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At least 631 records · Page 35Linked to original sources
PubMed2001

[Transoral atlanto-axial plate fixation in the treatment of a malunited dens fracture and secondary atlanto-axial instability].

INTRODUCTION: A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instability is presented. The significant narrowing of the spinal canal due to the atlanto-axial instability was associated with anterior myelon compression and neurological deficit. METHODS: A transoral approach with odontoid resection and anterior atlanto-axial plate fixation was performed. With this technique the atlanto-axial subluxation was reduced and the myelon was decompressed. RESULTS: The postoperative course was uneventful. The follow-up showed a complete remission of the neurological deficit and a bony fusion of the atlanto-axial joints. CONCLUSIONS: The presented case illustrates the importance of an accurate initial diagnosis of the degree of instability and the need for short-term follow-up examinations. If atlanto-axial pseudarthrosis or malunion with anterior spinal cord compression occurs, a transoral procedure with odontoid resection and atlanto-axial plate fixation seems to be an excellent salvage procedure.

Adult↗
PubMed2002

[Injuries of the alar ligaments in children and adolescents].

Cervical spine trauma most commonly involves the lower parts in adults. In children lesions of the cervical spine can predominantly be found in the region of C1/C2 including ligament injuries at this level. However such injuries are difficult to detect and only few data are available concerning therapy and prognosis of atlantoxial ligament lesions. We report on two children suffering from isolated rupture of the alar ligaments. Both injuries were proven by magnetic resonance imaging which is recommended as the resource of choice for the evaluation of the cervical spine soft tissues in children. Although the biomechanic properties of the alar ligaments remain unclear non-operative treatment for the rupture of these ligaments seems to be adequate. In order to avoid neurologic symptoms or long term complications an immediate diagnosis is indispensable.

Adolescent↗
PubMed2002

[Mobility of unstable fractures of the odontoid during helmet removal. A biomechanical study].

In severe motorcyclist accidents unstable injuries of the cervical spine can usually not be excluded before an X-ray has been taken in the hospital. Despite this the helmet has to be taken off at the place of the accident in order to provide adequate treatment and airway management of the injured driver. There are no data in the current literature showing what happens to unstable lesions of the cervical spine during helmet removal. An experimental unstable lesion of the cervical spine was created by an osteotomy of the odontoid in 10 fresh frozen cadavers with intact soft tissues. All motions occurring in the segments C1-2 and C2-3 during helmet removal were recorded by fluoroscopy. The average motion in the unstable segment C1-2 was 23.7 degrees during a full range of extension-flexion movement of the cervical spine without any signs of dislocation of the segment. After application of the helmet there was one case of dislocation of C1-2 in neutral supine position already, and two further cases of dislocations during helmet removal. The average motion of C1-2 recorded during helmet removal was 19.0 degrees (2-25 degrees ), median 18.0 degrees. In order to avoid fracture dislocations and motion in the unstable upper cervical spine the helmet should better be cut in pieces at the place of the accident. There is a need for discussions with helmet producers to develop a new generation of helmets that can be removed easily without manipulating the head.

Accidents, Traffic↗
PubMed2004

[Reosteosynthesis in dens pseudarthrosis. Case report and review of the literature].

According to general recommendations, unstable nonunions of the odontoid are treated by posterior fusion of the segments C1/C2 and transarticular screwosteosynthesis. The aim of the surgical procedure is to obtain secure reduction stabilization, and fusion of the nonunion. We present a case of secondary atlanto-axial instability treatment following of an odontoid nonunion. In this situation stability of C1/C2 was achieved by atlanto-axial fusion by transarticular screw fixation. The ventral parts of the broken implants were left in place. Diagnosis, treatment and complications of pseudarthrosis of the dens axis are discussed in the context of this case and of literature.

Bone Screws↗
PubMed2006

[Injuries of the cervical spine with Forestier's disease. Problems in the diagnostic and surgical management].

The incidence of diffuse idiopathic sceletal hyperostosis (DISH) is described in men more than 50 years old up to 25% and in women up to 15%. Even little trauma in patients with DISH often leads to injuries of the spine, especially the cervical spine. In many cases MRI is necessary to find the injury in this anatomically modified spine. It is often difficult to detect the injury by plane radiographs or even CT. Based on two cases of cervical spine fractures in patients with DISH we will describe the difficulties and specialities in the diagnostics and surgical treatment of injuries of the cervical spine in patients with DISH. In the one case we stabilized a patient with an odontoid fracture type Andersson II, the other case was a traumatic spondylolisthesis C4/C5. Both cases were treated operatively, the odontoid fracture was stabilized by a single screw, the spodylolisthesis by a ventral plate. If there are modifications in the spinal anatomy by degenerative diseases like DISH or spondylitis ankylosans, it is important to perform an intense search for injuries of the spine. In many cases MRI is indicated to detect the injury because plane radiographs and CT are not sensitive enough. For the planning of the operation it is important to meet concerns to the thick anterior longitudinal ligament and to use screws, that are long enough because the use of standard instruments is often not successful.

