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At least 775 records · Page 43Linked to original sources
PubMed2001

Simultaneous noncontiguous cervical spine injuries in a pediatric patient: case report.

OBJECTIVE AND IMPORTANCE: Noncontiguous traumatic injuries of the cervical spine in children are rare. We present the case of a child who simultaneously sustained a separation of the odontoid synchondrosis and a C6-C7 dislocation with a complete spinal cord injury. The management of simultaneous cervical spine injuries is discussed. CLINICAL PRESENTATION: A boy aged 4 years and 2 months was a restrained back-seat passenger involved in a head-on motor vehicle accident. The patient lacked neurological function below C7. Imaging studies revealed a separation of the odontoid synchondrosis as well as a traumatic dislocation of the spine at C6-C7. INTERVENTION: The patient was placed in a halo vest shortly after admission. Four days after his injury, he underwent a posterior wiring and fusion of C6 to C7. As the C6-C7 dislocation was reduced by posterior element wiring, intraoperative x-rays showed a gradual increase in the subluxation of C1 on C2. This increase in C1-C2 subluxation required intraoperative repositioning of the halo crown on the ventral halo vest posts to maintain acceptable C1-C2 alignment. Postoperatively, ideal alignment of the odontoid peg on the body of C2 could not be achieved by halo adjustments alone. The patient required a custom-made posterior neck cushion attached to the halo vest to maintain cervical lordosis and good alignment of the odontoid peg on the body of C2. CONCLUSION: Simultaneous traumatic cervical spine injuries in pediatric patients are rare. The intraoperative reduction of one spine injury can affect the alignment at the location of the second injury. In this case, a custom adjustment of the halo vest improved the alignment of the odontoid peg on the body of C2.

Bone Wires↗
PubMed2002

C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note.

OBJECTIVE AND IMPORTANCE: Transarticular screw fixation of the C1-C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus. CLINICAL PRESENTATION: The authors describe a rigid screw technique for the surgical treatment of a woman who was excluded as a candidate for C1-C2 transarticular screw fixation. TECHNIQUE: C1-C2 pedicle screw fixation was achieved using a fixed moment arm cantilever beam system. This system provided immediate rigid fixation of the C1-C2 complex in a patient who was not a candidate for transarticular screw fixation. CONCLUSION: This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.

Bone Screws↗
PubMed2002

Isolated fractures of the axis in adults.

UNLABELLED: FRACTURES OF THE ODONTOID: STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: Type II odontoid fractures in patients 50 years and older should be considered for surgical stabilization and fusion. OPTIONS: Type I, Type II, and Type III fractures may be managed initially with external cervical immobilization. Type II and Type III odontoid fractures should be considered for surgical fixation in cases of dens displacement of 5 mm or more, comminution of the odontoid fracture (Type IIA), and/or inability to achieve or maintain fracture alignment with external immobilization. TRAUMATIC SPONDYLOLISTHESIS OF THE AXIS (HANGMAN'S FRACTURE): STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Traumatic spondylolisthesis of the axis may be managed initially with external immobilization in most cases. Surgical stabilization should be considered in cases of severe angulation of C2 on C3 (Francis Grade II and IV, Effendi Type II), disruption of the C2--C3 disc space (Francis Grade V, Effendi Type III), or inability to establish or maintain alignment with external immobilization. FRACTURES OF THE AXIS BODY (MISCELLANEOUS FRACTURES): STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: External immobilization is recommended for treatment of isolated fractures of the axis body.

Adult↗
PubMed2002

Management of combination fractures of the atlas and axis in adults.

STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Treatment of atlas-axis combination fractures based primarily on the specific characteristics of the axis fracture is recommended. External immobilization of most C1--C2 combination fractures is recommended. C1--Type II odontoid combination fractures with an atlantodens interval of 5 mm or more and C1--hangman's combination fractures with C2--C3 angulation of 11 degrees or more should be considered for surgical stabilization and fusion. In some cases, the surgical technique must be modified as a result of loss of the integrity of the ring of the atlas.

Adult↗
PubMed2002

Os odontoideum.

