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PubMed2004

[Calcium pyrophosphate dihydrate deposition disease in the transverse ligament of the atlas].

Calcium pyrophosphate dihydrate (CPPD) deposits, answerable for chondrocalcinosis, are frequently observed in elderly people. Involvement of the spine is not rare. We present the case of a woman hospitalised for an acute arthritis of the right knee related to CPPD crystal deposition disease who suffered from acute neck pain. The computerised tomography showed calcified deposits in the transverse ligament of the atlas highly suggestive of CPPD deposits. This localisation seems to be very common for CPPD deposits. These CPPD crystal deposits may induce pseudo-meningitic attacks or chronic mechanical neck pain. CPPD crystal deposits in the upper cervical spine should be diagnosed when the disease is quiet, in order to avoid unnecessary investigations and therapies when an acute cervical flare occurs.

Aged↗
PubMed1998

[Cervical myelopathy caused by bilateral vertebral artery compression].

We report a rare case of myelopathy caused by compression of the upper cervical cord by the bilateral anomalous vertebral arteries. A 49-year-old man had dragged his right foot for 4 years. He also complained of a tingling sensation in his right arm and occipitalgia. Neurological examination disclosed right hemiparesis, hypalgesia in the right half of the body and hypertonicity of the lower extremities. MRIs showed a flow void area which compressed and distorted the spinal cord bilaterally at the level of the atlas. A vertebral angiogram showed that the bilateral vertebral arteries had pierced the dura matter under the posterior arch of the atlas, turned upward and laterally in the vertebral canal, making vascular loops at the level of the atlas. 3D CT angiography showed the loops convex medially in the anterior part of the vertebral canal. With these findings, we diagnosed the patient as suffering compression of the cervical cord by the bilateral anomalous vertebral arteries. Suboccipital craniectomy and C1 laminectomy were performed. When the dura mater was opened, the dorsolateral aspect of the spinal cord was found to be compressed and indented markedly by the vertebral arteries. To decompress the spinal cord, the vertebral arteries were retracted dorsolaterally by means of Gore-tex tape and anchored to the spinous process of the axis. Postoperatively, his neurological symptoms improved. Postoperative MRIs showed that the spinal cord was decompressed and had recovered its contour. A review of the literature revealed that only 3 such cases as this one have been reported. The clinical features of these rare cases are nonspecific myelopathy and concomitant occipitalgia or neck pain. The main cause of this rare entity seemed to be the compression of the vertebral artery through its course when it enters the vertebral canal between the atlas and the axis.

Humans↗
PubMed1991

Association between morphology of the first cervical vertebra, head posture, and craniofacial structures.

In order to test the assumption of an association between the anatomy of the first cervical vertebra, the atlas, and dentofacial build, roentgen-cephalograms of 78 young adults with either a markedly high or a low atlas dorsal arch were analysed with regard to head posture, and cervicovertebral and dentofacial anatomy. The high and low dorsal arch groups each comprised 22 women and 17 men. The head was more extended in the low arch groups and particularly so among the women, in whose low arch group there was a tendency for the cervical spine to be inclined more forward. Both the dorsal arch and the dens of the second vertebra were vertically smaller in the low arch groups, and more so among the men. Vertebral length was reduced more in the women, however. The clival plane was more parallel to the foraminal plane in the low arch groups and the gonial angle was more obtuse. Furthermore, the women with low arches showed a steepened mandibular plane, a backward-rotated condylar head, a decrease in the ratio of posterior to anterior face height, smaller vertical overbite and reduced proclination of the lower incisors. The prevalence of severe malocclusions was higher than in the corresponding high arch group.

Adult↗
PubMed2006

Palpatory diagnosis of plagiocephaly.

INTRODUCTION: The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. METHODS: The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. RESULTS: We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). CONCLUSION: We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.

Atlanto-Occipital Joint↗
PubMed1979

An alternate method for posterior fixation in anterior and inferior atlanto-axial dislocation.

A modification of common methods is described for fixation of anterior and inferior atlanto-axial dislocation (AAD and IAD). In AAD a wire is passed around the atlas arch and knotted around the spinous process of the axis in a way that a figure 8 arrangement is achieved as seen in the lateral view. In IAD a wire is passed through holes in the occiput and knotted around the spinous process of the axis. A rectangular bone graft is inserted between the occiput and the spinous process of the axis, thus preventing further inferior dislocation. In both methods methyl methacrylate and bone grafts are as a rule added for further long-time stabilization. The methods have been used in 15 cases of AAD and in three cases of IAD. On radiologic examination with attention focused on the immediate postoperative fixation the follow-up time has been three months. The long-time results of fixation have been recorded with a follow-up time of six years. The fixation proved to be satisfactory in 14 patients with AAD and in the three patients with IAD. The clinical results were good in the 14 patients with AAD and in the three with IAD.

