magnetic resonance imaging (MRI) in healthy volunteers. OBJECTIVES: To demonstrate in vivo intervertebral coupled motions of the upper cervical spine. SUMMARY OF BACKGROUND DATA: Although various in vivo and in vitro studies have identified the normal movement patterns of the upper cervical spine, no previous studies have accurately analyzed in vivo three-dimensional intervertebral motions of the upper cervical spine during head rotation. METHODS: Fifteen healthy volunteers underwent three-dimensional MRI of the upper cervical spine using a 1.0-T imager in progressive 15 degrees steps during head rotation. Segmented three-dimensional MRIs of each vertebra in the neutral position were superimposed over images taken at other positions, using voxel-based registration. Relative motions between occiput (Oc) and atlas (C1) and between C1 and axis (C2) were measured and described with 6 degrees of freedom by rigid body Euler angles and translations. RESULTS: Mean (+/- SD) maximum angles of axial rotation in Oc-C1 and C1-C2 were 1.7 +/- 1.5 degrees and 36.2 +/- 4.5 degrees to each side, respectively. Increases in angle of axial rotation in C1-C2 became smaller with increased head rotation, indicating axial rotation in C1-C2 displayed nonlinear motion. Coupled lateral bending with axial rotation was observed in the direction opposition to that of axial rotation in Oc-C1 (mean, 4.1 +/- 1.4 degrees) and C1-C2 (mean, 3.8 +/- 3.0 degrees). Coupled extension with axial rotation occurred at both C0-C1 (mean, 13.3 +/- 4.9 degrees) and C1-C2 (mean, 6.9 +/- 3.0 degrees). CONCLUSIONS: We developed an innovative in vivo three-dimensional motion analysis system using three-dimensional MRI. In vivo coupled motions of the upper cervical spine investigated using this system supported the results of the previous in vitro study.

Adult↗
PubMed2007

Safe atlantoaxial fixation using a laminar screw (intralaminar screw) in a patient with unilateral occlusion of vertebral artery: case report.

STUDY DESIGN: A case of atlantoaxial fusion using an intralaminar (unilateral-crossing laminar screw) screw is presented in a patient with unilateral vertebral artery communication with the basilar artery. OBJECTIVES: To document the significance of the intralaminar screw technique in the aforementioned case. SUMMARY OF BACKGROUND DATA: Vertebral artery injury is directly linked with intraoperative or perioperative death if the vertebral artery communicates only unilaterally to the basilar artery or has an obvious dominant side. In this situation, irrespective of whether the pedicle is confirmed to be sufficient for pedicle screw placement, if the vertebral artery is violated, fatal complications will occur. The literature reports that even proficient surgeons cannot guarantee 100% accuracy in pedicle screw placement. The intralaminar screw technique is currently the safest with regard to avoiding violation of the vertebral artery. Biomechanical studies have also shown this technique to ensure sufficient strength. METHODS: The patient had rheumatoid atlantoaxial subluxation, and the right vertebral artery alone communicated with basilar artery, while the left ended blind. She underwent atlantoaxial fixation with an intralaminar screw (unilateral-crossing laminar screw) of the axis and lateral mass atlas screws inserted via the posterior arch. RESULTS: The intralaminar screw (unilateral-crossing laminar screw) was completed, and comprised lateral mass atlas screws and rods. There were no complications during and after surgery. Good bone union was achieved. CONCLUSION: Patients with unilateral dominant vertebral artery are good candidates for the intralaminar screw technique, even if the pedicle anatomy is sufficient to insert pedicle screws.

Atlanto-Axial Joint↗
PubMed1991

[Treatment of injuries of the cervical spine].

Injuries of the cervical spine are re-evaluated at present. New surgical procedures and research on the stability, when these procedures are used, caused that surgical treatment is used more frequently. Attention is draw to provisions in the field as well as in hospitals, on the diagnostic approach and classification of these injuries, on the procedure of conservative surgical treatment. The domain of conservative treatment are injuries of the upper cervical spine (C1 and C2); injuries of the lower cervical spine are frequently unstable, and therefore frequently indicated for operation. Attention is drawn to modern views on surgical treatment of comminuted fractures of the atlas and the dens axis. The authors analyzed their own material from 1986 to April 30, 1989 and in case-histories of three patients they draw attention to their therapeutic method. The authors demonstrate their own modified plates for the anterior stabilization of the cervical spine and their modification of the Halo device "Halo Vest". They discuss biomechanical properties of posterior and anterior stabilization methods.

Adult↗
PubMed1995

[Fixed atlanto-axial rotational dislocation--a rare cause of torticollis in the child].

Two patients aged 2 and 13 years old are presented, both of whom had torticollis caused by atlanto-axial rotatory subluxation. The correct diagnosis was delayed for 3 months as a result of inappropriate radiologic evaluation. In each patient increased atlanto-dental distance, anterolisthesis of the atlas, and malrotation of the atlas relative to the axis were found on a simple lateral projection. Treatment, consisting in reduction under anaesthesia and plaster fixation for 8 weeks, was successful in the smaller child, whereas redislocation occurred in the other patient. It is imperative to exclude by early radiological examination skeletal abnormality in the presence of persisting acquired torticollis in children.

Atlanto-Axial Joint↗