DIAGNOSIS STANDARDS: There is insufficient evidence to support diagnostic standards. GUIDELINES: There is insufficient evidence to support diagnostic guidelines. OPTIONS: Plain x-rays of the cervical spine (anteroposterior, open-mouth odontoid, and lateral) and plain dynamic lateral x-rays performed in flexion and extension are recommended. Tomography (computed or plain) and/or magnetic resonance imaging of the craniocervical junction may be considered. MANAGEMENT STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Patients with os odontoideum, either with or without C1--C2 instability, who have neither symptoms nor neurological signs may be managed with clinical and radiographic surveillance. Patients with os odontoideum, particularly with neurological symptoms and/or signs, and C1--C2 instability may be managed with posterior C1--C2 internal fixation and fusion. Postoperative halo immobilization as an adjunct to posterior internal fixation and fusion is recommended unless successful C1--C2 transarticular screw fixation and fusion can be accomplished. Occipitocervical fusion with or without C1 laminectomy may be considered in patients with os odontoideum who have irreducible cervicomedullary compression and/or evidence of associated occipitoatlantal instability. Transoral decompression may be considered in patients with os odontoideum who have irreducible ventral cervicomedullary compression.

Evidence-Based Medicine↗
PubMed1985

Computed axial tomography in C1-C2 trauma.

Twenty patients with C1-C2 vertebral trauma underwent computed tomographic (CT) scans to evaluate prospectively its efficiency for diagnosis and treatment. It is suggested that if standard roentgenograms are inconclusive, CT scan is recommended for further evaluation of C1 fractures and C1-C2 rotatory subluxation in preference to tomography and cineradiography. CT scans do not assess dynamic stability and may miss minimally displaced odontoid fractures. It was also concluded that they add little in the treatment of hangman's fractures, although scanning did show that the pathology was often more complex than anticipated. The clinician must be aware of the capabilities and the limitations of the specific scanner in use and work closely with the radiologist to maximize the yield of information. The CT scan is very helpful as an adjunct to standard x-ray studies, but is not recommended as a screening procedure.

Adolescent↗
PubMed1987

Odontoid fractures treated with halo-vest.

In a consecutive series of 75 patients with unstable cervical spine injuries treated with halo-vest, 1976-1984, a total of 14 patients (comprising 18.7%) had odontoid fractures. Of the patients with odontoid fractures, 1 patient had an incomplete tetraparesis. All patients except 1 were treated within the first day after the trauma. A total of 50% were injured in motor vehicle accidents. The odontoid fracture was reduced by skull traction and then stabilized with a halo-vest for 12 weeks. One patient died within the first 2 weeks after the injury. There were no other serious complications during the treatment. The initial dislocation and reduction was studied. Ten patients were followed-up after 2 years. Another 2 patients died of other causes during that time. One had an Anderson-d'Alonzo Type II fracture that failed to unite. Different prognostic factors were analyzed. Fracture gap and fracture type may have contributed to nonunion. Only 1 patient was totally free from symptoms after 2 years. The halo-vest was well tolerated in all patients and assured a high percentage of healing.

Adult↗
PubMed1987

Upper cervical involvement in rheumatoid arthritis.

Atlanto-axial dislocation and upward migration of the odontoid were studied in patients with rheumatoid arthritis treated conservatively and those treated by atlanto-axial posterior fusion. Upward migration of the odontoid was evaluated by Ranawat's and Redlund-Johnell's methods after determining the normal range in healthy Japanese adults. Of the 100 patients treated conservatively, atlanto-axial dislocation was found in 49% and upward migration of the odontoid in 26% by the former method, and in 8% by the latter method. The detection rate of these lesions increased with the increase in the duration of the disease and progression of rheumatoid lesions. Abnormal Ranawat values are associated with lesions in the C1-C2 segment and abnormal Redlund-Johnell values with 0-C2 lesions. The latter suggests severe conditions and seems to be a useful indicator for the diagnosis of upward migration of the odontoid in our study. Though rheumatoid lesions in the upper cervical spine mainly involved the C1-C2 level, marked deterioration of the atlanto-occipital joints was also occasionally observed. Therefore, in surgical treatment, attention should be paid also to this region. Patients with abnormal Redlund-Johnell values require spinal fixation including the occipital bone.

Adult↗
PubMed1987

Management of the fractured odontoid with halo-thoracic bracing.

This study of 65 cases of fractured odontoid indicates that halo-thoracic bracing is an effective method for treatment of the Types II and III fractures. There were 28 Type II, and 19 Type III fractures treated with halo-thoracic braces. Of these 47 patients, only 4 went on to nonunion after an average of 8 weeks in the brace, a rate of bony union of 91.5%. Seven of the remaining 18 patients underwent primary fusion at C1-2, two were treated in Guilford braces, and six received no treatment. Surgery was performed if the fracture was unstable, if the patient could not be relied upon to leave the halo in place, or if the patient chose it as primary treatment. All seven of these patients went on to bony fusion. All of the six patients who refused treatment went on to nonunion of the fracture. Three patients were lost to follow-up.

