Gallium SPECT detection of lymphomatous involvement of the cervical dens.
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Adult↗
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Results for “Odontoid Process”
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Natural history of rheumatoid arthritis of the cervical spine.
This article reviews the natural history of rheumatoid arthritis involving the cervical spine with special attention given to predictors of paralysis. Understanding the natural history of rheumatoid arthritis of the cervical spine is necessary to determine the benefit of various interventions. The primary treatment goal for cervical instability is prevention of irreversible neurologic injury. The natural history of rheumatoid arthritis for a period of 10 years or more is one of significant disease progression. The natural history of cervical instability in patients with rheumatoid arthritis is more variable, with only some patients having a neurologic deficit develop. Recent studies support prophylactic stabilization of the rheumatoid cervical spine to prevent paralysis in high risk patients. However, proponents for prophylactic arthrodesis must acknowledge that not all cervical instability in rheumatoid arthritis progresses to neurologic deficit, and surgical intervention in patients with rheumatoid arthritis incurs added morbidity and mortality. Identifying the risk factors for progression of cervical instability is the first step in eliminating morbidity and mortality from spinal cord and brain stem compression. Surgical stabilization is indicated not only for those patients with paralysis, but for the subgroups of patients with cervical rheumatoid disease who are at risk for spinal cord and brain stem compression. The posterior atlantodental interval is the most reliable screening tool and predictor of progressive neurologic deficit.
Arthritis, Rheumatoid↗
Vertical fracture of the odontoid: CT diagnosis.
A patient with a vertically oriented fracture of the odontoid is described. We found no previous report of this type of fracture. In our patient CT was the best imaging modality for defining the anatomic extent of the fracture.
Adult↗
Diffusion-weighted MRI of the cervical cord in acute spinal cord injury with type II odontoid fracture.
The authors present a case of acute spinal cord injury demonstrated by diffusion-weighted MRI (DWI) of the cervical cord. DWI taken 2 hours after injury showed intramedullary hyperintensity with a decrease of the apparent diffusion coefficient (ADC) value at C1-C2 vertebral levels. On T -weighted images obtained 1 month after injury, the lesion was hyperintense, indicating the existence of myelomalacia. DWI of the cervical cord provided satisfactory images and was a useful method for detecting and visualizing of the affected cord in the super-early stage.(2)
Cervical Vertebrae↗
Fractures of the dens in adult patients.
The series involves 42 consecutive acute fractures of the dens, of which 41 were treated nonoperatively. There were 26 Type II and 16 Type III fractures, as classified by Anderson and D'Alonzo. All Type III fractures and undisplaced or anteriorly displaced Type II fractures united. Posteriorly displaced Type II fractures had an overall nonunion rate of 50%, which increased to 75% if displacement was more than 5 mm. Eight patients died within 40 days after sustaining their fracture; seven had Type II fractures with an average of 10-mm posterior displacement. Seven patients with a Type II fracture had an associated atlas fracture; five of these patients died early. In Type II fractures, posterior displacement is an important prognostic factor for union and possibly for early mortality of elderly patients. In Type II fractures with an associated atlas fracture, the mortality rate is high. Nonoperative management, preferably halo-thoracic immobilization, is successful in all acute fractures of dens, except posteriorly displaced Type II fractures.
Axis, Cervical Vertebra↗
Myelopathy due to hypertrophic nonunion of the dens: case report.
Fractures which occur near the base of the dens have a low propensity to unite spontaneously. One of the major complications of nonunion is displacement of the fracture resulting in neuraxis compression and the development of myelopathy. Hypertrophic nonunion of the dens may cause spinal cord compression even if displacement does not occur. This situation has not to our knowledge previously been reported. A literature review and appraisal of the issues raised are discussed. Appropriate therapeutic options are outlined, including posterior surgery and the use of transoral decompression.
Axis, Cervical Vertebra↗
Dynamic computerized tomography of the occiput-atlas-axis complex in trauma patients with odontoid lateral mass asymmetry.
Over a 23-month period, 25 patients aged 11 to 74 years presented to our Level I trauma center with odontoid lateral mass asymmetry of 2 to 5 mm on properly centered AP open-mouth X-rays: 32% of patients were asymptomatic, 68% had cervical pain, and 32% had limited range of motion. Patients with cervical spine fractures or dislocations and those with fixed deformity were excluded. The clinical significance of asymmetry was determined utilizing dynamic axial CT scanning of the occiput (C0), atlas (C1) and axis (C2) with the head neutral and with 15 degrees to 30 degrees active rotation. Nineteen patients demonstrated greater than 5 degrees of relative motion of C1 on C2 bilaterally. Three patients had less than 5 degrees of relative motion bilaterally and three patients had less than 5 degrees relative motion with left rotation only. No patient had formal treatment and all had nearly normal cervical range of motion on clinical examination at the time of hospital discharge. The finding of an asymmetric odontoid-lateral mass interspace on properly centered open-mouth AP X-rays in the presence of otherwise normal cervical spine X-rays, in conscious patients without fixed deformity, appears to be incidental and requires no further evaluation or treatment.
