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PubMedDate not supplied

Lateral retrovascular approach to the upper cervical spine.

The authors describe the surgical anatomy of lateral approach to the upper cervical spine. The approach is retrovascular retropharyngeal extraoral allowing for anterolateral exposure of the upper cervical column, and it may be enlarged posteriorly on the homolateral posterior hemiarch of C1 and C2, and/or inferiorly on the lower cervical column. Absolute indications to this approach are anterolateral fusion with transarticular screws C1-C2 and excision of skeletal neoplasms adjacent to the vertebral artery. For other indications such as the treatment of anterior neoplasms and spinal cord decompression it is preferable to use pre-vascular extraoral approach or transoral approach.

Adolescent↗
PubMed1990

Pseudotumor of the craniocervical junction during long-term hemodialysis.

A systematic study of the upper cervical spine was performed using magnetic resonance imaging in 25 patients (15 men and 10 women) who had been undergoing hemodialysis for more than 10 years. Seven pseudotumors of the periodontoid soft tissue were disclosed, which were similar to the pannus recently described in rheumatoid arthritis. Bone cystic radiolucencies were observed in association with these pseudotumors in 5 patients. The radiolucencies were located in the atlas (1 in the lateral mass and 1 in the anterior branch) and in the axis (3 in the odontoid process and 1 in the vertebral body). No horizontal or vertical atlantoaxial subluxation was demonstrated. These features were observed only in patients who had amyloid arthropathy. They could be a frequent, yet thus far little-recognized, feature of beta 2-microglobulin amyloidosis.

Adolescent↗
PubMed1980

[Instability and kyphosis following cervical laminectomy and occipital craniectomy in children (author's transl)].

The authors analyse the various factors of spinal instability and their respective importance in a series of 113 patients in which, either the occipital cerebellar pits or the cervical spine had been approached surgically. The essential cause was mechanical failure consecutive and related to the number of levels of laminectomies performed, even when the articular processes and their capsule were left intact. While craniectomy and ablation of the posterior arch of the Atlas was rarely, if ever, responsible for instability, the frequency rises to 25% once the Axis, the spinous processes and laminae have been removed. Instability was present in 80% of the cases in which three or more levels are involved. Moreover, cervical laminectomy was nearly always followed by instability, above all when the cervico-dorsal transitional zone was involved and even when only a small number of vertebral levels had been operated on. Location of the instability was always at the limit between the lowest level of laminectomy and the lover lying intact vertebra. Diagnosis has gone unrecognized until presently: the severity of the possible complications have led the authors to propose preventive surgical management. It this serie, an anterior vertebral bone graft was prefered. Consciousness of the risks involved should lead to better prevention, be it at the moment of neurosurgical surgery or in the follow-up period. However, preventive treatment creates several problems, which may only be solved by a currently undertaken prospective study.

Adolescent↗
PubMed1980

Development of bilateral collateral circulation after fracture of the axis.

The authors present a patient with chronic myelopathy after atlanto-axial fracture and vertebral artery occlusion treated by removal of the arch of the atlas. The natural arterial collaterals and their role are discussed. It is suggested that the knowledge of all the anastomoses is very important to avoid damage of blood flow during surgery. Fenestration of the vertebral artery causing by kinking is to be seen--a rare form of pathological collaterals.

Arterial Occlusive Diseases↗
PubMed1997

Transverse process of the atlas(C1)--an important surgical landmark of the upper neck.

BACKGROUND: The internal carotid artery, the internal jugular vein, and the spinal accessory nerve are the main structures that are preserved in conservative neck dissections. In the upper neck, one surgical landmark used to find these structures is the transverse process of a cervical vertebral body. There is controversy about the origin of the transverse process in the upper neck. METHODS: We applied three-dimensional computerized tomography (3-D CT), an intraoperative navigational system and cadaver dissection of the neck to clarify the controversy. RESULTS: The origin of the transverse process was from the atlas (C1). CONCLUSIONS: The transverse process of the atlas is an important surgical landmark in the upper neck. The neurovascular bundle is located anteriorly. The transverse process of the axis (C2) is less prominent and is situated antero-inferior to the spinal accessory nerve where the nerve emerges from the posterior border of the internal jugular vein.

Cadaver↗
PubMed2004

[Atlanto-axial subluxation posssibly due to eosinophilic granuloma of the axis: a case report].

