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At least 1,009 records · Page 56Linked to original sources
PubMed2003

[Odontoidectomy in the treatment of medically refractory, neurogenic hypertension].

The authors present a case of medically refractory, neurogenic hypertension where the MR examination revealed an odontoid compression of the anterior medulla as a consequence of a basilar impression. Following transoral odontoidectomy and craniocervical fixation, the blood pressure in the 24-year-old woman returned to normal, and 1 year postoperatively she remains normotensive and off all medication. This reported case provides further support to the theory that there is a subgroup of patients who may have a vascular compression of the medulla with no neurological symptoms other than hypertension.

Adult↗
PubMed1992

Understanding the os odontoideum.

Five cases of os odontoideum and associated instability of C1-2 involving patients who underwent a posterior spinal fusion are reviewed, along with the literature. Four of the patients had Down's syndrome, and two of them were symptomatic at the time of presentation. In the two asymptomatic patients, the os odontoideum was an incidental finding on routine roentgenographic survey. The fifth patient presented with trauma and neck pain. The operation was successful in all of the patients with Down's syndrome but one, who had preoperative signs of myelopathy. Patients known to have an os odontoideum must be followed closely; if there is instability, posterior spinal fusion is recommended to avoid the risk of neurologic compromise. An understanding of the pathoanatomy of this condition is essential to recognize and properly treat these patients.

Adolescent↗
PubMed1992

[Surgical treatment of injuries of the upper cervical spine].

The surgical treatment of instabilities of the upper cervical spine requires the use of differentiated procedures if physiological anatomy is to be largely restored. Successful procedures are diagonal screw fixation of the axis from the anterolateral aspect in the case of odontoid fractures Anderson type II and III (high type), transpedicular screw osteosynthesis of C2 in hangman's fractures, and transarticular screw fixation of C1/2 with posterior fusion for atlantoaxial instabilities. In occipito-atlantal trauma occipitoatlantoaxial fusion is required.

Atlanto-Axial Joint↗
PubMed1992

Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities.

C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.

Accidents, Traffic↗
PubMed2004

Immediate endovascular stent-graft repair of an acute traumatic rupture of the thoracic aorta: case report and subject review.

We describe a case of emergency endovascular stent-graft placement for acute traumatic rupture of the thoracic aorta in a patient with an associated unstable type II odontoid fracture. The stent-graft placement procedure was performed within 4 hours of admission under sedation and local anaesthesia while the neck remained externally splinted. After exclusion of the rupture the patient could then undergo treatment of the associated cervical fracture and other injuries.

Accidents, Traffic↗
PubMed2004

Injury biomechanics of C2 dens fractures.

The objective of this study is to analyze the biomechanics of dens fractures of the second cervical vertebra in the adult population due to motor vehicle crashes. Case-by-case records from the Crash Injury Research and Engineering Network (CIREN) and National Automotive Sampling System (NASS) databases were used. Variables such as change in velocity, impact direction and body habitus were extracted. Results indicated that similarities exist in the two databases despite differences in sampling methods between the two sources (e.g., CIREN is not population based). Trauma is predominantly associated with the frontal mode of impact. Majority of injuries occur with change in velocities below current federal guideline thresholds. No specific bias exists with respect to variables such as age, height, weight, and gender. Because similar conclusions can be drawn with regard to vehicle model years, design changes during these years may have had little effect on this injury. To ameliorate trauma, emphasis should be placed on the frontal impact mode and entire adult population. Because of clinical implications in the fracture type (II being most critical) and lack of specific coding, CIREN data demonstrates the need to improve injury coding in the AIS and application in the NASS to enhance occupant safety and treatment in the field of automotive medicine.

Adult↗
PubMed1992

A longitudinal study of atlanto-dens relationships in asymptomatic individuals with Down syndrome.

This study was designed to investigate the natural history of atlantoaxial instability in individuals with Down syndrome and to determine whether significant changes in C1-C2 relationship are taking place over time. Although more than 400 patients with Down syndrome who are presently followed at the Child Development Center had cervical spine radiographic examinations in the past, only 141 patients who had serial radiological examinations and whose radiographs were available for reevaluation participated in this study. The results of our investigations revealed that there were only minor changes (1 to 1.5 mm) of atlanto-dens interval measurements over time in 130 (92%) patients with Down syndrome. Eleven patients (8%) had changes of atlanto-dens interval measurements between 2 and 4 mm over time; however, none of these patients had any clinical symptoms. The analyses of data obtained from several subgroups (males and females, various age groups, and patients with and without atlantoaxial instability) did not show any significant changes of atlanto-dens interval measurements of successively obtained radiographs. Our recommendations for and rationale of routine screening for atlantoaxial instability and follow-up examinations are discussed in detail.

