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PubMed2002

[Anterolateral extension of the lateral suboccipital approach: an anatomical study].

We studied the extensions of the lateral suboccipital approach (LSOA) in seven cadaver heads, in the microsurgical laboratory, in order to establish the extensions necessary to approach the anterolateral area of the foramen magnum and the jugular foramen. The extensions (bone resection) were accomplished in five progressive steps: 1) suboccipital retrossigmoid craniectomy (LSOA retrocondylar); 2) extending the craniectomy with removal of half the occipital condyle (LSOA partial transcondylar); 3) extending the drilling of the occipital condyle to open the hypoglossal foramen, followed by removal of the jugular tubercle and opening the jugular foramen (LSOA transcondylar-transjugular); 4) complete drilling of the occipital condyle (LSOA complete transcondylar); 5) LSOA complete transcondylar plus removal of the atlas lateral mass up to the odontoid process (ASOL transcondylar-transjugular). We concluded that the extensions of LSOA should be adapted to the topography of the lesion: the LSOA retrocondylar for the lateral area of the foramen magnum; the LSOA partial transcondylar for the anterolateral portion; the LSOA transcondylar-transjugular to reach the jugular foramen; the LSOA complete transcondylar for the anterior part, and the LSOA complete transcondylar/translateral mass of the atlas for extradural lesions anterior to the foramen magnum.

Craniotomy↗
PubMed1975

[Effects of 9-fluoro-11 beta, 21-dihydroxy-16 ampha-methylpregna-1, 4-diene-3, 20-dione (A41 304) and dexamethasone on the fetus of mice and rats].

A41 304 at 400 mug/kg produced depression of body weight gains in the rat dams but did not increase the number of the fetuses with gross malformations. At 400 mug/kg of dexamethasone, body weight gains of the rat dams were markedly depressed and fetuses presented cleft palate and depression of the placental weight, body weight and crown-rump length. As for the influence of both drugs upon the fetal skeleton, ossification of the odontoid process and metatarsus was delayed and lumbar ribs increased. Dexamethasone at 400 mug/kg, in addition to these findings, caused prominently delayed ossification to the caudal vertebrae. When A41 304 at 1600 mug/kg and dexamethasone at 400 mug/kg were given to pregnant mice, cleft palate occurred with high incidences, but neither visceral abnormalities nor skeletal malformations attributable to the drug administration were observed. The critical period of cleft palate which was noted in the mice given A41 304 was day 11 through day 15 of pregnancy, mainly 11 approximately 13 of pregnancy. Cleft palate was seen in a dose-related manner in either A41 304-treated groups or dexamethasone-treated groups, but the incidence at the same dosage level was higher in dexamethasome-treated groups than in A41 304-treated groups.

Abnormalities, Drug-Induced↗
PubMed1975

[Transoral approach for the treatment of atlanto-axial dislocation with the Os odontoideum and obstruction of the bilateral vertebral arteries (author's transl)].

The two approaches are well-known in the surgical treatment of atlanto-axial dislocation, the one is the anterior and the other is the posterior approach. The indication of these methods is still controversial. This report concerns with one case of atlanto-axial dislocation with the separate odontoid and bilateral obstruction of both vertebral arteries, which was successfully treated by transoral decompression and fusion between the bodies of the atlas and axis. The reasons why we chose this method were: (1) the spinal cord decompression was necessary because of the presence of compression of the cord by the separate odontoid process, (2) the spinal fusion had to be performed to stabilize the atlanto-axial articulation, (3) it was necessary to avoid the damage of collateral circulations to the brainstem through the deep cervical arteries demonstrated by bilat vertebral angiography. The posterior approach is highly susceptible to injure these collateral circulations.

Adolescent↗
PubMed2003

[The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation].