A 29-year-old male presented with symptoms of acute severe neck pain with no other neurological symptoms. He had noticed lymph node swelling with pain in his neck about 2 months before admission and had been treated by the transoral administration of antibiotics for about 10 days. His neck was protected with a neck collar and an evaluation of any possible neck lesion was performed. Plain X-ray film and CT scans of the cervical spine showed an anterior subluxation of the atlas and an anterior declination and erosion of the dens. The MRI findings showed long T1 and T2 values in many parts of the bone marrow of the body of the axis and the dens, and both the bone marrow and thickend soft tissue between the pharynx and the axis were slightly enhanced. Inflammatory disease, tuberculosis, rheumatoid arthritis, malignant lymphoma, and leukemia were all ruled out based on the laboratory data, Ga schintigrams and other examinations. Almost no changes in the lesion were observed on MRI at about 6 weeks after admission. As a result, we presumed that this lesion was not likely to be malignant, but might be some kind of granuloma, especially an eosinophilic granuloma. A laminectomy of the atlas and a resection of the posterior margin of the foramen magnum and upper portion of the lamina of the axis was performed to achieve decompression of the craniovertebral junction, and posterior fusion was performed with a rod betweeen the occipital bone and the C4 lamina. The rod was fixed with screws and wires to the occipital bone and with lamina hooks to the axis and C4 laminas. At 14 months postoperatively, the patient is doing well and the axis and the dens have been reconstructed without any need to resect the lesion, or perform either chemothrapy or radiotherapy. Our clinical findings of this case correlate with the opinion that an immobilization of the lesion is a sufficient treatment for many cases of eosinophilic granuloma. Although a biopsy or histological examination of the lesion was not performed, the clinical course of this case strongly suggests that this lesion was indeed an eosinophilic granuloma.

Adult↗
PubMed2006

Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases.

BACKGROUND: Bone tumors located at the cranio-cervical junction (CCJ)are rare. Tumoral involvement of the neighbouring structures including bone, nerves and vertebral artery and the dynamic aspects of the bone structures raise technical difficulties in the surgical approach. The surgical management includes tumoral resection and stabilization of the CCJ. METHODS: Forty-one patients presenting a bone tumor (26 benign and 15 malignant tumors), excluding chordomas, located at the CCJ (including lower third of the clivus, C1 and C2) were observed over 20 years from 1981 to 2001. Imaging work-up included CT scanner with bone windows sequences and reconstruction in the coronal and sagittal plane; since 1984 most of the patients (N=35) underwent a MRI and angioMR scanning. Vertebral angiography was rarely performed (N=9) and mostly when the diagnosis was doubtful. In some cases the diagnosis was clear but in others, imaging studies showed destructive lesions suggesting a malignancy, which sometimes required a biopsy (N=4). The surgical resection was only performed through a lateral approach. FINDINGS: Complete resection was achieved in 38 cases while in 3 cases a small remnant was left behind. A complementary stabilization procedure was necessary in 18 cases using either bone grafting during the same procedure and through the same approach (N=5) or a craniocervical plating and bone grafting (N=13). No recurrence in the group of benign tumors was seen during an average follow-up of 6 years (from 2 to 11 years). The pre-operative symptoms of pain and neck stiffness, improved or disappeared in most patients. Three patients with lower cranial nerves (N=2) or sphincter disturbances (N=1) remained unchanged. One patient with tetraplegia eventually died. CONCLUSIONS: Various types of bone tumors may be found at the CCJ. Confusion between benign and malignant tumor or pseudo tumors must be avoided, sometimes requiring a biopsy. Surgery using a lateral approach, usually permits the surgeon to achieve a complete resection either preserving the stability of the CCJ whenever intact or associated with a stabilization procedure.

Adolescent↗
PubMed1995

The ISG viewing wand: an application to atlanto-axial cervical surgery using the Le Fort I maxillary osteotomy.

Surgical access to the clivus and upper cervical spine may be facilitated by a number of approaches. The Le Fort I maxillary osteotomy has been described to give improved access to the skull base for removal of tumours and treating vertebrobasilar aneurysms. We describe a case in which the combination of a particularly high translocation of the body of C2 and poor mouth opening had precluded a standard transoral approach by restricting access to the operative field. Anterior decompression of the body of C2 was therefore performed via a maxillary down-fracture with the aid of an interactive image guidance system, the ISG Viewing Wand. The ISG Viewing Wand is a new intra-operative 3 dimensional (3D) image guidance system which has now been used in over three hundred neurosurgical cases at Frenchay Hospital, Bristol. We briefly discuss the principles of the viewing wand and describe its unique application providing anatomical navigation in upper cervical spine surgery.