Adolescent↗
PubMed2026

Spatial concordance metrics and related risk factors of brain-peripheral barrier axes: unveiling distinct concordance patterns for mental and neurological axes.

Numerous studies have documented bidirectional interactions between the central nervous system and barrier organs (skin, gut, and lung). While genome-wide association studies have revealed shared genetic factors across brain-peripheral barrier axes, investigating these connections from an environmental perspective in large populations remains difficult. Using data from the Global Burden of Disease (GBD) 2023, I extracted annual incidence rates for 56 diseases related to brain-peripheral barrier axes and exposure rates for the 70 most detailed risk factors across 204 countries and territories. By categorizing regional incidence rates into four quartiles for each disease, I pinpointed regions with concordance of these axes and constructed a spatial atlas of disease concordance within the brain-peripheral barrier axis from a macro-epidemiologic view. Subsequently, I calculated global spatial concordance percentages for each axis, which allowed the comparatively assessment of concordance patterns across different axes, specific diseases, and their variations over time, across the lifespan, and by gender. Finally, I applied machine learning models and Shapley additive explanations to identify risk factors related to the spatial concordance of each axis. From 1990 to 2023, the overall trend for most brain-peripheral barrier axis pairs remained stable. Spatial concordance patterns showed dynamic fluctuations across the lifespan, followed by a convergence toward stability in older age. Several risk factors are related to most brain-peripheral barrier axes. Notably, the mental and neurological axes exhibited distinct concordance patterns. Compared with neurological axes, concordance within mental axes showed a broader and more dispersed geographic distribution, with greater variation across sexes and over time. Furthermore, concordance percentages of mental and neurological axes exhibited opposing age-related trends, contrasting disease spectra for peripheral conditions, and inverse relationships with alcohol and sodium consumption. Those divergences suggest distinct mechanisms underlying the brain-peripheral barrier axes in mental and neurological diseases. Related risk factors offer population-based hypotheses for further investigation in individual-level studies.

Humans↗
PubMed2004

An investigation of cervicovertebral morphology in different sagittal skeletal growth patterns.

The purpose of the present study was to examine and compare cervicovertebral morphology in subjects with different sagittal skeletal patterns. The material comprised lateral head films of 90 untreated subjects, 45 girls and 45 boys, aged 13-15 years. The radiographs were obtained in the natural head position using a fluid level method. The subjects were divided into three groups according to ANB angle: ANB angle between 1 and 5 degrees (skeletal Class I), larger than 5 degrees (skeletal Class II), and smaller than 1 degree (skeletal Class III). Each ANB group consisted of 30 subjects, 15 girls and 15 boys. Twenty-nine linear and four area measurements were used to assess cervicovertebral morphology. Differences between the ANB groups and between genders were assessed by means of analysis of variance and the least significant difference test. In addition, cephalometric measurements for all subjects were subjected to discriminant analysis. The results of the analysis of variance showed that there were statistically significant differences in the measurements of the lumen length of C1, inferior depths of C2 and C4, anterior intervertebral spaces of C2 and C3, posterior intervertebral space of C3, and anterior and posterior body heights of C4 among the ANB groups. The total length of C1, inferior depths of C2-C5, anterior intervertebral spaces of C2-C4, posterior intervertebral space of C2, anterior body heights of C4 and C5, and posterior body heights of C3-C5 demonstrated significant gender differences. The results of the discriminant analysis indicated that 54.4 per cent of the original grouped cases were correctly classified in the total sample. The final discriminant model was able to classify correctly 20 of the 30 Class I subjects (66.7 per cent), 17 of the 30 Class II subjects (56.7 per cent), and 12 of the 30 Class III subjects (40.0 per cent).

Adolescent↗
PubMed1990

Histology of the alar and transverse ligaments.