A-38-year-old man suddenly developed nausea, vomiting and vertigo during chiropractic neck manipulation. This was followed by right hemiplegia, right deep sensory disturbance and left hypoglossal nerve palsy, consistent with the medial medullary infarction (Dejerine syndrome). The MRI revealed infarction at left medial part of the medulla. The vertebral angiogram and MRA showed marked narrowing of the left vertebral artery. X-rays of the cervical spine showed no spondylosis, dislocation nor osteolysis of the odontoid process. The serological studies, including lupus anticoagulant, protein C, and protein S gave normal results. Although vascular accidents involving the brain stem after chiropractic neck manipulation have been reported since Pratt-Thomas and Berger, previous reports are still rare. In them lateral medullary infarction (Wallenberg syndrome) is probably the most common case. On the other hand, medial medullary syndrome (Dejerine syndrome) is absolutely rare. To our knowledge, the only one report has been made by Watanabe and his colleagues before our present case. The mechanism was suggested that rotation and tilting of the neck stretches and compresses the vertebral artery at the cervical joint causing injury to the vessel, with an intimal tearing, dissection, and pseudoaneurysm formation. Consequently, the present case may be caused by injury to the left vertebral artery with an intimal tearing during neck manipulation sufficient to cause disection and subsequent infarction of the brain stem.

Adult↗
PubMed2003

Rheumatoid arthritis. Radiological changes in the cervical spine.

OBJECTIVE: To describe the radiographic cervical spine changes in rheumatoid arthritis patients. METHODS: Forty-nine patients (37 females and 12 males) diagnosed with rheumatoid arthritis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between June 1998 and June 2000, were studied for their radiographic cervical spine changes. Their mean age at disease onset was 41.4 +/- 13.4 years (range of 18-73) and mean duration of the disease was 9.1 +/- 6.28 years (range of 2-34). Their demographic data including rheumatoid factor status was obtained. Standard conventional radiographs of cervical spine were obtained to study the cervical spine changes. RESULTS: Cervical spine radiographic changes were found in 34 patients (27 females and 7 males), 10 had subluxation (7 with atlanto-axial subluxation, 2 with sub-axial subluxation, and one with lateral subluxation). No vertical impaction was seen. Erosion of odontoid process was seen in one patient. All were rheumatoid seropositive. CONCLUSION: Cervical spine changes in patients with rheumatoid arthritis are common, in particular subluxation in the upper cervical spine. Our study showed somewhat lesser prevalence of these changes. These were clinically correlated with disease duration, female sex, and rheumatoid factor, but were not statistically significant.

Adolescent↗
PubMed2003

Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis: comparison of occipitocervical fusion between c1 laminectomy and nonsurgical management.

STUDY DESIGN: A matched controlled comparative study of patients with upper cervical lesions caused by rheumatoid arthritis was performed at two different hospitals to evaluate occipitocervical fusion associated with C1 laminectomy and nonsurgical treatment. OBJECTIVES: To evaluate the long-term results and advantages of occipitocervical fusion associated with C1 laminectomy, and to compare these results with those of nonsurgical management of patients with myelopathy related to rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: Few studies have reported the prognosis of patients with rheumatoid arthritis managed by occipitocervical fusion associated with C1 laminectomy. METHODS: In this study, 40 patients with rheumatoid arthritis and myelopathy caused by irreducible atlantoaxial dislocation with or without upward migration of the odontoid process were studied. Of these 40 patients, 19 were treated by occipitocervical fusion using a rectangular rod associated with C1 laminectomy at one hospital, whereas 21 matched patients were treated conservatively at another hospital. The patients were observed by the same protocol to assess the radiologic and clinical results, including functional recovery and survival rate. All the patients were followed until their death. RESULTS: The atlantodental interval was reduced immediately after surgery, and this result had been well maintained at the final follow-up assessment. Redlund-Johnell values did not vary significantly throughout the course of the study. As for neural assessment with the Ranawat classification system, improvement was found in 13 (68%) of the 19 patients who underwent surgery. The survival rate was 84% 5 years after surgery, and 37% in the first 10 years. In the patients who did not undergo surgical treatment, atlantodental interval and Redlund- Johnell values were aggravated. These patients showed no neural improvement, and aggravation was found in 16 (76%) of the 21 cases during the follow-up period. All the patients were bedridden within 3 years after the onset of myelopathy. The survival rate was 0% in the first 8 years. CONCLUSIONS: The findings lead to the conclusion that occipitocervical fusion associated with C1 laminectomy for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.

Adult↗
PubMedDate not supplied

Atlantoaxial subluxation and syringomyelia in Down syndrome: report of one case.

