Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Odontoid Process”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources
PubMed2005

Os odontoideum: a significant radiographic finding.

Os odontoideum can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk for acute catastrophic events after minor trauma or chronic neurological change. We present two cases of os odontoideum in pediatric patients that were not appreciated at earlier remote imaging but were, in retrospect, detectable. One patient presented with an acute spinal cord injury. Incorporating assessment of dens integrity into the evaluation algorithm for all pediatric cervical spine studies should lead to early detection of os odontoideum lesions and allow referral to appropriate clinical spinal services for evaluation, surveillance and possible surgery to prevent future complications.

Adolescent↗
PubMed2000

Is the open-mouth odontoid view necessary in children under 5 years?

OBJECTIVES: Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Other questions relating to imaging protocols of the odontoid also were included, and there were 432 respondents. RESULTS: Of these, 161 respondents indicated that an open-mouth odontoid view was not routinely included in their imaging protocol. CONCLUSIONS: There was considerable variability on how the problem of imaging of the odontoid was addressed, but overall there were enough data to begin to consider the concept that the open-mouth odontoid might not be needed in patients under 5 years of age if a lateral view is normal.

Child, Preschool↗
PubMed2005

Early neurosurgical intervention in spondyloepiphyseal dysplasias.

GOALS: The aim of this study is to evaluate the benefits of early intervention in two major spondyloepiphyseal dysplasias of Saudi Arabia, namely, multiple sulfatase deficiency (MSD, Austin's disease) and Morquio's disease. The MSD is encountered frequently in the Kingdom and poses significant health risk to the child because of cord compression. The clinics of this hospital have several Austin's patients. RESULTS: This study indicates that early intervention before serious irreversible damage to the cervical cord occurs improves the neurological course of the patient; no patient had a worse outcome. On the other hand, neurosurgical intervention after the neurological symptoms of cord compression occurs was not as rewarding. CONCLUSION: Morquio's disease is more common outside the Kingdom. The results in this study also confirm that early intervention in this disease is beneficial. Other surgeons make a similar recommendation for Morquio's disease. However, their experience with Austin's disease is not reported due to the rarity of this disease elsewhere.

Age Factors↗
PubMed2003

[Cervical myelopathy induced by calcium pyrophosphate tophus in primary chondrocalcinosis].

A 78 year old female patient with cervical myelopathy induced by a calcium pyrophosphate dihydrate tophus around the dens axis with clinical signs of a cervical tumor is presented. After operation of the tumor, the diagnosis of a generalized CPPD disease was established retrospectively, where by patient had complained of joint pain already for many years. This known complication of a primary chondrocalcinosis should be a reason for a careful investigation of the cervical spine in CPPD disease, because neurological disturbances might increase the joint destruction in the manner of "Charcot joints".

Aged↗
PubMed1999

Clinical and radiological features of atlantoaxial joints in rheumatoid arthritis.

Atlantoaxial (AA) instability is frequent radiological finding in patients with rheumatoid arthritis (RA). Mostly no serious neurological disorders are expected in such patients. The purpose of the study was to assess the sagittal spinal canal diameter according to Steel's rule of third and its relationship to clinical symptoms. Radiological and clinical evaluation was performed in 65 in-patients with RA. Fifty four patients complained of neck pain, 39 had vertebrobasilar symptoms, and 25 mild neurological disorders. Hyperreflexy tendon responses were registered in 16 patients. Only 1 patient had extensor plantar response. Forward AA dislocation was verified in 28 (43%) cases with a mean value of 8.3mm (4-17 mm). Still free space for spinal cord in spinal canal was obtained in 62 (95%) of patients, which can explain such a low incidence of serious neurological disorders. Our results suggest an association among duration of disease, atlantodental distance, and sagittal spinal canal diameter. We consider that it is important to detect early the most jeopardized patients on the basis of radiological analysis at C1 level according to Steel's rule of third and recognize when rising dbl quote, left (low)safe zone" has exceeded and enters the area of impending spinal cord compression.

Adolescent↗
PubMed2003

Halo jacket in odontoid fractures type II and III.

The treatment of odontoid fractures remains controversial. The late results of 14 patients with Anderson D'Alonzo type II and III treated with halo jacket from 1995 to 1999 are presented. The fractures were reduced under image intensifier and stabilized by halo jacket. The immobilization period was 12 weeks. After 1 year, the fracture was roentgenologically consolidated in 12 out of 14 patients (85.7%), and all the patients were without neurological deficit. Nine patients (64.3%) were without subjective complaints, five had a reduced range of motion. Painful motion appeared in four patients (28.6%), and cervical stiffness was noted in five (35.7%). We recommend halo jacket for the treatment of most type II and III odontoid fractures which are unstable or displaced 6 mm and more, except for patients with tetraplegia. Fractures with minimal displacement and without neurological deficit were treated conservatively with rigid collars. In our institution, internal fixation was performed in selected cases. The presence of neurological deficit and the anatomic properties of the fracture site crucially influence the choice of treatment.

Adolescent↗
PubMed2001

Traumatic cervical central cord syndrome due to intramedullary hemorrhage studied with MRI: case presentation.