Aged, 80 and over↗
PubMed2006

[Temporary percutaneous spondylodesis C1/2 and halo vest immobilisation. An alternative treatment of complex injuries of the upper cervical spine].

Dislocated combined injuries of the upper cervical spine such as C 1/2 fractures require occipitocervical fusion, especially if the dislocation can not be redressed using halo vest immobilisition. We report on the clinical course and outcome of a young woman who sustained complex cervical spine injuries. Closed reduction and a percutaneous transfixation of C 1/2 with k-wires (Magerl) and an additional halo vest immobilisition was performed to avoid permanent fusion. The 25 year old patient was involved in a motor vehicle accident that resulted in a dislocated Jefferson's fracture, an odontoid fracture type II (Anderson and d'Alonso) with protrusion into the foramen magnum, and a dislocated C 6/7 fracture. A ventral spondylodesis C6/7 was followed by temporary dorsal spondylodesis C1/2 with k-wires (Magerl) and additional halo vest immobilisition after closed reduction. The temporary percutaneous fixation C1/2 was removed after 11 weeks, as was the halo vest immobilisition. After removing the temporary percutaneous fixation (k-wires) and the halo system, the patient showed very good functional results in terms of range of motion with only minor discomfort. Complex injuries of the upper cervical spine that cannot be retained by external fixation often require an occipitocervical fusion or fixation of C1/2. In the case presented, the temporary percutaneous fixation (Magerl) with k-wires was terminated after 3 months to avoid significant functional impairment. Younger patients benefit most from temporary fusion of the upper cervical spine, which results in better functional outcome and only minor pain.

Adult↗
PubMed2000

[Anterior screw fixation for odontoid fractures].

The results of anterior screw fixation of odontoid fractures in 28 patients are presented. There were 27 type II- and 1 type III-injuries. Non-union with persistent instability had to be notified in one patient (3.6 %), secondary posterior C1/2 fusion had to be performed. Incorrect positioning of the screws in the odontoid with penetration of the postero-lateral cortex occurred in 3 patients (10.7 %). Malpositioning of the odontoid after screw fixation was documented in 5 cases (17.9 %). Cardiopulmonary complications had to be treated in 5 patients (17.9 %), 4 patients (14.3 %) died in the postoperative period. 17 patients could be followed up. Only 3 patients (17.8 %) were free of symptoms. A significant limitation in ROM of axial rotation was seen in 44 % of the patients. With anterior screw fixation of the odontoid high fusion rates can be achieved, however the procedure is technically demanding. Regarding the functional outcome, there is no significant difference to other established treatment methods.

Adolescent↗
PubMed1998

[Os odontoideum. Etiology, clinical aspects, therapy].

The etiology of os odontoideum is still controversial. In most patients, it is found by accident because of neurological symptoms and/or painful range of motion of the cervical spine. Upon recognition of the os odontoideum, it is unknown whether or not immediate surgery is beneficial. This is in contrast to an "unstable" os odontoideum, which could result in atlantoaxial instability or compression of the myelon. In this study, we present the results of our treatment of four patients with an unstable os odontoideum. In all four cases, a C1-2 fusion was performed (3 x Magerl/Seemann, 1 GallieBrooks). Postoperatively, we found a complete regression of neurological symptoms in three patients and one was significantly improved. The range of motion of the cervical spine was free of pain in all patients. As a result, we strongly support immediate surgical treatment of an unstable os odontoideum in order to prevent severe and life-threatening neurological complications.

Adult↗
PubMed1998

[Accident-induced pseudarthroses of the dens axis. Etiology, follow-up and therapy].

In a retrospective analysis the significance of internal fixation of unstable and symptomatic non-union of the odontoid was evaluated. In all but one cases a type II fracture of the odontoid was the underlying cause for the pseudarthrosis. The time interval between trauma and definitive diagnosis varied between 6 months and 30 years. All patients asked for medical advice because of acute neck pain; in three cases additional neurological deficits were notified. In all but one case the pseudarthrosis was classified as unstable on flexion-/extension views. The occurrence of neurological deficits showed a positive correlation with the amount of dislocation of the pseudarthrotic odontoid. Nine out of 10 patients underwent internal stabilisation of the non-union. Reoperation because of persistent instability/failure of stabilisation had to be performed in two cases (22.2%). At follow-up all 9 patients were pain-free. The neurological deficits in two patients had improved significantly. According to our experience internal stabilisation in unstable non-union of the odontoid is recommended to achieve significant reduction of the pain level. Also improvement of the neurological deficits can be expected depending on the duration of the symptoms.

Adolescent↗
PubMed2000

[Transoral correction osteotomy in transdental fracture dislocation that healed in the wrong position].

Undislocated odontoid fractures may lead on the basis of conventional x-rays only to a wrong conclusion with regard to biomechanical aspect of stability. In this aspect the classification based on Anderson and D'Alonzo takes a high risk to misunderstand the fracture stability and can results in a secondary fracture dislocation. Therefore it is important to make the decision about operative versus nonoperative treatment on the base of the trauma mechanism. In this case report we elucidate this problem and the higher risk of anterior approach for correction. Furthermore a better classification of dens fractures will be recommended.