Seven sets of human transverse and alar ligaments, after tensile testing, and eight corresponding ligaments without testing, were examined histologically with respect to their fiber composition and fiber orientation. Various staining techniques were supplemented by polarized light microscopy. Both the transverse and the alar ligaments consist of collagen fibers, with very few elastic fibers in the peripheral layer. In the central portion of the transverse ligament, the collagen fibers cross each other at an angle of approximately 30 degrees. Close to the dens, the transverse ligaments show on their ventral side a transition into fibrocartilage. Except for the immediate site of failure, no differences became evident between tested specimens and controls. The collagen, as the almost exclusive constituent, together with the fiber orientation determine the mechanical properties of these ligaments. This supports the hypothesis that the ligaments could be irreversibly overstretched or even ruptured when the head is rotated and, in addition, flexed by impact trauma, especially in unexpected rear-end collisions.

Aged↗
PubMed1994

Morphology and kinematics of the baboon upper cervical spine. A model of the atlantoaxial complex.

STUDY DESIGN: Quantitative and qualitative analyses were performed to compare the anatomy and biomechanics of baboon and human upper cervical spines. OBJECTIVES: This study examined the baboon as a potential model for in vivo and in vitro atlantoaxial research. SUMMARY OF BACKGROUND DATA: A variety of animal models have been used for spine research; however, no species have been used for C1-C2 research. Most species have remarkably different C1-C2 morphology compared with that of humans. METHODS: Twenty baboon and seven human normal adult cadaveric upper cervical spines were studied morphologically. C1-C2 motion segments were analyzed biomechanically using a flexibility method of testing with physiologic range, nondestructive loading. Motion and load-deformation relationships were studied during flexion, extension, bilateral lateral bending, and bilateral axial rotation. RESULTS: The bones and ligaments of the baboon and human upper cervical vertebrae have similarly proportioned structures, identical individual components, and similar geometric configurations. The average size of the baboon vertebrae was 50% to 60% of the human specimens. There were several minor anatomical differences. Baboons had more horizontal C2-C3 facet joints and more vertical C1-C2 articular surfaces; the vertebral arteries were encased in a continuous bony canal in C1. Biomechanical testing demonstrated that baboons and humans had similarly proportioned neutral zones and elastic zones. Compared with humans, baboons had a 2 degrees to 9 degrees wider range of motion in all directions. CONCLUSIONS: The baboon and human upper cervical anatomy and biomechanics are similar. The baboon may be useful to study atlantoaxial biomechanics and pathology.

Adult↗
PubMed1975

Sudden death in rheumatoid arthritis with atlanto-axial dislocation.

A post mortem material of 11 consecutive cases of severe atlanto-axial dislocation (a.a.d.) with cord compression is reported. The total number of deaths from rheumatoid arthritis (RA) during the period of 5 years was 104, and all were autopsied. Neurological symptoms correlated poorly to fatal a.a.d. Hemiplegia was found in three cases, one of which, however, was caused by thrombosis cerebri. Spastic signs were transiently recorded in two patients and dysphagia in a further two. Five patients had a history of recent vomiting. A.a.d. was the sole or main cause of death in 8 cases and contributory in 2. Sudden death occurred in 7 of the cases. Only 2 cases had obtained a correct diagnosis intra vitam. The CNS findings at autopsy consisted of cord compression (11/11 cases), cord malacia (2/11) and cerebral oedema (3/11). One case had polyarteritis and renal amyloidosis and one pulmonary carcinoma with metastatic spread. Signs of active inflammation in the axial joints were present in 4 cases. This study, based on systematic post mortem examinations, revealed an unexpectedly high and not previously reported incidence of fatal medulla compression in RA patients with a.a.d. (10%).

Arthritis, Rheumatoid↗
PubMed2006

Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes.

Headache syndromes often suggest occipital and neck involvement, although it is still unknown to what extent branches of segment C1-C3 contribute actively to primary headache. Pain within the occipital area may be referred to the trigeminal territory. However, a modulation of trigeminal transmission by affecting cervical input in humans has not been elucidated so far. A convergence of cervical and trigeminal input at the level of the caudal part of the trigeminal nucleus in the brainstem has been suggested due to anatomical and neurophysiological studies in animals. We examined the R2 components of the nociceptive blink reflex responses in 15 healthy subjects before and after unilateral nerve blockade of the greater occipital nerve with 5 ml prilocain (1%). R2 response areas (AUC) decreased and the R2 latencies increased significantly after the nerve blockade only on the side of injection. AUC and latencies on the non-injection side remained stable. Thresholds for sensory or pain perception did not differ significantly between the repeated measurements on both sides. Our findings extend previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and suggest that the modulation of this pathway is of potential benefit in primary headache disorders.

Adult↗