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At least 991 records · Page 55Linked to original sources
PubMed1999

Occipitocervical fusion in patients with rheumatoid arthritis.

Instability and deformity of the cervical spine caused by rheumatoid arthritis is a well known entity. Operative intervention is indicated for patients with progressive deformity and when pain is resistant to conservative treatment. In a series of 39 patients who underwent posterior occipitocervical fusion with a Y plate, 22 patients were observed clinically and radiographically at average 41.5 months after surgery. In 35 of the 39 patients the main indication for surgery was pain, and in 30 of the 39 patients additional neurologic deficit (radiculopathy or myelopathy) was present. Thirty-one of the 39 patients had atlantoaxial instability. The atlantoaxial instability was associated with cranial migration of the dens in 19 patients. According to the classification of Conaty and Mongan 77.3% patients had satisfactory results and 22.7% had unsatisfactory results. Of the 30 patients with neurologic deficit, nine patients had a significant improvement. No patient had a worse result after surgery. Solid fusion was seen in all 22 patients at followup. Seven patients experienced complications directly related to the surgical procedure. Posterior fixation combined with anterior decompression in the presence of spinal stenosis represents a useful and safe method to treat instability and deformity caused by rheumatoid arthritis. Early surgical procedures may reduce the complication rate.

Aged↗
PubMedDate not supplied

[Fixating techniques of craniocervical junction: selection criteria].

Adequate choice of fixation technique at craniocervical junction depends on many factors: anatomical conditions at fusion site (e.g. anterior dislocations of the odontoid and rupture of the transverse ligament are contraindications for direct odontoid screw fixation. Sublaminar wiring and interlaminar clamps are useless in case of deficiency of posterior bony elements of C1 and C2 whether a result of laminectomy or destruction), bone quality (osteopenic bone is contraindication for screw techniques either transarticular or transpedicular). Enclosing of occipital bone into instrumentation may be difficult in wire and clamping techniques. In contrast screw techniques allow for easy grip the occipital bone. Screw techniques seem ideal in cases requiring enclosing of the occipital bone. The fusion rate at C1/C2 level seems independent of fixation techniques. When supplemented with external immobilization even biomechanically inferior wiring or interlaminar clamping provide nearly 100 rate of fusion. Screw techniques are technically demanding but they seem the method of choice when occipital bone is to be enclosed in instrumentation.

Fracture Fixation, Internal↗
PubMedDate not supplied

[A radiological study of the cervical alterations in Down syndrome. New findings on computerized tomography and three dimensional reconstructions].

OBJECTIVE: We studied a large proportion of the population in our health district who have Down's syndrome to determine the incidence and variety of changes in the spine and to define the guidelines for preventive diagnosis advisable in relation to atlanto-axial instability, a common disorder in these patients. PATIENTS AND METHODS: First phase: a plain X-ray of the cervical spine in a neutral lateral projection and in flexion in 188 patients, measuring the atlanto-odontoid distance. Second phase: computerized tomography (CT) studies and three dimensional reconstructions in 25 patients (13.3%) chosen at random. The axial cuts from the upper portion of C3 to the occiput were 3 mm in thickness with 3 mm intervals and a standard reconstruction algorithm. RESULTS: The incidences of atlanto-axial instability with an atlodontoid distance (3)5 mm were not comparable with the published series. There was a lower incidence (4.2%), with no difference between measurements in flexion and in the neutral lateral views. There was a greater incidence of malformations than in other reports, including a rare case of os odontoideum and also constant asymmetry of the occipital condyles (100%) in the patients of the CT series and consequently instability of the atlas (96%) and off-centered odontoides (84%). CONCLUSIONS: The study showed that there was deficient asymmetrical development of the occipital bone, which caused different heights of the occipital condyles and led to cervico-cranial mal-position. For study of the degree of error of position and congenital anomalies. We recommend replacing plain X-ray studies by CT with three dimensional reconstructions.

Adolescent↗
PubMed2001

[Anterior screw fixation of fractures of the dens axis].

INTRODUCTION: The aim of the present study was to evaluate the results of anterior screw fixation in the treatment of odontoid fracture. MATERIALS AND METHODS: The clinical and radiographic records of the first 14 patients treated with anterior screw fixation for odontoid fracture were reviewed retrospectively. RESULTS: Satisfying stabilisation of the fracture was achieved in 10 patients (71%). In four patients, two of whom had severe osteoporosis, additional posterior C1/C2 fusion, owing to failure of screw treatment was needed. Two patients developed small occipital bedsores caused by preoperative treatment, but no further complications were observed. CONCLUSION: Although only a few patients were entered in the study, the results justify the use of anterior screw fixation as the treatment of odontoid fracture in selected patients.

Adolescent↗
PubMed2001

Single-screw fixation for acute Type II odontoid fracture.