Adult↗
PubMed2006

[Rare pathological alterations of the upper cervical spine requiring surgical treatment].

Because of its unique anatomy, specific diseases and lesions arise in the upper cervical spine, which differ widely from the rest of the spine. During the last two decades standardised diagnostic and therapeutic algorithms have been defined for most of the craniocervical pathologies often occurring in combination with an underlying disease requiring surgical intervention as well. On the other hand there are some very rare phathological alterations: about 20% of the patients suffering from neurofibromatosis type I develop spinal deformities. These are mostly found in the thoracic and lumbar spine (dystrophic/non-dystrophic type). In rare cases the dystrophic neurofibromatosis type I involves the upper cervical spine leading to bizarre deformities endangering the spinal cord. An aggressive, timely and combined operative therapy is necessary. Patients with Down syndrome should be investigated regularly for affections of the upper cervical spine. Though only in about 1% of all patients with Down syndrome do instabilities require surgical intervention, the upper cervical spine should be screened on a regular basis, since neurological changes due to the pathognomy of the underlying disease often remain undetected for a long time. The operative therapy of the instable os odontoideum in Down syndrome follows the general principles of this pathoanatomical variation. Even though the Klippel-Feil syndrome is generally not linked with neuropathological findings, rare associated deformities of the upper cervical spine should be excluded by proper diagnostic procedures.

Adolescent↗
PubMed1996

[Spinal pseudarthroses].

Pseudarthroses of the spine are classified into congenital, acquired non-traumatic, posttraumatic and postoperative (iatrogenic) pseudarthroses. The various types of non-unions of the spine are described according to their clinical and radiological appearance. In line with their clinical importance, special attention with respect to the operative treatment is given to non-union of the axis of C2 and to spondylolysis. For the pseudarthrosis of the dens a posterior fusion according to Gallie-Brooks is recommended, in spondylolysis without marked slipping a "direct repair" should be considered in young patients.

Child↗
PubMed1998

[Microsurgical transoral decompression in diseases of and injuries to the cranio-cervical junction].

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Bone Neoplasms↗
PubMed2002

A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas.

We describe CT and MRI of a previously unreported combination of atlantoaxial anomalies consisting of posterior arch hypoplasia in a bipartite atlas with an os odontoideum, in a 30-year-old woman presenting with neck and left arm pain. MRI showed the os odontoideum, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. CT revealed a bipartite atlas with midline clefts in anterior and posterior arches, thickening in the anterior arch and hypoplasia of the posterior arch with incurving of both hemiarches. Flexion and extension radiographs demonstrated atlantoaxial instability.

Adult↗
PubMed2002

MRI assessment of the alar ligaments in the late stage of whiplash injury--a study of structural abnormalities and observer agreement.

Our aim was to characterise and classify structural changes in the alar ligaments in the late stage of whiplash injuries by use of a new MRI protocol, and to evaluate the reliability and the validity of this classification. We studied 92 whiplash-injured and 30 uninjured individuals who underwent proton density-weighted MRI of the craniovertebral junction in three orthogonal planes. Changes in the alar ligaments (grades 0-3) based on the ratio between the high signal area and the total cross-sectional area were rated twice at a 4-month interval, independently by three radiologists. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa. Cases classified differently were reviewed to identify potential causes for disagreement. The alar ligaments were satisfactorily demonstrated in all cases (244 ligaments in 122 individuals). The lesions, 2-9 years after the injury, varied from small high-signal spots to high signal throughout the cross-sectional area. Signal was highest near the condylar insertion in 82 of 94 ligaments, indicating a lesion near that insertion, and near the dental insertion in eight, indicating a medial lesion. No grade 2 or 3 lesion was found in the control group. At least two observers assigned the same grade to 214 ligaments (87.7%) on the second occasion. In 30 ligaments (12.3%) this agreement was not obtained. Pair-wise interobserver agreement (weighted kappa) was fair to moderate (0.31-0.54) in the first grading, improving to moderate (0.49-0.57) in the second. Intraobserver agreement (weighted kappa) was moderate to good (0.43-0.70). Whiplash trauma can cause permanent damage to the alar ligaments, which can be shown by high-resolution proton density-weighted MRI. Reliability of classification of alar ligament lesions needs to be improved.

Adolescent↗
PubMed2004

Split atlas in a patient with odontoid fracture.

We report the unusual association of a split atlas and an odontoid fracture in a case of a cervical trauma, thus mimicking a complex C1-C2 fracture. The normal embryology of C1 and the literature on this rare malformation are reviewed.

Adult↗
PubMed1997

MRI of atlanto-odontoid osteoarthritis.

We present the MRI appearances of advanced degenerative changes at the atlanto-odontoid (AO) joint. Changes including obliteration of the joint space, subchondral sclerosis and osteophytosis were clearly depicted on fast gradient-echo T1-weighted MRI images. Recognition of these changes may be helpful in the diagnosis in patients with suboccipital pain.

Aged↗