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At least 1,081 records · Page 60Linked to original sources
PubMed1989

[Conservative fracture treatment of the cervical spine with halo fixation].

A differentiated therapeutic approach is necessary in discoligamentous or osseous lesions of the cervical spine. Whereas lesions with neurological disturbances are stabilised by operation almost in all cases--and extensive lesions of the lower cervical spine (C3 to C7) quite frequently--, conservative treatment is the order of the day in sequels to trauma at the upper cervical spine (C1 and C2) as well as in mild lesions of all sections of the cervical vertebral column. Fractures of the dens of Types II and III (after Anderson and d'Alonzo) are the exception, since they are now being stabilized by surgery on a large scale. The advantages of the halo-fixateur therapy compared against extension and immobilization in Minerva gypsum are that secondary correction of positioning is possible; that functionally disturbing and extended spondylodeses are avoided; that care of the polytraumatized patient is facilitated; that X-ray films are easy to assess; and that the period of hospitalization is greatly reduced. Successful treatment is possible only of the possible complications are known. Failures are possible if the head screws become loose, if there are pin-trac infections, if dislocations and fractures are redislocated, and if there are points of pressure beneath the jacket.

Braces↗
PubMed1989

[Possibilities and limits of therapy of injuries of the cervical vertebrae with halo fixation].

74 patients were treated with a Halo-thoracic brace in the Department of Traumatology of the AK St. Georg between 1980 and 1986. Of these, 61 had fractures of the cervical spine, nine had tumor-osteolysis, and four had inflammatory destructions of the vertebrae. In almost all cases of fractures of the upper cervical spine (C0-C2) bone healing occurred with applying the Halo fixation alone. In the middle and lower cervical spine, however, secondary operative measures were often necessary because of persistent instabilities, redislocations or neurologic disturbances. New experience in the palliative treatment of malignant osteolysis of the cervical spine shows, that restabilisation of the segments concerned can be achieved by the combined use the Halo apparatus, surgical resection of the involved vertebral bodies with bone grafting and radiotherapy. A new radiolucent Halo apparatus broadens diagnostic and therapeutic facilities.

Adult↗
PubMed1989

[Bone screw osteosynthesis of dens fractures. Technical surgical aspects and results].

Twenty cases of Anderson and d'Alonzo type II and "shallow" type III fractures of the dens were treated by anterior screw fixation: the results were reviewed and compared with previously published results obtained in series of such fractures treated non-surgically, by posterior C1-C2 arthrodesis or anterior screw fixation. The complication rate of 25% in our series is comparable to those reported in a previously published review of studies on posterior wiring for C1-C2 arthrodesis. Three of our cases in which complications occurred (15%) were recognized in retrospect as inappropriate for the use of this technique: in one of these patients there was confirmed non-union, and the other two had markedly osteoporotic bone. A meticulous operative technique and the use of special instruments may improve the success rate. The anterior screw fixation method, however, allows for maximal post-treatment cervical motion, since it makes arthrodesis unnecessary and minimizes the degree and duration of postoperative external immobilization. It also reduces the iatrogenic trauma since an anterior rather than a posterior cervical approach is taken and supplementary bone grafting is not required. Anterior screw fixation of type II dens fractures appears to be the ideal method of treatment for these injuries, but since it is difficult to perform its use should be limited only to experienced spine surgeons with access to the appropriate surgical facilities.

Adolescent↗
PubMed1989

[Rheumatoid arthritis with cervical localization. Description of a case with neurological symptomatology and review of the literature].

A case of a patient with rheumatoid arthritis with a cranio-cervical junction involvement is presented. Medullary compression was present and was partially invalidating. Radiological and CT scan signs are explained and their relationship with a clinical symptomatology is discussed. The importance of radiological monitoring is emphasised in order to avoid dangerous neurological complications.

Aged↗
PubMedDate not supplied

[The transoral approach in neurosurgical practice].

Operations were performed on 25 patients by the transoral approach. All of the pathological processes were localized epidurally in the clival, craniocervical or upper cervical regions. These were tumors, developmental anomalies, inflammatory processes, and odontoid fracture with compression of the brain stem, cranial nerves, spinal cord or spinal radices. The advantages of the transoral operation are obvious in decompressing the neural structures from the direction of the exerted pressure. Surgery led to improvement in the 25 primarily operated patients and there was no operative mortality. Among 7 reoperations an emergency and tenable transoral reoperation (C2-4 twice recurrent chordoma) undertaken to relieve respiratory arrest, however, was only a transitory success.

Adolescent↗
PubMed1988

[Occipitocervical fusion in metastasis to the dens].