BACKGROUND: The management of odontoid fractures is still controversial. The main current trends of treatment are conservative management with HALO immobilization, posterior surgical fixation or anterior surgical fixation. The authors report a consecutive series of 17 cases of patients with acute Type II odontoid fracture treated between November 1994 and February 2000. METHODS: Since June 1997 anterior odontoid screw fixation was performed in nine cases. The technical aspects of the internal fusion are described. RESULTS: Spinal stabilization was achieved in all patients. The postoperative neuroimaging demonstrates the successful positioning of the odontoid screw of all patients. CONCLUSIONS: The success of this treatment depends on patients' selection, attention to technical operative details and adequate follow-up. Internal screw fixation gives immediate direct fixation of the fracture, offers a high rate of fusion without requiring prolonged HALO immobilization, it gives a reduction of the cervical pain and preserves the normal mobility of C1-C2.

Adult↗
PubMed2001

[Fractures of the cervical vertebrae: diagnosis with multi-slice spiral CT].

PURPOSE: It is the aim of this study to investigate the efficiency of multislice helical CT for the diagnosis of cervical spine fractures. The advantages of this technique are demonstrated by case reports. MATERIAL AND METHODS: The entire cervical spine or selected vertebral bodies of 66 patients with cervical spine fractures known from preceding plain films were scanned with a multislice helical CT. The CT-scans were obtained with a slice thickness of 1.25 mm and with two different pitches (0.75 or 1.5) and table speeds (3.75 or 7.5 mm/rot.). Additionally, sagittal and coronal reformations were performed. RESULTS: The mean scan-time for the cervical spine was 13 seconds. High quality sagittal and coronal reformations were obtained from axial images within a few minutes. Fractures of the dens (n = 17) and of the vertebral body of C3-C7 (n = 12) occurred predominantly. CONCLUSION: Multislice helical CT is an effective tool to diagnose fractures of the cervical spine rapidly and exactly.

Adult↗
PubMed1999

[Treatment of complex crainocervical junction malformation by transoccipito-cervical posterolateral approach].

OBJECTIVE: To report the treatment of six patients suffering from complex craniocervical junction (CCJ) malformation by transoccipitocervical posterolateral approach which is a new surgical method. METHODS: Transoccipitocervical posterolateral approach was confirmed feasible by anatomy of the body. Diagnosis was made sure CT-three dimensional image and MRI for every patient. All cases reaived odontoidectomy and suboccipital decompression and/or bone graft. RESULTS: All patients showed favorable outcome without deterioration or recurrence. Six patients were followed up for 15 - 10 months. All patients showed marked progressive improvement of neurological disturbances and three of them resumed work half a year after operation. CONCLUSION: Transoccipitocervical posterolateral approach is a new surgical procedure by which anterior and posterior decompression of foramen magnun aria and bone graft (posterior craniocervical stabilization) could be fulfilled during one operation.

Adult↗
PubMed2002

Laron syndrome abnormalities: spinal stenosis, os odontoideum, degenerative changes of the atlanto-odontoid joint, and small oropharynx.

BACKGROUND AND PURPOSE: Patients with Laron syndrome have an inborn growth hormone resistance. We investigated abnormalities in the upper airways and cervical spine in patients with Laron syndrome. METHODS: We prospectively examined 11 patients (one child aged 9 years and 10 adults aged 36-68 years), 10 of whom underwent MR imaging of the spine or head; nine, radiography of the cervical spine; and four, CT of C1-C2. The width of the spinal canal was evaluated visually and quantitatively and compared with reference values. The smallest diameter of the oropharynx and the thickness of the palate were measured and compared with reference values. Nine age-matched female patients referred for MR imaging for unrelated reasons served as control subjects. RESULTS: Cervical spinal stenosis was present in seven of the adult patients, within a confidence interval of 95%. Anomaly of the dens compatible with os odontoideum was present in three patients, causing focal myelomalacia in two. The atlanto-odontoid joint showed osteoarthritic changes in six of the adult patients. The mediolateral diameter of the oropharynx was significantly smaller in the patients with Laron syndrome than in the control subjects (P <.005). There was no difference in the thickness of the soft palate. CONCLUSION: Patients with Laron syndrome develop significant narrowing of the cervical spinal canal and early degenerative changes of the atlanto-odontoid joint. Laron syndrome is associated with os odontoideum causing myelomalacia. The dimensions of the oropharynx are small. Patients may be prone to neurologic morbidity and sleep disturbances. Routine MR imaging of the cervical spine is recommended in these patients.

Adult↗
PubMed1997

Incidence and type of cervical spine injuries associated with mandibular fractures.