Cervical central cord syndrome is characterized by disproportionately greater motor impairment of the upper than the lower extremities, predominantly distal motor dysfunction, varying degrees of sensory abnormalities, and bladder dysfunction. Although the original description stated that intramedullary hemorrhage is a possible cause of traumatic cervical central cord syndrome, recent studies have not demonstrated its presence on the basis of magnetic resonance imaging (MRI) or pathological evidence. The authors describe and discuss a case of traumatic central cervical cord syndrome studied with MRI, which presented intramedullary hemorrhage. This supports hemorrhage as a possible cause of traumatic cervical central cord syndrome.

Aged↗
PubMed2002

Posterior atlanto-axial fusion with the Olerud Cervical Fixation System for odontoid fractures and C1-C2 instability in rheumatoid arthritis.

In posterior C1-C2 fusion, traditional wire fixation gives poor stability. The bone quality is often insufficient to provide the competent structural bone graft that is required, and the introduction of sublaminar wires is somewhat dangerous. The stability is markedly improved by adding transarticular screws, but the drawbacks of structural bone graft and sublaminar wires remain. The C1 claw of the Olerud Cervical Fixation System improves C1-C2 fixation without relying on structural bone graft or compromising the spinal canal. The aim of this study was to evaluate radiological healing and possible complications in a consecutive series of C1-C2 fusions from our department operated with the C1 claw device. Twenty-six patients (14 women) with a mean age of 73 (range 37-93) years were included. The diagnoses were odontoid fracture in 18 patients, rheumatoid instability in 6, and odontoid non-union and os odontoideum in 1 each. The patients were followed clinically and with plain radiographs for an average of 15 (range 3-27) months. There were no neurological or vascular complications, and no secondary displacements or reoperations in the series. Twenty patients followed for 6-27 months were radiographically healed. Six patients died from unrelated causes 1-38 months postoperatively. Three of these patients had no radiographs later than the postoperative control, one had a healed odontoid fracture but resorbed bone graft at 8 months, while the remaining two patients were not healed, but showed no signs of healing disturbance at the time of death. On the basis of the findings of this study, posterior C1-C2 fusion with the Olerud Cervical Fixation System seems promising. No serious complications related to the surgical procedure were encountered. The stability of the implant obviates the use of a solid bone block as a graft and still allows a high frequency of fusion healing.

Adult↗
PubMed2003

Non-rigid immobilisation of odontoid fractures.

Despite various reports on the management of odontoid fractures, there is no consensus on the subject, and the appropriate treatment still remains controversial. While untreated fractures or fractures treated only with a cervical orthosis seem to have the highest rate of non-union, the need for rigid external stabilisation has never been substantiated. In a retrospective analysis we reviewed 26 patients with acute type II and III fractures of the odontoid, treated with a cervical orthosis only. Study inclusion was limited to fractures that had a fracture gap of less than 2 mm, an initial antero-posterior displacement of less than 5 mm and angulation of less than 11 degrees, less than 2 mm displacement on lateral flexion/extension views, and were without neurological deficits. These fractures were defined as stable. There were 19 (73.1%) type II and 7 (26.9%) type III fractures; in 10 (38.5%) of these fractures the odontoid was displaced and/or angulated. The overall complication rate was 11.4% ( n=3). One patient suffered from pulmonary embolism, in two patients (7.7%) with initially minimally displaced fractures, secondary internal stabilisation had to be performed because of persistent instability. In 20 (77%) of the remaining fractures healing was uneventful. In 4 nondisplaced fractures (15%) fibrous union was documented. Three of these patients were over 65 years old. The overall fusion rate was 73.7% for type II and 85.7% for type III fractures. At follow-up 39% of the patients were free of symptoms; however, the clinical outcome did not correlate with the radiological findings. According to our findings, stable type II and type III fractures of the odontoid can be successfully treated with non-rigid immobilisation, even if they are displaced. A thorough assessment of the stability of the odontoid with lateral flexion/extension views or dynamic fluoroscopy is recommended to evaluate the appropriate treatment. Non-rigid immobilisation may be an option in selected cases with stable injuries.

Adolescent↗
PubMed2004

The jigsaw sign. A reliable indicator of congenital aetiology in os odontoideum.

There is evidence in the literature for both a congenital and a post-traumatic aetiology for os odontoideum. In no series published to date has CT been used to aid in the diagnosis. This is a prospective study of the history of trauma and presence of diagnostic features on CT of 18 consecutive cases with os odontoideum. Our objective was to derive clinically useful radiological features enabling accurate differentiation between congenital and post-traumatic aetiologies. A mid-sagittal CT reconstruction of the atlanto-dens joint was obtained. Hypertrophy of the anterior arch of the atlas was quantified by measurement of the arch-peg-area ratio. The presence of dysplastic features (a positive "jigsaw" sign) of the atlanto-axial joint were noted. These included narrowing of the cartilage space and interdigitation of the two joint surfaces. A history of a potential traumatic aetiology was only obtained in one of the 18 (6%) in our series. A significant elevation of the arch-peg ratio was found when comparing this series to 85 controls. And a positive jigsaw sign was observed in 75% of cases. These features were not seen in paediatric cases of atlanto-axial instability, including odontoid non-union. In conclusion, an elevated arch-peg ratio and the presence of a jigsaw sign are sensitive and specific diagnostic criteria for os odontoideum. This series supports a congenital aetiology for this condition.