Metastasis of the cervical spine or pathological fracture respectively presents a demanding therapeutical task. Pain and threatening, neurological deficit require an active action, even if curative treatment is unlikely. The remaining survival time after appearance of osseous metastasis is on the average nine to twelve months and justifies an operation, especially in view of psychosocial consequences for the patient. We are describing the unique case of cervical spinal manifestation after liver transplantation because of primary hepatic cancer.

Axis, Cervical Vertebra↗
PubMed1986

[Forms of fracture of the dens axis in the application of ventral flexion force].

In fracture experiments in 220 cast models of the axis and atlas, an attempt was made to separate two different factors influencing the position of the dens fracture (superior and inferior type): the direction of the force application and the inclination of the dens axis. For this purpose, two extreme forms of dens inclination in the sagittal plane were used, namely a form with a ventrally inclined axis (kyphotic form) and a dorsally oriented axis (lordotic form). The force was applied in ventral flexion in 11 single steps between 10 and 75 degrees. The fracture types occurring under natural conditions could be reproduced with this experimental paradigm. Depending on the direction of the force application, both types of dens fracture occurred in ventral flexing traction alone. Independent of the inclination of the dens axis, this ventral flexion led to an inferior fracture type with a shallow angle, and a superior fraction type with a steep angle. With 75 degrees flexion, no longer the dens fracture, but the Hangman's fracture was the usual fracture type in both dens forms. With fundamental agreement of both dens forms with regard to the direction-dependent genesis of the fracture pattern, the lordotic dens and kyphotic dens displayed differences in the details which are discussed exhaustively. In this connection, the differences in the size of the horizontal thrust component due to the primary form of the dens with the same direction of force application is pointed out. According to the present investigations, a classification of dens fractures should be made more precise by specification of the dens form.

Axis, Cervical Vertebra↗
PubMed1989

Atlantoaxial instability and neurologic indicators in rheumatoid arthritis.

Atlantoaxial subluxation in rheumatoid arthritis is characterized by pain, disability, and occasionally death. Surgical fusion of the offending vertebrae is the appropriate surgical remedy, but it is a procedure with a high failure and complication rate. Because cord compression and myelopathy are the main complications of this condition, it would be logical to use evidence of early neurologic deficit as an indicator for surgery. A group of 250 patients with rheumatoid arthritis were investigated to evaluate the neurologic status with respect to the degree of instability in the proximal cervical spine. Neurologic isolated signs such as hyperreflexia could not be correlated with the onset of cervical myelopathy or quadraparesis or to the radiographically measured degree of atlantoaxial instability. These signs should not be used as an indication for surgery. The positive indications are intractable pain, cervical myelopathy, and severe atlantoaxial instability.

Adult↗
PubMed1986

Absent dens on submentovertex view of the skull: new sign of an abnormal odontoid.

Anomalies of the dens are clinically important and should be recognized by the radiologist. Frequently, skull, sinus, and facial examinations are performed that include projections of the upper cervical spine. The odontoid may not be readily apparent on these examinations. The absence of a recognizably normal dens on a submentovertex (SMV) projection of the skull has not been previously described. A one-year retrospective review of 425 examinations that included the SMV projection was carried out. In 421 the normal dens was easily recognized on the SMV view of the skull. Lack of identification in the other four indicated a dens abnormality and warranted further investigation.

Adolescent↗
PubMed1987

Atlantoaxial instability in individuals with Down syndrome: epidemiologic, radiographic, and clinical studies.

Atlantoaxial instability is a relatively frequent finding in individuals with Down syndrome. We examined 404 patients with this chromosome disorder and observed their atlanto-dens intervals and spinal canal widths to be significantly different from children without Down syndrome. Significant differences were also noted between boys and girls with Down syndrome in spinal canal widths but not in atlanto-dens interval measurements. When different neck positions were compared, measurements obtained in flexion were significantly greater than in extension or in neutral position. In addition, more patients had greater than or equal to 5 mm atlanto-dens interval measurements in flexion than in extension or neutral. A total of 59 (14.6%) of 404 patients displayed atlantoaxial instability. Fifty-three (13.1%) patients had asymptomatic atlantoaxial instability, and special precautions will have to be taken with this group of children. Six (1.5%) patients had symptomatic atlantoaxial instability who underwent surgery to prevent further injury to the spinal cord. In our follow-up studies of 95 patients with Down syndrome, we did not find any significant changes during either clinical or radiographic reexaminations.

Adolescent↗
PubMed1988

[Atlanto-axial dislocation in Down syndrome and os odontoieum. Case report and review of the literature].

A case is reported of the rare coincidence of mongolism and os odontoideum in an eleven-year-old child, leading to compression myelopathy in consequence of atlantoaxial dislocation, and an overview of literature to the present time is given. Recommendations on diagnostic and prophylactic measures are offered designed to counteract as early as possible the spinal complications of atlantoaxial instability.

Atlanto-Axial Joint↗