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At least 595 records · Page 33Linked to original sources
PubMed1994

Realignment of postoperative cervical kyphosis in children by vertebral remodeling.

STUDY DESIGN: This study analyzed radiographically change in the sagittal curvature of the cervical spine after atlantoaxial (C1-C2) posterior fusion in children. OBJECTIVES: This study clarified the process of spinal remodeling after postoperative cervical deformation in children. SUMMARY OF BACKGROUND DATA: Postoperative spinal deformations in children are observed frequently. However, there have been only a few reports on postoperative changes in the sagittal curvature of the cervical spine and spinal remodeling after those changes. METHODS: Between 1979 and 1991, there was a total of 12 children who underwent C1-C2 posterior fusions. The average age at the time of surgery was 9.8 years. The alignment of the cervical spine was classified into four groups (lordosis, straight, kyphosis, and swan-neck deformity). Radiographic findings suggestive of the remodeling were as follows: 1) new bone formation on the anterior vertebral cortex, and 2) increase in body/canal ratio (BCR). The follow-up period averaged 6.2 years. RESULTS: Postoperative cervical malalignment (kyphosis or swan-neck deformity) occurred in four patients. In all four patients, new bone formation and increase in BCR at the apex of kyphosis were observed. Therefore, there was gradual improvement of the malalignment by vertebral remodeling. This phenomenon was not observed in eight patients with normal alignment. CONCLUSION: Realignment of postoperative cervical kyphosis by vertebral remodeling was observed in children. The results of this study suggested that remodeling occurred even in the spine, which was similar to the remodeling in long bones.

Atlanto-Axial Joint↗
PubMed1988

Congenital odontoid aplasia and posterior circulation stroke in childhood.

Head trauma and vigorous physical activity were followed by delayed-onset posterior circulation stroke in a 5-year-old boy with odontoid aplasia and C1-C2 subluxation. Angiography demonstrated vertebral artery narrowing and occlusion of the left anterior-inferior cerebellar and posterior cerebral arteries. Odontoid aplasia and other atlantoaxial dislocations are treatable causes of posterior circulation insufficiency in childhood; these defects may be overlooked without appropriate radiographic study of the cervical spine using flexion-extension views.

Atlanto-Axial Joint↗
PubMed1991

Septic arthritis of the C1-C2 lateral facet joint and torticollis: pseudo-Grisel's syndrome.

We present the case of a 76-year-old man who experienced the sudden development of fever, rightsided neck pain and stiffness, and torticollis. A soft tissue mass was noted on the right side of his neck, but his head was tilted to the left. Computed tomography scans (with reformatted sagittal and coronal images) of the patient's cervical spine revealed destructive changes of the right lateral masses of C1 and C2 and the clivus, and a well-delineated peridontoid soft tissue mass (confirmed by magnetic resonance imaging). After the second episode of right-sided hemiparesis, he underwent transoral surgical exploration, with anterior decompression and odontoidectomy. Histologic examination of the surgical material revealed granulation tissue, fibrosis, and chronic inflammation, consistent with abscess formation with invasion and compression of the spinal cord and bone. This case suggests that nonreducible rotational head tilt to the side opposite the side of lateral mass collapse should raise the suspicion of a possible infection.

Aged↗
PubMed2005

Do sagittal plane anatomical variations (angulation) of the cervical facets and C2 odontoid affect the geometrical configuration of the cervical lordosis?

Anthropometric and statistical evaluation of measurements from digitization of 252 lateral cervical radiographs were used to investigate any correlation between radiographic measurements of cervical lordosis with sagittal plane facet angulation, articular pillar height, and inclination of the C2 odontoid with respect to the body of C2. Some researchers have hypothesized that facet and odontoid architecture variations can cause a reduction in cervical lordosis. To evaluate this hypothesis, the posterior aspect of the C2 dens, vertebral body corners, and superior and inferior facet surfaces of C2-C7 were digitized on 252 lateral cervical X-rays to calculate global angle, segmental angles, dens angle, facet angles, and facet height. No correlation between facet angle, articular pillar height, and cervical curve was found. Similarly, no correlation between the sagittal angle of the dens and any angle of cervical curvature was identified. There was correlation between the global ARA C2-C7 angle and the Cobb angles at C1-C7 (r = 0.71) and C2-C7 (r = 0.82). There was correlation between the global inclination of the atlas vertebral angle (APL) and the Cobb angle at C1-C7 (r = 0.66), Cobb angle at C2-C7 (r = 0.39), ARA C2-C7 (r = 0.42), and anterior translation of C2 compared to C7 (r = -0.46). Because no correlation between cervical facet and odontoid architecture and any segmental or global angle of cervical lordosis was found, conservative and surgical rehabilitative techniques aimed at the reduction of sagittal cervical deformities do not need to account for a patient's architecture of the cervical facets nor odontoid.

Adult↗
PubMed2005

Accessory joints between basiocciput and atlas/axis in the median plane.