Aged↗
PubMed2000

Transoral decompression, anterior plate fixation, and posterior wire fusion for irreducible atlantoaxial kyphosis in rheumatoid arthritis.

STUDY DESIGN: Fifteen consecutive patients with irreducible atlantoaxial kyphosis caused by rheumatoid arthritis were treated by combined transoral odontoid resection, anterior plate fixation, and posterior wire fusion. OBJECTIVES: To investigate the clinical results of this new surgical procedure. SUMMARY AND BACKGROUND DATA: Irreducible atlantoaxial kyphosis in rheumatoid arthritis results from a destruction of the craniocervical joint ligaments and the anterior aspects of the lateral atlantoaxial joints. The development of a paradental synovial pannus and atlantoaxial joint impaction prevents reduction by conservative treatment, such as skull traction. Posterior surgical procedures for the treatment of the irreducible atlantoaxial kyphosis with spinal cord compression have been associated with high morbidity and mortality. METHODS: Fifteen consecutive patients were treated by transoral odontoid resection. The fixation was performed with anterior plating, according to the method of Harms in combination with posterior wire fusion according to Brooks. Before and after surgery, evaluation was performed using the parameters of pain (visual analog scale), range of motion, and subjective assessment of improvement and the Health Assessment Questionnaire. The neurologic deficit was defined according to the classifications proposed by Ranawat, Frankel, and Nurwick. Plain radiographs, including lateral flexion and extension views, and magnetic resonance scans were obtained. RESULTS: No perioperative fatality occurred. The average clinical and radiographic follow-up was 50.7 +/- 15.6 months (range, 26-77). Postoperative pain was relieved (mean pain score before surgery, 7.9 +/- 1.87; after surgery, 3.8 +/- 1.27), and the range of motion of all patients increased (mean 21.5 +/- 14.0 degrees for rotation; mean 17.2 +/- 5. 54 degrees for bending). The score on the Health Assessment Questionnaire increased in three patients, remained unchanged in three and decreased in six patients (three had died). All patients improved at least one Ranawat level after surgery, except a patient in Ranawat Class II, whose condition remained unchanged. All patients were satisfied with the procedure and reported subjective improvement. CONCLUSION: Transoral plate fixation combined with posterior wire fixation after transoral odontoid resectionis an effective, reliable, and safe procedure for the treatment of irreducible atlantoaxial kyphosis in rheumatoid arthritis.

Adult↗
PubMed1990

[Craniocervical amyloid tumor with destructive spondyloarthropathy and myelocompression as a rare complication of long-term dialysis].

Dialysis-associated amyloidosis has become a frequent and sometimes disabling complication in long-term dialysis patients. The main protein implicated in amyloidosis is beta 2 microglobulin, which accumulates in patients with renal insufficiency. We report on a 47-year-old patient, who was on haemodialysis treatment for 17 years. After a period of 15 years on dialysis treatment he underwent surgery for a carpal tunnel syndrome. Two years later he developed destructive spondyloarthropathy of the cervical region and destruction of the occipital bone. He lost stability of his neck necessitating his remaining mainly in the lying position. Since the type of dialysis membrane may play an important role in the pathogenesis of dialysis-associated amyloidosis, a dialysator with a polysulfone membrane, which is assume to have a beneficial effect on the progression of amyloidosis, was established.

Amyloidosis↗
PubMedDate not supplied

A chiropractic perspective on atlantoaxial instability in Down's syndrome.

The purpose of this paper is to review the current information on atlantoaxial instability in Down's syndrome. There are potentially fatal consequences to performing adjustive manipulation to the cervical spine of the Down's patient. Atlantoaxial subluxation can cause death. Up to 50% of those suffering from atlantoaxial instability have it due to anomalous axis formation and/or agenesis or laxity of the transverse ligament. Trauma or progressive anterior displacement of atlas may cause serious neurological complications. The standard treatment for atlantoaxial instability is surgical fusion of the upper cervical spine. Conservative chiropractic care is suggested as a possible alternative in some cases. Standards for adjusting patients suffering from Down's syndrome have not been established. However, guidelines reviewed in this paper may indicate when adjusting may be hazardous. Potential protocol for the evaluation and diagnosis of atlantoaxial instability are suggested.

Atlanto-Axial Joint↗