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PubMed1994

[Structure of the axis--key to the etiology of the dens fracture].

Fractures of the dens are seen especially in young adolescents but also in individuals after the sixth decade of life. The etiology of these fractures and the occurrence of non-union after initial treatment is still discussed controversially. To address these issues, the axis was removed from thirty-seven autopsy cases for histomorphometric analysis. The base of the dens is a region of least resistance for fractures due to its reduced trabecular bone volume, a poorer trabecular interconnection and a cortical thickness one third that of the axis. In all of the cases, trabeculae disconnected from the trabecular lattice, and in 30% microcallus formations were demonstrated in the base of the dens. In osteoporotics the microarchitectural differences of cancellous bone between the base of the dens and the other regions of the axis are increased markedly. The obtained data suggest that the bone structure of the axis is responsible for the location, the distribution and the frequency of fractures of the odontoid process. The deficiency of bone mass within the base also offers a new explantation for the occurrence of non-unions even after treatment of fractures of the base of the dens.

Adolescent↗
PubMed2000

The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease.

The crowned dens syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.

Acute Disease↗
PubMed1998

Plasmacytoma of dens as a cause of atlanto-axial instability.

A case of Plasmacytoma of dens (Odontoid Process) in an adult male managed by trans-oral excision and posterior fusion is reported for its rarity. The importance of neuro-imaging and the treatment options, in view of the associated instability at the atlanto-axial region and the difficulty in preoperative diagnosis are emphasized.

Adult↗
PubMed2000

Dolichoodontoid. A rare cranio-cervical anomaly--MRI findings.

The case of a 40-year-old woman with a dolichoodontoid, a rare congenital anomaly of the cranio-cervical region, is presented. Due to summation image and overlying bony structures, plain radiographs in two planes were inconclusive. MRI revealed the hyperplasia of the odontoid process, allowed a grading of the subtype of this disorder and demonstrated its relationship to the neural structures within the foramen magnum and the upper cervical spine. Additional inflammatory disease, suspected in this patient with long standing rheumatoid arthritis could be excluded by MRI.

Adult↗
PubMed1992

Osteosynthesis of injuries and rheumatic or congenital instabilities of the upper cervical spine using double-threaded screws.

The surgical treatment of instabilities of the upper cervical spine, independent of their cause, requires the use of differentiated procedures if functional anatomy is to be largely restored. Successful procedures have been the diagonal screw fixation of the axis from the anterolateral aspect in case of acute fractures of the odontoid process, transpedicular screw osteosynthesis of C2 in hangman's fractures with bony instability, and the transarticular screw fixation of C 1/2 with interarcual fusion for atlantoaxial instabilities. Compared with conventional screws, the use of double-threaded screws which are almost totally imbedded in the vertebral body has the advantage of eliminating local irritation, reducing the risk of surgery, and simplifying the operative procedure itself.

Bone Screws↗
PubMed1989

The transoropalatal approach to the atlantoaxial-clival region: considerations for the head and neck surgeon.

The transoropalatal approach to the atlantoaxial-clival area provides excellent exposure for neurosurgical decompression and fusion procedures. The technique has been effectively applied in the treatment of bony and soft tissue abnormalities of the anterior spinal region. Although this approach is safe and reliable, it is not part of the otolaryngologist's usual surgical armamentarium. In the present study, we describe the case histories of five patients who underwent resection of the odontoid process for cervicomedullary compression. Neurological compromise was manifested by progressive upper and/or lower extremity paresis in all patients. In each patient, a transoropalatal approach was used. The surgical technique is discussed, and the prevention of possible sequelae, including velopharyngeal incompetence and palatal or pharyngeal wound dehiscence, is addressed.

Adult↗
PubMed2003

Stresses on the cervical column associated with vertical occlusal alteration.

The biomechanical effects on cervical vertebral columns (C1-C7) during mastication were calculated using a three-dimensional (3D) finite element method. To verify the biomechanical influences of vertical occlusal alteration to the cervical column, three finite element models (FEM) showing a normal (model A), a steep (model B), and a flat occlusal plane (model C) were constructed. The occlusal stress distribution showed various patterns for the three models; the stress extended to the anterior area as the occlusal plane became steeper. The plots of the stresses on the mid sagittal section of the cervical columns showed different patterns for the three models; the stress converged at the odontoid process in models A and B, whereas the stresses at C7 in model B tended to decrease compared with model A. Concentrated stress was observed at C5 in model C, supporting the hypothesis that vertical occlusal alteration could influence stress distribution in the cervical columns.

Adult↗
PubMedDate not supplied

[Incidence of occipito-cervical instability in Down syndrome].

Seventy children with Down Syndrome (22 boys and 48 girls), ages ranging between five and seventeen years, were evaluated for instability of the upper cervical-spine. X-ray study of this region in lateral projection was did, in neutral position and flexion-extension of the neck. The distance between the anterior arch of the atlas and odontoid process as well as the displacement of the basion in relation to the first cervical vertebrae were examined. Twelve patients (17.14 percent) exhibited motion alterations of the region studied: atlanto-axial instability in eight cases (interval bigger than 4.5 mm) and atlanto-occipital instability in four cases.

Adolescent↗
PubMed1989

[Odontoid fractures in childhood].

Using a case report as an example, we report on the special features involved in fracture of the odontoid process in childhood. Although fractures of the cervical spine are very rare in children, this is the most common form. The fracture line will follow in subdental synchondrosis, so that it is possible to obtain complete recovery in nearly all cases. Conservative therapy is indicated if the diagnosis is correct. There is a detailed discussion on the embryonal and radiological peculiarities of this age group.