Adolescent↗
PubMedDate not supplied

[Direct fixation of the odontoid fracture in a child].

The use of spinal implants in the pediatric population is controversial in terms of skeletal immaturity. The authors present the case of a 12-year-old boy with displaced Type III odontoid fracture, successfully treated by direct screw fixation. Fractures defined as Type II and Type III according to the classification by Anderson and D'Alonzo are instable spinal injuries. Type III fractures generally heal when treated conservatively. In certain circumstances, like displaced fractures or patients refusing long-term external immobilization, Type III fractures are treated surgically. A 12-year-old boy had neck injury caused by a bike accident. His main symptoms were neck pain and limitation of neck movements. Displaced Type III odontoid fracture was diagnosed. The authors treated this lesion surgically by screw fixation in order to correct displacement and to preserve the normal range of head motion. Fixation was performed by means of a single cannulated screw. Healing of the fracture was confirmed by roentgenograms done at follow-up examinations. The range of motion of the cervical spine examined 6 months after operation was normal. Direct anterior screw fixation was an effective method for treating displaced Type III odontoid fracture in a child. The rotatory motion between C-1 and C-2 was preserved.

Bicycling↗
PubMed2005

Anterior screw fixation for a pediatric odontoid nonunion: a case report.

STUDY DESIGN: A case of an odontoid nonunion in a child treated with anterior screw fixation. OBJECTIVES: To demonstrate that an anterior screw procedure can be performed with an odontoid nonunion with resultant fusion to maintain range of motion. METHODS: A 15-year-old boy presented with pain in his neck following a rugby football injury. Admission plain radiographs and computed tomography scan demonstrated an odontoid nonunion. Radiographs of a previous cervical spine injury 2 years before demonstrated a missed odontoid fracture. RESULTS: The child was initially treated conservatively with halo vest immobilization, which did not result in healing. Direct anterior screw fixation was performed and the fracture united 5 months following surgery. DISCUSSION: The nonunion was asymptomatic for 2 years until the second injury when it became clinically symptomatic. It did not respond to conservative treatment and was unstable on screening requiring operative intervention. CONCLUSIONS: Very few cases have been reported of pediatric odontoid nonunions. If the fracture pattern allows, then direct anterior screw fixation should be considered in order to maintain range of motion at the atlantoaxial articulation.

Adolescent↗
PubMed2005

The treatment of odontoid fractures with a significant displacement.

OBJECTIVE: The purpose of this study was to determine the treatment features of odontoid fractures with a significant displacement. MATERIAL AND METHODS: Thirty-seven patients with acute odontoid fractures were treated in Kaunas University of Medicine Hospital between 1998 and 2003. Seventeen persons with displacement of fragments less than 5 mm or 5 mm (according to E. A. Seybold and J. C. Bayley method) were in the first group. Twenty patients with displacement of fragments more than 5 mm were in the second group. The attempt of closed reduction of the cervical spine axis was performed for all patients. If successful closed reduction was achieved, patients were placed in halo-vest device for 8 weeks. If closed reduction failed, patient was operated according to W. E. Gallie. Postoperatively, all patients wore a halo-vest device during the first 8 weeks. RESULTS: Demographics including age, sex, neurological condition, and associated spinal fractures were similar in patients from these groups (p>0.05). Successful closed reduction of the cervical spine axis was achieved in 11 (64.7%) patients from the first group and in 13 (65%) patients from the second group (p>0.05). Six (35.3%) patients from the first group and seven (35%) from the second group were treated with immediate C1-C2 posterior fusion (p>0.05). Two (16.7%) from twelve patients from the second group were treated by external immobilization by halo-vest device and had nonunion of fracture 8 weeks after the treatment. All operated patients had a solid fusion. CONCLUSIONS: If closed reduction of the odontoid fracture with a significant displacement was achieved then external immobilization by halo-vest device can be used. Posterior fusion is the treatment of choice for irreducible odontoid fractures.

Acute Disease↗