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PubMed1987

[Suboccipital Pott's disease].

A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.

Adult↗
PubMed1987

[Classification of injuries of the cervical spine].

Recent advances and the technical options that have lately become available in the surgical treatment of spinal injuries mean that clear definition of the indications is essential. Precise observation and classification of each injury to the cervical spine are of paramount importance for this purpose, to allow the comparison of proposed methods of treatment and of the results obtained with them. There are a number of classification systems for injuries to the cervical spine, none of which, however, is generally accepted. These classification systems are based on different criteria, such as nature of the accident at which the injury was sustained, neurologic deficits, morphological criteria, the concept of instability, and implications for treatment and prognosis. These criteria, however, hardly allow the classification of most of the injuries affecting the upper and those affecting the lower cervical spine in a single system. Therefore, the authors propose a system of their own, which draws on the principles of classification suggested by the ASIF for fractures of the extremities. According to this proposed new system, injuries are divided into those of the upper and those of the lower cervical spine, and each of these two main groups is further divided into three subgroups. In the case of the lower cervical spine, injuries are classed according as whether they affect the anterior or the posterior section of the spine more, or both to the same degree. Beyond this, injuries are subdivided with reference to whether they affect primarily bone, bone and ligament equally, or primarily ligament. Further subdivision by severity and implications for treatment allows more detailed differentiation. This classification system is based on the analysis of over 200 cases of injury to the cervical spine treated by the authors and of cases from the literature.

Axis, Cervical Vertebra↗
PubMed1987

[Neurologic symptoms and their dynamics in contusions of the spinal cord of mild and moderate severity at the level of the 1st and 2d cervical vertebrae].

The results of the study of 154 patients with an acute trauma of the cervical portion of the vertebral column showed that fractures, dislocations and fractures/dislocations of the first-second cervical vertebrae accounted for 10.4% of all the studied cases. In mild contusion of the first-second segments the leading clinical symptoms in the acute period were pareses of the arms and paralyses of hands with retained reflexes and insignificant impairments of sensitivity in fingers, i.e., the level of clinical manifestations did not correspond with the conventional segmento-metameric innervation. In the acute period of contusions of moderate severity tetraplegia is formed, which, however, does not affect the reflexes. Timely elimination of the compression helps to restore motor activity and sensitivity first in the legs and the body and later in the arms. In the long term of the injury motor activity in the arms recovers and the leading clinical symptoms become manifestations of pyramidal deficiency with insignificant sensitivity disorders in the hands and feet, predominantly of a subjective-radicular nature.

Adult↗
PubMed1985

High-resolution, cross-sectional computed tomography of the normal spine.

CT has proved to be an excellent method of studying the spine in cross section. The osseous axial skeleton may be imaged without the need for contrast media. Analysis of the contents of the spinal canal requires administration of intrathecal contrast material, except in the lumbar region, where epidural fat serves as a natural contrast agent. This article illustrates and discusses normal axial CT anatomy of the spine.

Axis, Cervical Vertebra↗
PubMed1985

[Evaluation of 138 fractures of the cervical spine during a recent 5-year period (1979 to 1983). Therapeutic approaches].

138 cervical spine fractures are reviewed during a recent period of 5 years (1979-1983). Their frequency stay high. The serial concern 67% of men and 33% of women. We observe a peak age between 20 and 30 (23%). 65% of lesions are caused by a traffic injury, 27% by a falling down, 10% by a diving. 45% of cases interest the upper cervical spine (C1-C2) with a high proportion of odontoid process fractures (60%) and Hangman's fractures (30%); 54% of cases concern the lower cervical spine (C3-C7) with an important part of fracture-luxation (72%), specially C5-C6 (35%). Clinically, we note almost a same part of fractures without neurological disturbances (54%) and with neurological abnormalities (46%). In this situation, the sensitive and motor loss are often severe (78%). In 40%, the injuries are polytraumatism and association spine lesion, cranio-cerebral lesion is the most frequent (61%). In upper cervical spine fractures, after Crutchfield or Gardner traction, posterior fixation was performed (62%). The treatment was conservative in 30%. In lower cervical spine lesions, a secondary surgical approach by an antero-lateral way was made (53%). The treatment was initially surgical in 13% and conservative in 28%. The mortality rate of this pathology is important (22%; i.e. 30 deaths on 138 cases).

Adult↗