Axis, Cervical Vertebra↗
PubMed2000

[Delayed diagnosis of odontoid fracture after whiplash trauma of the cervical spine].

Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially if combined with a dens displacement of over 6 mm. In severe cervical spine trauma, these fractures do not usually cause difficulties in diagnosis. However, in whiplash injuries, which are very common and only rarely associated with such fractures, the surgical management can be complicated if they are underestimated. These patients can present without significant neurological deficits or the situation can be complicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented.

Adult↗
PubMed1997

Odontoid fractures in the child with neurological injury. Direct anterior osteosynthesis with a cortico-spongious screw and literature review.

Few cases of fracture of the odontoid process in children have been reported in the literature. A case with an associated severe traumatic brain injury and a suspected clinical high cervical spinal cord injury is reported here. This case is of interest because of the surgical treatment selected. A direct surgical approach was used for anterior screwing, with an excellent result. In some precisely defined circumstances, therefore, this treatment can be indicated.

Bone Screws↗
PubMed1992

Quantitative internal dens morphology.

Recent work has demonstrated the highly variable and unpredictable external dimensions of the dens (odontoid process). No data have been available regarding internal dimensions. Quantitative computed tomography analysis of 120 axis vertebrae allowed nondestructive measurement of external and internal dens dimensions. The external computed tomography measurements correlated well with caliper-derived data. Minimum internal dens dimensions and cortical thicknesses in the sagittal and transverse planes are reported. Some axis vertebrae may not be amenable to internal fixation of type II dens fractures. Preoperative planning should include quantitative computed tomography analysis of the dens.

Adult↗
PubMed1990

[Axial osteosynthesis of dens axis fracture as a routine procedure in neurotraumatology. Diagnosis--Surgical-technique--Complications--Follow-up].

A survey on 34 cases of odontoid process fractures treated by means of axial osteosynthesis since 1981. In cases of acute fractures rate of bony consolidation was 100%, in cases of pseudoarthrosis 50%. 6 complications until the first 20 weeks were successfully treated. No later complications. Removal of implanted material is usually not necessary. Operative treatment of non union by means of bony grafting, axial osteosynthesis and atlanto-axial arthrodesis seems to be helpful. Investigations for the best implantation model must be continued.

Adolescent↗
PubMed1993

Synovial cyst of dens causing spinal cord compression. Case report.

We report a rare case of synovial cyst of the dens (odontoid process) in a 61 year old women with no previous history of trauma. She had progressive symptoms of 1 year's duration due to spinal cord compression. Magnetic resonance imaging of cervical spine revealed a large mass posterior to the dens which was compressing the spinal cord near the cervicomedullary junction. This lesion was at first considered radiologically to represent an exuberant pannus formation or a meningioma of the foramen magnum, but subsequent surgical intervention and pathological examination revealed that it was a synovial cyst. Similar cases reported in the literature are reviewed and discussed.

Female↗
PubMed1996

Odontoid fracture and C1-C2 subluxation in psoriatic cervical spondyloarthropathy. A case report.

STUDY DESIGN: Case presentation and review of pertinent literature. OBJECTIVES: To present an unusual case and alert other physicians to possible missed diagnoses. SUMMARY OF BACKGROUND DATA: An unusual case is presented of a young man with server psoriatic spondyloarthropathy and fusion of C2-C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1-C2 and the transitory tetraplegia. The patient presented with torticollis, and the fracture was unrecognized for a long period of time. METHODS: Case presentation. RESULTS: This patient became independent in all activities of daily living after surgery and rehabilitation despite persistence of torticollis. CONCLUSIONS: A patient who presents clinically with traumatic torticollis after minor trauma and who also has psoriasis and ankylosis of the cervical spine should be suspected of having a fracture-subluxation until definitely proven otherwise. In the present case, the late diagnosis delayed surgical stabilization.

Adult↗
PubMed2005

Abnormal mandibular growth after craniovertebral surgery in Morquio syndrome type A.

Morquio syndrome or MPS4A is an autosomal recessive inherited metabolic disease, due to a deficiency of N-acetil-galactosamine-6-sulfatase (OMIM 253000). Hypoplastic odontoid processes causing atlantoaxial subluxation and cervical myelopathy are usual clinical findings. Surgical intervention of craniocervical fusion is often performed to prevent this complication. Clinical and cephalometric findings in a patient affected by Morquio syndrome after craniovertebral surgery are described. Facial growth pattern in the lateral plane changed dramatically. The mandibular gonial angle (ArGoMe), the body of the mandible (GoGn), and the total length of the mandible (CoGn) increased abnormally, whereas the mandibular ramus (CoGo) exhibited normal growth. Knowledge of the possibility of abnormal mandibular growth may contribute in long-term orthodontic management of such subjects.

Adult↗
PubMed2004

Retroodontoid pseudotumor resected by a high cervical lateral approach in a rheumatoid arthritis patient: a case report.

A retroodontoid pseudotumor is a nonneoplastic mass arising posterior to the odontoid process. We describe a 67-year-old woman admitted to our hospital with numbness of the left upper extremity, dysbasia, and impairment of fine motor movement of the fingers. She was diagnosed with myelopathy due to a retroodontoid pseudotumor underlying rheumatoid arthritis. According to previously published reports, reduction of the pseudotumor was achieved by posterior fusion alone. However, in the present report, the tumor was very large, and there was no instability at the atlantoaxial segment. Therefore we managed the patient by resection of the mass through a high lateral cervical approach without fusion. The spinal cord symptoms diminished rapidly.

Aged↗