To explore the many osseous irregularities that are found in the area between the basiocciput, the anterior arch of the atlas and the tip of the dens axis we studied 99 cadaver specimens using magnetic resonance tomography (MRT), computed tomography (CT), median saw-cut sections, and histological sections. Additionally, "dry" specimens of the skull (n = 110), atlas (n = 56), and axis (n = 33) were investigated. In the median plane, the dry and cadaver specimens exhibited osteoarthritis-related osseous outgrowths and osteophytes of the articular surfaces of the median atlanto-axial joint (n = 63), and the presence of congenitally developed free ossicles (n = 22) and of third occipital condyles (n = 3). The largest osteophytes (giant osteophytes) (n = 4) of the anterior arch of the atlas formed osseous contact zones with the basiocciput that were visible histologically as real joints and were designated accessory median atlanto-occipital joints. The third occipital condyles also formed osseous contact zones, visible histologically as real joints, with the anterior arch of the atlas or with the tip of the dens, and were designated accessory atlanto-occipital or occipito-odontoid joints. Frequent free ossicles, incorporated into the accessory joint, were found by histological examination to be covered with hyaline cartilage.

Adult↗
PubMed1988

The transoral approach to the anterior superior cervical spine. A review of 29 cases.

The transoral surgical approach is the most direct operative approach to pathology ventral to the brain stem and superior spinal cord. This approach is useful in the treatment of extradural compressive cervicomedullary lesions in selected patients. Twenty-nine patients with ventral extradural brain stem or cervical cord compressive lesions who were treated via the transoral surgical approach are presented. Their evaluation, treatment, and long-term outcome will be reviewed (median follow-up, 24 months). Specific features of the transoral procedure, including intraoperative monitoring, methods of retraction, and microsurgical techniques that contributed to minimal operative morbidity (3%) and zero operative mortality, will be discussed.

Humans↗
PubMed1988

Posterior acrylic surgical fixation of odontoid fractures.

Fourteen cases of odontoid fractures had, as primary treatment, a posterior surgical fixation (C1 + C2 + C3 and occiput in some cases) by means of acrylate and stainless steel wires, without waiting for the unpredictable final results of external systems of stabilization. The youngest patient was 20 years old, the oldest 84 years old. No immediate or late neurological complications occurred (follow-up: one year to ten years). All the patients were mobilized early without external fixation. Union of the dens took place in eleven cases, and good stabilization in the remainder. Thirteen patients recovered, one improved. Posterior acrylic fixation is the treatment of choice in cases of odontoid fracture, particularly in elderly patients in whom a solid union rarely is obtained.

Acrylates↗
PubMed1993

Os odontoideum in identical twins: perspectives on etiology.

Most authorities favor the hypothesis of an acquired etiology of os odontoideum. We present the cases of identical twin sisters with os odontoideum in association with a congenital partial fusion of the posterior elements of the second and third cervical vertebrae, and discuss the implications. We believe that this is the first report of familial os odontoideum in a context which suggests a genetic etiology.

Adult↗
PubMed1995

Atlantoaxial instability in a 7-year-old boy associated with traumatic disrupture of the ossiculum terminale (apical odontoid epiphysis).

A case of atlantoaxial instability with a rare etiology in a boy of 7 years and 3 months is presented. Computerized tomography with three-dimensional reconstruction revealed avulsion of the ossiculum terminale (apical odontoid epiphysis). Developmental peculiarities and relevant disorders of the infantile upper cervical spine are discussed. Temporary posterior C1/C2 fusion and transdental screw fixation of the ossiculum terminale were attempted in order to stabilize C1/C2 and avoid permanent fusion. After removal of the dorsal implants, the transdental screw broke, the instability recurred and a permanent atlantoaxial fusion had to be performed.

Atlanto-Axial Joint↗
PubMed1994

Non-traumatic atlanto-axial subluxation in an 8-year-old child.

An 8-year-old child with a previous history of neonatal retropharyngeal abscess presented with a 6-month history of progressive quadriparesis. Investigations demonstrated atlanto-axial subluxation with anterior displacement of the odontoid peg to a position anterior to the vertebral body of C2. Magnetic resonance imaging confirmed severe neural compression at this level. The child was placed in a halo fixation device and underwent transoral removal of the odontoid peg together with the upper part of the body of C2. At a subsequent procedure a posterior occipito-cervical fusion was performed. The aetiology and management of this case are discussed.

Atlanto-Axial Joint↗
PubMed1989

CT of dens axis fractures.

The distinction between the different types of dens axis fracture is important. Fractures at the base of dens (Type II) may be overlooked if reformated images are not made. If the fracture extends downward into the body of the vertebra (Type III), the body fragment may rotate into the spinal canal. The rotation is difficult to see on plain films, but is easily seen at axial CT.

Axis, Cervical Vertebra↗
PubMed1985

"V" shaped predens space.

"V" shaped widening of the predens space (PDS) in flexion can be a worrisome finding in trauma patients, possibly representing injury to the transverse ligament. These patients may also show widening of the C-1/C-2 interspinous distance. We think this appearance is usually due to increased flexion mobility at the atlantoaxial level with developmental elongation or laxity of the cranial end of the transverse ligament and/or the posterior ligamentous complex. Tearing of only the cranial end of the transverse ligament must be extremely rare, if it occurs at all; there is no reported proven case. Tearing of only posterior ligaments seems possible and should be evaluated clinically.

Adolescent↗