Adolescent↗
PubMed2005

Os odontoideum with bipartite atlas and segmental instability: a case report.

We report on the case of a 15-year-old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor hyperflexion trauma to the cervical spine. Neuroimaging studies revealed atlantoaxial dislocation and ventral compression of the rostral spinal cord with increased cord signal at C1/C2 levels caused by an os odontoideum, as well as anterior and posterior arch defects of the atlas. The patient underwent closed reduction and posterior atlantoaxial fusion. We describe the association of an acquired instability secondary to an os odontoideum with an anteroposterior spondyloschisis of the atlas and its functional result after 12 months. The rare coincidence of both lesions indicates a multiple malformation of the upper cervical spine and supports the theory of an embryologic genesis of os odontoideum.

Adolescent↗
PubMed2006

Atlantoaxial fixation using the polyaxial screw-rod system.

The aim of this study is to evaluate the first results of the atlantoaxial fixation using polyaxial screw-rod system. Twenty-eight patients followed-up 12-29 months (average 17.1 months) were included in this study. The average age was 59.5 years (range 23-89 years). The atlantoaxial fusion was employed in 20 patients for an acute injury to the upper cervical spine, in 1 patient with rheumatoid arthritis for atlantoaxial vertical instability, in 1 patient for C1-C2 osteoarthritis, in 2 patients for malunion of the fractured dens. Temporary fixation was applied in two patients for type III displaced fractures of the dens and in two patients for the atlantoaxial rotatory dislocation. Retrospectively, we evaluated operative time, intraoperative bleeding and the interval of X-ray exposure. The resulting condition was subjectively evaluated by patients. We evaluated also the placement, direction and length of the screws. Fusion or stability in the temporary fixation was evaluated on radiographs taken at 3, 6, 12 weeks and 6 and 12 months after the surgery. As concerns complications, intraoperatively we monitored injury of the nerve structures and the vertebral artery. Monitoring of postoperative complications was focused on delayed healing of the wound, breaking or loosening of screws and development of malunion. Operative time ranged from 35 to 155 min, (average 83 min). Intraoperative blood loss ranged from 50 to 1,500 ml (average 540 ml). The image intensifier was used for a period of 24 s to 2 min 36 s (average 1 min 6 s). Within the postoperative evaluation, four patients complained of paresthesia in the region innervated by the greater occipital nerve. A total of 56 screws were inserted into C1, their length ranged from 26 to 34 mm (average, 30.8 mm). All screws were positioned correctly in the C1 lateral mass. Another 56 screws were inserted into C2. Their length ranged from 28 to 36 mm (average 31.4 mm). Three screws were malpositioned: one screw perforated the spinal canal and two screws protruded into the vertebral artery canal. C1-C2 stability was achieved in all patients 12 weeks after the surgery. No clinically manifested injury of the vertebral artery or nerve structures was observed in any of these cases. As for postoperative complications, we recorded wound dehiscence in one patient. The Harms C1-C2 fixation is a very effective method of stabilizing the atlantoaxial complex. The possibility of a temporary fixation without damage to the atlantoaxial joints and of reduction after the screws and rods had been inserted is quite unique.

Adult↗
PubMed2000

Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly.

This study is a retrospective analysis of patients older than 65 years with odontoid fractures. The series consisted of 29 consecutive patients with odontoid fractures (18 women, mean age 78, range 66-99 years). Twenty-six patients were neurologically intact, Frankel E, whereas three had neurological symptoms: two Frankel D and one Frankel C. Eleven patients were treated with anterior screw fixation according to Böhler, seven with a posterior C1-C2 fusion. Ten patients with either minimally displaced fractures or with complicating medical conditions were treated conservatively. At follow-up, 7/7 patients with posterior fusion had healed without any problems, whereas 8/11 patients treated with anterior screw fixation, and 7/10 conservatively treated patients were either failures or had healed, but after a complicated course of events. We conclude that anterior screw fixation according to Böhler is associated with an unacceptably high rate of problems in the elderly. Probable causes may be osteoporosis with comminution at the fracture site, or stiffness of the cervical spine preventing ideal positioning of the screws. As non-operative treatment also often fails, the method of choice seems to be posterior C1-C2 fusion.

Aged↗
PubMed1998

Occipitocervical fixation with a single occipital clamp using inverted hooks.

A simple occipitocervical osteosynthesis technique using cervical CCD (compact Cotrel-Dubousset) material is described in a clinical case. The originality of this technique consists in the occipital fastening used, involving the simultaneous insertion of two hooks into a single burr-hole. This greatly facilitated the positioning of the osteosynthesis rods, reduced surgical time, and provided immediate stability. These criteria are of considerable importance since this difficult surgical procedure is often performed in patients in a frail condition.

Breast Neoplasms↗