Adolescent↗
PubMed1988

Halo-vest treatment of unstable traumatic cervical spine injuries.

Eighty-three patients with unstable cervical spine injuries were treated with halo-vest stabilization in a prospective consecutive series during a 10 year period. At the follow-up 2-7 years after the trauma, six patients had died and eight patients had been surgically stabilized. Sixty-seven of the remaining 69 patients (97%) were subjected to the follow-up performed with validated protocols. All patients but three were reexamined clinically and radiographically. Flexion-extension motion and sidebending of the neck was measured radiographically. Rotation was measured with the aid of a compass placed on top of the head of the patient. Forty-four patients (53%) had initial neurological deficit, 26 with tetraparesis. The age range was 13-89 years and the male/female ratio was 2/1. The halo-vest treatment period was 10-12 weeks. The 1 year healing rate was 90%. Seven nonunions occurred, all in fracture types known to be prone to nonunion. Complications during the treatment were usually minor, with pin problems being the most frequent (pin loosening 60%). At the follow-up, approximately 80% of all patients had complaints of local neck symptoms. Pain at the extremes of neck motion and stiffness was the most frequent. The symptoms were mild and did not usually have any major impact on return to work or leisure activities. Seventy-five percent of patients with incomplete cord lesions and useless muscle function improved to useful function. The patients had a statistically significant decrease of rotation (18%) and sidebending (18%) of the neck but normal flexion-extension motion when compared to the normal.

Adult↗
PubMed1990

Posttraumatic atlanto-axial subluxation and myelopathy. Efficacy of anterior decompression.

Compression of the neuraxis may occur after displaced fractures of the dens. Nonunion or malunion increases the risk of developing neurologic complications because of the resulting atlanto-axial instability. Posterior decompression has generally been the surgical solution to myelopathy at this level. Two patients with cervical myelopathy due to displaced ununited dens fractures were treated with posterior fossa decompression and high cervical laminectomy. Both patients deteriorated after the surgery. Most of their neurologic deficits finally resolved after microsurgical transoral decompression (by resection of the dens). In those patients in whom atlanto-axial instability causes primarily anterior compression of the neuraxis, especially by a bony lesion, decompression posteriorly may not achieve the desired effect, and, instead, may cause a deterioration in the patient's condition. Anterior atlanto-axial subluxation effectively lengthens the bony spinal canal, which results in stretching of the relatively inelastic spinal cord over the bony deformity. If indirect methods of reduction fail to relieve the condition, then anterior transoral decompression is recommended.

Atlanto-Axial Joint↗
PubMed1991

Direct anterior fixation of dens fractures with a cannulated screw system.

Anterior screw fixation of dens fractures appears to be an optimal method of treatment for these injuries. Anatomic dens fracture reduction with stable internal screw fixation satisfies the established principles of the AO/ASIF. Iatrogenic trauma is minimized by the use of an anterior surgical approach, and no supplemental bone grafting is required. This procedure is quite prone to complications when performed improperly or in contraindicated situations. The use of meticulous surgical technique along with a newly designed cannulated screw system has evolved this procedure into an established form of treatment at our department. Since 1982, 23 patients were treated with direct screw fixation of dens fractures. The overall rate of fracture union was 92.3%, and fracture resolution averaged 5.5 months. The major complication rate of 17% (4/23) resulted from inappropriate use of this technique. The 11 most recent cases, all of which involved stabilization with cannulated screws, resulted in only a single complication (9%) and an average fracture healing time of 3.5 months. A recommended operative technique for anterior screw fixation of dens fractures will be presented along with a discussion of potential sources of difficulty or failures.

Bone Screws↗
PubMed1991

Odontoid fractures treated by anterior odontoid screw fixation.

While odontoid fractures are common injuries, disagreement exists regarding treatment. Some authors claim a high rate of pseudoarthrosis and have therefore recommended early posterior fixation and fusion. This, however, results in decreased cervical rotation. Therefore, it has been recommended that a more direct approach to the fracture be taken. Results on anterior screw fixation in 14 patients are reported. The technique was found to be especially useful in multiple trauma patients, patients who refuse halo treatment, and in some nonunions.

Bone Screws↗