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At least 739 records · Page 41Linked to original sources
PubMed2005

Surgical management of remote, isolated type II odontoid fractures with atlantoaxial dislocation causing cervical compressive myelopathy.

OBJECTIVE: The remote (more than 6 mo after injury) and isolated (not associated with any other cervical spinal fractures) Type II fractures of the odontoid (RI IIO) are unique in being inherently unstable and prone to malunion or nonunion, leading to cervical compressive myelopathy. The present study discusses their surgical management. METHODS: Nineteen patients with RI IIO with atlantoaxial dislocation (AAD) causing compressive myelopathy were treated. Their preoperative disability was graded as Grade I: neurologically intact (presented with hyperreflexia and mild spasticity; n = 3); Grade II: independent with minor disability (n = 7); Grade III: partially dependent for daily needs (n = 6); and Grade IV: totally dependent (n = 3). They were classified as irreducible AAD caused by 1) malunited fracture of the odontoid (n = 2), 2) fixed anterolisthesis of the anterior arch of a C1-fractured odontoid complex (n = 3), and 3) fixed retrolisthesis of the anterior arch of a C1-fractured odontoid complex (n = 1); and reducible AAD caused by 1) mobile AAD (n = 11) and 2) hypermobile AAD (n = 2). The patients with irreducible AAD underwent a transoral decompression and posterior fusion; those with a malunited fracture underwent surgery immediately, whereas those with fixed anterolisthesis or retrolisthesis were initially placed in cervical traction. The patients with reducible AAD underwent a direct posterior fusion. In the patient with "hypermobile" AAD, a proper alignment of the fractured segment of the odontoid relative to the body of the axis in a neutral position of the neck was ensured before the posterior fusion was performed. RESULTS: At follow-up (mean, 15.37 +/- 9.67 mo), three patients in Grade I maintained their neurological status. Of the seven patients in Grade II and six in Grade III, five had improved to Grade I, and eight were in Grade II. The three patients in Grade IV improved to Grade I, II, and III, respectively. CONCLUSION: The patients with RI IIO may be divided into five groups on the basis of their differing management protocols. There is a considerable risk of delayed myelopathy unless surgical reduction and stabilization are performed. Posterior stabilization is the preferred option in dealing with these fractures. Despite the presence of severe neurological deficits and the prolonged duration of symptoms, a significant neurological improvement usually occurs after surgery.

Adolescent↗
PubMedDate not supplied

Some tips and tricks in reading cervical spine radiographs in trauma patients.

Despite the fact that we are living in the era of spiral CT and multidetector spiral CT allowing us to scan the whole spine in less than a minute and to make high quality multiplanar reformatted images, plain films remain important in clearing the spine of polytraumatised patients. Particularly hemodynamic unstable patients that must be urgently transferred to the operation room need to be rapidly cleared for (cervical) spine lesions, without being transported to the CT unit which is--in most hospitals--located relatively far away from the emergency room and the operation rooms. In these patients, for the time being, spiral CT cannot replace conventional radiographs for the detection of sometimes subtle lesions. Knowledge of the direct but also the indirect signs of fractures remains important in the evaluation of these plain films. This article demonstrates some of these sometimes subtle signs that can help in making the diagnosis of these lesions.

Axis, Cervical Vertebra↗
PubMed1990

Congenital fusion C0-C2 associated with spondylolysis of C2.

This is the report of a very rare malformation at the cranio-cervical junction, including congenital occipito-cervical fusion C0-C2, spondylolysis of C2, and hypoplasia of the right vertebral artery. The malformation itself is part of a Klippel-Feil syndrome with sensory-neural hearing loss on the left side, congenital high thoracic scoliosis, rib agenesis on the right side, and kidney malformations on both sides.

Axis, Cervical Vertebra↗
PubMed1990

A new method of screening for vertical atlantoaxial dislocation.

A new method for the screening and grading of vertical atlantoaxial dislocation is described. The Sakaguchi-Kauppi method is based on a pathologic process in the atlantoaxial joints and the grading system gives a reproducible (interobserver coefficient of variation = 0.062) tool for the screening of vertical dislocation and is also applicable to patients for whom earlier radiographs are not available. There were differences between the results obtained using Redlund's method and the new Sakaguchi-Kauppi method (chi 2 = 44.7, p less than 0.001). This difference stems from the variations in the height of the axis in the normal population and results in a sensitivity and specificity of 84.2% and 90%, respectively, for Redlund's method compared to the new method.

Arthritis, Rheumatoid↗
PubMed1990

The differential diagnosis of isolated ossicles in the region of the dens axis.

2 osteological specimens of the atlanto-occipital region with accessory ossicles sitting on the dens axis are described. Considering the anatomical and radiological literature, the differential diagnosis of isolated accessory ossicles in the region of the dens axis is discussed (e.g. os odontoideum, ossiculum terminale BERGMANN persistens, ossifications of the ligamentous apparatus).

Aged↗
PubMed1978

[Double gunshot head injury with lesion of the upper cervical vertebrae in a case of attempted suicide].

The authors hold their case reported in this paper interesting for the following reasons: in several minutes two shots were fired by intention of suicide. Two entrance openings were found that had the characteristics of shots fired within close range, but no exit openings were to be seen. Considering the entrance openings, the bilateral fracture of the atlas and a comminuted unilateral fracture of the axis and spotting the jammed missiles inside the tunnel, one must deduce that the missiles went by vital structures without severing them.

Alcoholic Intoxication↗
PubMedDate not supplied

CT anatomy of the craniovertebral junction in infants and children.

Computed tomographic (GE 9800) images of 129 patients (from newborn to 18 years old) with no evidence of cervical spine pathology were reviewed retrospectively from available material to evaluate normal anatomic appearances in childhood. The synchondroses may appear solid at soft-tissue window settings, while, with appropriate bone-window settings, a lucent line will be seen. Residual lucency and then (generally) sclerosis were seen at synchondroses past the age of classic anatomic fusion. A transversely oriented groove on the undersurfaces of the occipital condyles was imaged in children ages 5-12 years. This groove is described radiologically in that age range for the first time in this report. The development of the ossification centers of C1 was illustrated with CT. The two vertically oriented, rod-shaped ossification centers of the lower dens develop a bilobed appearance in axial section when they begin to fuse. An apparent deficiency of the cortex seen posteriorly in this area (in children as old as 7 years) represents the last remnant of the cleft between the dens centers. The cord was always outlined distinctly by CSF at soft-tissue settings at the foramen magnum and C1 levels without intrathecal or IV contrast enhancement. This anatomic feature is particularly useful since it enables the evaluation of the spinal canal in this region in some cases (especially craniovertebral junction anomalies) without the need for intrathecal contrast materials.

Adolescent↗