Atlantoaxial instability is a relatively frequent finding in Down syndrome, but syringomyelia is a rare symptom. A four-year-old girl with Down syndrome was noted to have one year history of torticollis and progressive motor deterioration presenting with abnormal gait, ataxia or quadriparesis for the past three months. She was admitted because of acute urinary retention. Physical examination showed distended urinary bladder, hyperreflexia, bilateral ankle clonus and the existence of Babinski's signs. The x-ray films of the cervical spine showed widening between the joint space of atlas and odontoid processes. Magnetic resonance imaging revealed C1-C2 subluxation with syringomyelia. After bladder training and cervical orthosis, the symptoms improved.

Atlanto-Axial Joint↗
PubMed2004

[A case of brainstem and cerebellar infarctions related to basilar impression].

We report a 30-year-old man presenting with medial longitudinal fasciculus (MLF) syndrome after an afternoon nap. Magnetic resonance imaging revealed a right medial pontine tegmental infarction and right cerebellar infarctions. This patient was complicated with basilar impression detected on cervical X-ray and MRI. Three-dimensional CT angiography disclosed that the odontoid process migrated into the posterior fossa, thrusting the bilateral vertebral arteries postero-laterally. The mechanical stress on the bilateral vertebral arteries may have caused infarctions in the territories of the posterior circulation of this patient with basilar impression.

Adult↗
PubMed1992

[Transoral approach to the lower clivus and upper cervical spine].

5 cases were operated via a transoral approach for basilar impression (2 cases), tumor (2), or traumatic dislocation of the odontoid process (1). In all except 1 there was compression of the lower medulla and/or upper cervical cord. Posterior cervical fusion was also performed in 2 patients. There was significant improvement in all the patients who presented with neurological deficits. Surgical morbidity was low and there was no mortality. The use of the operating microscope, microdrill, self-retaining mouth retractor, flexible oral endotracheal tube, and intraoperative fluoroscopy permit a safe, direct approach to the lower clivus and upper cervical region.

Child, Preschool↗
PubMed2004

Application of CT 3D reconstruction in diagnosing atlantoaxial subluxation.

OBJECTIVE: To evaluate and compare the diagnostic value in atlantoaxial subluxation by CT three-dimensional (3D) reconstruction. METHODS: 3D reconstruction findings of 41 patients with atlantoaxial subluxation were retrospectively analyzed, and comparisons were made among images of transverse section, multiplanar reformorting (MPR), surface shade display (SSD), maximum intensity project (MIP), and volume rendering (VR). RESULTS: Of 41 patients with atlantoaxial subluxation, 31 belonged to rotary dislocation, 5 antedislocation, and 5 hind dislocation. All the cases showed the dislocated joint panel of atlantoaxial articulation. Fifteen cases showed deviation of the odontoid process and 8 cases widened distance between the dens and anterior arch of the atlas. The dislocated joint panel of atlantoaxial articulation was more clearly seen with SSD-3D imaging than any other methods. CONCLUSIONS: Atlantoaxial subluxation can well be diagnosed by CT 3D reconstruction, in which SSD-3D imaging is optimal.

Adolescent↗
PubMed2005

Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study.

OBJECTIVE: To investigate the frequency and the severity of radiological cervical spine involvement in patients with rheumatoid arthritis (RA). METHODS: We investigated 165 consecutive unselected patients with RA who fulfilled the revised American College of Rheumatology criteria for RA. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation that included hand and wrist radiographs, as well as cervical spine radiographs in anteroposterior, lateral, and lateral in full flexion views. Hand radiographs were evaluated according to the Larsen criteria, while cervical radiographs were evaluated according to Winfield classification. RESULTS: There were 143 women and 22 men, with a mean age of 59.6 +/- 12.5 and disease duration 12.3 +/- 13.9 years. Positive rheumatoid factor was found in 63.6% of patients. One hundred forty-six patients presented radiological findings related to cervical spine involvement: atlantoaxial subluxations were found in 20.6% and erosions of the odontoid process in 2.4%; none presented vertical subluxation. Subaxial subluxations were found in 43.6%, disc space narrowing at C2-C3, C3-C4, C4-C5 levels in 66.1%, and vertebral plate sclerosis and erosions in 43.6%. CONCLUSION: Cervical spine radiological involvement is a frequent finding in our patients with RA, but the severity of the disease is rather mild, possibly related to the ethnic background.