Adolescent↗
The stabilizing effects of different orthoses in the intact and unstable upper cervical spine: a cadaver study.
BACKGROUND: Although cervical orthoses are frequently used in prehospital stabilization and in the definitive treatment for lesions of the cervical spine, there is little information about the control of extension-flexion, lateral bending, and rotation given to individual segments by different designs. METHODS: In an experimental in vitro study with four fresh frozen cadavers, the halo vest was compared with the soft collar, prefabricated Minerva brace, and Miami J collar. The controlling effects for the segments C1-2 and C2-3 were tested for all four devices in the intact and the unstable spine with an Anderson type II fracture of the odontoid. RESULTS: All four orthoses reduced the range of motion at both C1-2 and C2-3 of the intact spine significantly, although none of the three semirigid devices provided a halo-like immobilization in the intact spine. The osteotomy of the odontoid increased the range of motion in the segment C1-2. The soft collar did not give any clinically relevant stability to the unstable spine. Miami J and Minerva brace provided a similar moderate control in the sagittal plane but a much better control of "torque" in the upper cervical spine. The halo vest did not allow any measurable motion in any plane with our experimental external loading. CONCLUSION: The halo vest seems to be the first choice for conservative treatment of unstable injuries of the upper cervical spine, although pin track problems, accurate fitting of the vest, and a lack of patient compliance lead to clinical failures.
Biomechanical Phenomena↗
Safety of neck rotation for ear surgery in children with Down syndrome.
OBJECTIVE: Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery. STUDY DESIGN: Prospective consecutive patients, each serving as his or her own control. METHODS: Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal. RESULTS: When the anesthetized children had their necks placed in either right or left 60 degrees rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60 degrees neck rotation during surgery. CONCLUSION: Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.
Adolescent↗
Combination Jefferson fracture of C1 and type II odontoid fracture requiring surgery: report of two cases.
Two cases of simultaneous Jefferson fracture of C1 and Type II odontoid fracture requiring surgical stabilization are reported. One patient required early stabilization because alignment could not be maintained in a halo vest, and the second patient required late stabilization for nonunion after a 3-month period of immobilization in a two-poster cervical brace. Although this uncommon injury can often be managed conservatively, surgical fusion will need to be considered in the setting of early or late instability.
Aged↗
Fractured odontoid: the management of delayed neurological symptoms.
Undiagnosed and untreated odontoid fractures are relatively common in developing countries where treatment for minor injuries is not considered. As a result, patients frequently present with neurological deterioration secondary to delayed odontoid dislocation. Fifty-one consecutive patients with this problem were entered into a management protocol and reviewed for this report. After diagnosis, reducibility was analyzed by extension films, and all patients who could not be reduced were initially managed in cranial long traction. Thirty-seven were reduced spontaneously or by traction alone, and 12 required transoral decompression. All underwent posterior C1-C2 fusion. Postoperatively, all were treated in external orthoses. The neurological recovery was excellent in 34 patients. Seven patients could function but had some disability, three patients had disabling spasticity, and three remained bedridden. Four deaths occurred as a result of respirator-dependent patients being taken home for social and financial reasons. As a result of this case-controlled study, we recommend that the treatment protocol first analyze reducibility by extension x-rays and then try traction for as long as 14 days to attempt reduction in patients who did not reduce in extension. Failure of reduction is indication for transoral decompression, and all patients require C1-C2 fusion. The neurological recovery is related to initial impairement but can be satisfactory in > 75% of patients.
Adolescent↗
Primary hemangiopericytoma in the axis bone: case report and review of literature.
OBJECTIVE AND IMPORTANCE: To the best of our knowledge, this is the first reported case of primary hemangiopericytoma in the axis bone. With this report, we attempt to better characterize this uncommon lesion in the vertebral column. CLINICAL PRESENTATION: This report describes a case of primary heman-giopericytoma in the axis bone of a 16-year-old female patient who presented with acute torticollis. Her neurological status was unimpaired. A lateral radiograph of the cervical spine demonstrated an odontoid neck fracture and a C1-C2 rotatory deformity. The magnetic resonance imaging study showed a hypodense lesion with moderate enhancement on T1- and T2-weighted images on the dens and body of the axis with an odontoid neck fracture. Reviewing the literature, primary hemangiopericytoma in the spine is rare; 9 cases of hemangiopericytoma with vertebral bone involvement and 44 cases of this tumor with intraspinal meningeal involvement have been reported. INTERVENTION: The patient was treated with odontoidectomy via the transoral approach, along with posterior fixation using the Halifax clamp. She was followed up 17 months after surgery, and no evidence of tumor recurrence was found. CONCLUSION: The treatment for osseous hemangiopericytoma is still controversial. At present, adequate surgical removal with postoperative radio-therapy is recommended. In addition, although hemangiopericytoma is rare in the spine, it should be kept in mind in the differential diagnosis of spinal tumors.