The incidence of facial fractures accompanied by spinal injuries, while low, is of significant concern to the craniomaxillofacial surgeon. There are conflicting reports on the association between facial fractures and concomitant spinal damage. This retrospective study of 424 patients with mandibular fractures examines the relationship of mandibular fractures and concomitant spinal injuries. The incidence of concurrent mandibular and cervical fractures was 2.6%, predominantly associated with motor vehicle accidents. The purpose of this study is to examine the incidence of cervical spine injury associated with mandibular fractures, in order to improve the diagnosis and treatment of spinal injury associated with mandibular fractures.

Accidents, Traffic↗
PubMedDate not supplied

[Problems in the selection of surgical approach for the treatment of non-traumatic deformities of the craniocervical junction].

Developmental abnormalities or inflammatory disorders provoke deformations and instability of the craniocervical junction. The most dangerous results of these lesions are: sudden brainstem compression or cervical myelopathy. The authors propose the guidelines for surgical management of non-traumatic deformities caused by: a) rheumatoid arthritis of the spine, b) congenital anatomic changes of the occipit and odontoid. Main goals of surgical treatment are decompression and stabilization. The choice of surgical approach and method depends on pathology. It is very important to estimate individual anatomic changes and mobility--possibility of reduction. The authors discuss surgical methods actually used for fusion and decompression of the occipitocervical junction.

Arthritis, Rheumatoid↗
PubMed2002

Lack of aberrations of the BMP4, BMP2, and PTX1 genes in a patient with pituitary hypoplasia, os odontoideum, renal dysplasia, and right leg anomalies.

We report on a 15-year-old girl who presented with pituitary hypoplasia, os odontoideum, renal dysplasia, an asymmetrically short right leg, and postaxial hypodactyly of the right foot. Her endocrinological data showed anterior pituitary hormone deficiency. The fact that she had healthy parents and an elder sister suggests that she had either a de novo mutation or autosomal recessive inheritance. We speculated that bone morphogenetic protein 4 (BMP4), BMP2, or pituitary homeobox 1 (PTX1) might be the responsible genes in this patient based on the similarity of her clinical symptoms and phenotypes to knock-out mice of these genes. We performed mutation analysis of these genes by direct sequencing of genomic DNA. In BMP2 gene, AGA right curved arrow AGT transversion in exon 3, converting arginine to serine was detected. In PTX1 gene, transversion of GCC right curved arrow GGC in exon 2, converting alanine to glycine at codon 184 was found in the patient and controls. We did not find any non-sense mutations although 5 polymorphisms of these genes were found. This constellation of findings may represent a new entity of congenital combined pituitary hormone deficiency.

Adolescent↗
PubMedDate not supplied

The axis ring: a forgotten semiologic sign in the detection of low odontoid fractures.

The axis ring is a very important sign in the detection of low odontoid fractures. It can be the only radiological sign of a type III (low) odontoid fracture in a polytraumatised patient. As these are unstable fractures, their detection is important, even before a spiral CT is performed. Tracheal tube placement in patients with type III odontoid fractures should be performed very carefully to prevent displacement of the fracture. This sign, which has been published more than once in the radiological literature, seems to be not so well known by the physicians nor by a lot of radiologists. We can call it a forgotten semiologic sign. It is not even mentioned in the ATLS (Advanced Trauma Life Support) criteria for evaluation of the cervical spine.

Adult↗
PubMed2003

Anterior screw fixation in type II odontoid fractures: is there a difference in outcome between age groups?

OBJECTIVE: Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. METHODS: We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls. RESULTS: There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied. CONCLUSION: Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.

Adult↗
PubMed1992

Remarkable improvement of activity by CAPD in a hemodialysis patient with a pseudotumor of the craniocervical junction.

Pseudotumor of the craniocervical junction and destructive spondyloarthropathy (DSA) are the most serious forms of dialysis amyloidosis (DAA). Pain and paralysis due to these lesions significantly impair activity of a patients' daily life (ADL). CAPD improved ADL of a 54 year-old male patient complicated with various forms of DAA after 17 years of hemodialysis (HD) treatment. He was first diagnosed as having carpal tunnel syndrome 12 years after initiation of hemodialysis followed by dialysis shoulders(12 years), trigger fingers(12 years), bone cysts(15 years), tendon ruptures(17 years), DSA and a pseudotumor of the craniocervical junction(17 years). Magnetic resonance imaging (MRI) taken in May 1989 revealed a pseudotumor of the craniocervical junction, which was 30 mm in diameter, located in front of partially destroyed C1 and C2. Neck pain and muscle weakness rendered him bed ridden. Six months after switching to CAPD with administration of prednisolone, neck pain disappeared. He recovered the muscle power by physical rehabilitation. At last it became possible for him to perform the CAPD procedure by himself and drive a car to the hospital as an out patient. In such cases of pseudotumors of the craniocervical junction, CAPD is one of the best methods for relieving the pain and muscle weakness.

Activities of Daily Living↗