Aged↗
PubMed1992

Synovial cyst at the C1-C2 junction.

Intraspinal synovial or ganglion cysts of the cervical spine are rare. We present the third reported case of a degenerative articular cyst of the upper cervical spine, involving the quadrate ligament of the odontoid process. Magnetic resonance examination reveals typical images. A new, more general terminology is proposed.

Aged↗
PubMed1975

[Proceedings: Clinical presentations in nephrology].

Four clinical cases are presented: (a) cured systemic lupus erythematosus, fracture of the odontoid process of the axis; (b) renovascular stenosis following renal transplant; dissecting aneurysm of aorta, consolidated for the last 3 years; (c) rejection glomerulonephritis following renal transplant; (d) unusual complications in a patient of intermittent hemodialysis for the last 8 years.

Accidents, Traffic↗
PubMed1990

[Cervical chordoma. Apropos of a case].

The chordomas are malignant tumors arising from the remnants of the posterior spinal chord. The chordomas of the cervical spine are rare (5% of the spinal chordomas). A new case of spine chordoma at C5 level in a 76 years old woman is reported. The diagnosis depends on the results of the histological studies and especially the studies of the labelled elements as Protein S100 or Cytokeratin. Firstly a double osteosynthesis was realized by an anterior and posterior approach. There was no radiotherapy after this operation. A new operation for a fracture of odontoid process was necessary one year later. There was no recurrence. The patient was complaining from pains, two years after the first operation in relation to lateral recurrence. A third operation by an anterior approach was realized. A radiotherapy of 50 Gy was applied on the same level. The first osteosynthesis was with acrylic cement and the second one with an autologous bone graft and a plate after removing the cement without problem. Actually she is in good health, 78 years old.

Aged↗
PubMed1990

Sudden onset of velopharyngeal insufficiency in Klippel-Feil syndrome.

A 17-year-old girl with Klippel-Feil vertebral anomalies presented with sudden onset of VPI and hoarseness after a minor neck torsion injury. Her symptoms were felt to be due to compression of the brain stem by the odontoid process (through basilar invagination). The VPI and hoarseness responded to conservative management with oral steroids.

Adolescent↗
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

Atlantoaxial subluxation. Radiography and magnetic resonance imaging correlated to myelopathy.

Twenty-nine patients with atlantoaxial subluxation (18 with rheumatoid arthritis, 2 due to trauma, 4 with os odontoideum, and one each with polyarteritis nodosa, rheumatic fever. Klippel-Feil syndrome, achondroplasia, and cause unknown) were evaluated using a 0.22 tesla resistive MRI unit. Cord compression was classified into four grades according to the degree on magnetic resonance imaging. There were 7 patients with no thecal sac compression (grade 0). 10 with a minimal degree of subarachnoid space compression without cord compression (grade 1), 7 with mild cord compression (grade 2), and 5 with severe cord compression or cord atrophy (grade 3). Although the severity of myelopathy showed poor correlation with the atlantodental interval on conventional radiography, high correlation was observed between MR grading and the degree of myelopathy. The high signal intensity foci were observed in 7 of 12 patients with cord compression (grades 2 and 3) on T2 weighted images. Other frequently observed findings in rheumatoid arthritis included soft tissue masses of low to intermediate signal intensity in the paraodontoid space, erosions of the odontoid processes, and atlantoaxial impaction on T1 and T2 weighted images.

Adolescent↗
PubMed1988

[Injuries of the cervical spine--surgical therapy].

Surgical treatment of unstable cervical spine injuries has justifiably gained acceptance when based on definite indications and methods of internal fixation. Direct anterior screw fixation of the odontoid process is the appropriate procedure for stabilizing articulation fractures. Many instability problems of the upper cervical spine can be solved with posterior transarticular fixation C1/C2 according to Magerl. Of the posterior procedures for the lower cervical spine, hook-plate fixation according to Magerl is preferable to wirings. Plate fixation with hollow titanium screws (Morscher) has proved a successful anterior procedure. The two methods can be combined to treat severe osteoligamentous injuries.

Cervical Vertebrae↗