Adolescent↗
The Axis Fixation System for posterior instrumentation of the cervical spine.
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Adult↗
Myelopathy caused by retro-odontoid disc hernia: case report.
OBJECTIVE AND IMPORTANCE: Among masses in the craniovertebral junction causing severe compression of the medulla and upper cervical cord, cases of retro-odontoid disc hernia are extremely rare. We report a case of retro-odontoid disc hernia resulting in severe myelopathy. CLINICAL PRESENTATION: An 82-year-old man suffered from progressive tetraparesis. Although cervical radiological studies showed marked spondylotic change, no congenital malformations or traumatic lesions were identified. Magnetic resonance imaging disclosed a retro-odontoid soft tissue mass with peripheral enhancement compressing the medulla and the upper cervical cord posteriorly. INTERVENTION: The patient underwent surgery through the posterior approach. The histopathological examination of the surgical specimen revealed fibrocartilage accompanied by reactive vascular tissue; the mass was diagnosed as a retro-odontoid disc hernia. CONCLUSION: In the differential diagnosis of mass lesions compressing the neural structures in the craniovertebral junction, retro-odontoid disc hernia, although extremely rare, should be considered to be one possibility. The posterior approach with wide laminectomies provides a good operative field from which to remove the retro-odontoid mass and is especially adequate for elderly patients, because it is less invasive than other procedures.
Aged↗
Unusual foreign body causing quadriparesis: case report.
OBJECTIVE AND IMPORTANCE: An unusual foreign body traversing the spinal canal at the foramen magnum level is described. Interesting radiological findings and a review of nonmissile penetrating injuries are presented. This case demonstrates the importance of a thorough physical examination and the use of neurodiagnostic imaging in an inebriated, uncooperative patient with neurological dysfunction. CLINICAL PRESENTATION: The patient presented with quadriparesis confounded by cocaine intoxication. A physical examination revealed only a small punctate lesion in the posterior occipital region. INTERVENTION: After detection of the foreign body, the patient underwent immediate surgical exploration and removal of the object. The dura was repaired primarily, and the patient was maintained on intravenous antibiotics for 7 days. CONCLUSION: With physical therapy, the patient was walking with assistance at 2 weeks postsurgery. Upper extremity strength, especially intrinsic hand movement, was most severely affected. At 10 months' follow-up, the patient's only deficits were mild intrinsic hand weakness and incoordination with fine finger movements. Immediate surgical exploration is indicated for patients with retained fragments and progressive neurological dysfunction.
Adult↗
Management of acute odontoid fractures with single-screw anterior fixation.
OBJECTIVE: Accepted management strategies for odontoid fractures include external immobilization and surgical stabilization using anterior or posterior approaches. Displaced Type II fractures and rostral Type III fractures are at high risk for nonunion. Anterior fixation of odontoid fractures with a single cortical lag screw is a relatively new technique that combines rigid internal stabilization with preservation of intrinsic C1-C2 motion. We retrospectively reviewed our series of 26 consecutive patients who underwent odontoid screw fixation, to further define the safety and efficacy of the technique. METHODS: During a 5-year period, 26 patients presented with acute traumatic Type II odontoid fractures. Ten patients were female and 16 were male, with a mean age of 35 years. All patients underwent anterior odontoid screw fixation by the senior surgeon (RWH), within a mean of 3 days after injury. All patients were postoperatively maintained in external orthoses, for a mean of 7.2 weeks, and were monitored with serial clinical and radiographic examinations. RESULTS: With a mean follow-up period of 30 months, radiographic fusion was documented for 25 of 26 patients (96%). No complications related to the surgical approach were identified, and all patients remained in neurologically stable condition. Two complications (8%) were related to the instrumentation; one patient required external immobilization because of suboptimal screw placement, and one patient required posterior atlantoaxial arthrodesis because of inadequate fracture reduction. CONCLUSION: Single-screw anterior odontoid fixation was associated with a relatively low complication rate and a high fusion rate in this study. We think that this should be the preferred treatment method for acute Type II odontoid fractures.
Adolescent↗
Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients.
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Arnold-Chiari Malformation↗