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At least 1,135 records · Page 63Linked to original sources
PubMed1985

Fractures of the dens. A multicenter study.

The treatment of fractures of the dens is often inadequate, and surgeons are divided in their opinions regarding the best surgical management of these potentially serious injuries. Because of these concerns, the Cervical Spine Research Society conducted a multicenter survey of its membership regarding the management of these fractures. Fractures of the dens can be effectively classified according to the anatomical level of the fracture, as described by Anderson and d'Alonzo. We have found that the degree of angulation and amount of displacement are also important factors. Fractures occurring at the junction of the dens with the vertebral body (Type-II fractures) were found to be the most troublesome. The initial management of these fractures with a halo device was successful in only 68 per cent; however, posterior cervical fusion was successful in 96 per cent, and that appears to be the treatment of choice. Fractures extending into the vertebral body (Type-III injuries) were found not to be as benign as has been reported. Malunion and non-union occurred in patients with this injury who were treated with an orthosis alone, and a halo device or surgery may be indicated for unstable lesions.

Adult↗
PubMed1985

[Technic of C1-C2 fixation by posterior screwing].

A posterior screw fixation technique for C1-C2 is described which respects strict anatomical relations and allows associated posterior arthrodesis limited to C1-C2, using a single approach route. This method of posterior fixation can be used even when anomalies of the posterior arch of C1 or C2 exist, of whatever origin, as well as in the presence of a laminectomy. Four patients were operated upon using this method without any postoperative complications.

Axis, Cervical Vertebra↗
PubMed1984

Ventral approach for stabilization of atlantoaxial subluxation secondary to odontoid fracture in a foal.

Atlantoaxial subluxation secondary to odontoid fracture in a 30-day-old foal was corrected by alignment of the atlantoaxial joint and stabilization with 2 ventrally placed dynamic compression plates. At 90 days after surgery, healing of the fracture, with adequate alignment of the atlantoaxial joint, was confirmed radiographically. The foal was only slightly tetraparetic at that time. At 1 year after surgery, the gait was normal. It was concluded that the technique has advantages over the use of Steinmann's pins or external coaptation for stabilization. The ventral approach allows decompression, anatomic alignment, and immediate stabilization of the subluxation. Potential complications of the ventral approach include laryngeal paralysis.

Animals↗
PubMed1984

Basilar impression in children.

Ataxia is a common neurologic sign in childhood. Basilar impression due to bony abnormalities of the craniovertebral junction is an uncommon but readily treatable cause of ataxia in children. Two children who had neck stiffness, ataxia, nystagmus, and corticospinal tract signs are described. Basilar impression was recognized only after specific radiologic studies were performed. Both children were treated surgically with good results.

Ataxia↗
PubMed1995

[Combination of rare anomalies of the cervical spine and peripheral skeleton].

This paper presents a case report on a 59-year old patient of small stature with moderate mental retardation, strabismus and several rare skeletal anomalies. We found an os odontoideum, a dysontogenetic 3fold fusion of cervical vertebrae, multiple double-sided wrist bone dysplasias and brachytelephalangical digiti pedis I, but no anomalies of the heart or genitals. Clinical signs, biochemical parameters and results of x-ray and ultrasonic examination are demonstrated in this complex malformation syndrome that combines different anomalies known from other syndromes.

Abnormalities, Multiple↗
PubMed1995

Cruciate paralysis caused by injury of the upper cervical spine.

Cruciate paralysis is an uncommon injury to the cervicomedullary junction. Five patients with injuries of the upper cervical spine and the clinical manifestation of cruciate paralysis are presented. This injury pattern is characterized by bilateral upper extremity paralysis, with minimal or no lower extremity involvement. The neuroanatomic basis and the diagnosis of this clinical entity are discussed, and the related reports in the literature are reviewed.

Adult↗
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↗
PubMed1995

Frameless stereotactic guidance. An intraoperative adjunct in the transoral approach for ventral cervicomedullary junction decompression.

METHODS: The application of a video-interactive frameless stereotactic guidance system for the treatment of ventral cervicomedullary junction compression is described in a patient with basilar invagination, odontoid dysgenesis, and a Chiari malformation who had irreducible impingement on the ventral brainstem by a partially fused mass of bone made up of the malformed odontoid peg, the inferior clivus, and dorsally protruding osteophytes at the odontoid-clival junction. RESULTS: This technology permitted instantaneous feedback of the surgeon's orientation in all planes, facilitating extensive removal of the dens and clival tip to achieve adequate ventral brainstem decompression. In view of the distortion of the craniovertebral anatomy produced by the patient's anomalies, the ability to visualize three dimensionally the location of the vertebral arteries also added an element of safety to the lateral bone removal. Similarly, the ability to localize the rostral limit of the clivus that needed to be resected and the caudal extent of C2 that needed to be removed to achieve an adequate decompression helped ensure that the extent of bone removal was appropriately tailored to the patient's anatomy. CONCLUSION: The authors believe this technique represents a significant advance over standard radiographic intraoperative localization techniques during transoral approaches to the ventral cervicomedullary junction for patients in whom the odontoid is fixed in position in relation to the clivus. This is based on the speed with which localization can be obtained, the accuracy of the information provided, the ability to obtain localization in multiple planes simultaneously, and the lack of radiation exposure during the procedure.

Brain Stem↗
PubMed1994

[Traumatic lesions of the spine below the axis].

Sports activities and traffic accidents are leading to an increasing incidence of spinal injuries. To assist in correct and quick diagnosis of spinal fractures the radiologist such modern diagnostic tools as computerized tomography, magnetic resonance imaging and digital radiography. Nevertheless. The plain film is of major importance for recognition of the type of fracture from its biomechanical pattern. Apart from this, the radiologist should decide individually what other examination(s) are needed for visualization of the full amount of damage. We found the model of Magerl and co-workers for fracture types and the model of Denis for stability the best, covering almost the entire spine from C3 and L5. The different types of fractures and discoligamentous injuries are discussed with reference to the risks attached of neurological complications and stability.

Cervical Vertebrae↗
PubMed1994

Complete atlanto-axial dislocation associated with type II odontoid fracture: a report of two cases.

Two cases of complete atlanto-axial dislocation with associated Type II odontoid fracture are reported. In one case, the instability associated with this injury was treated with primary odontoid fixation. In the second case, the patient had full cardiac arrest associated with this injury. Due to the extreme instability present with this fracture sub-type and the potential for neurological compromise, early recognition of this fracture pattern by the treating physician is imperative to prevent fatal spinal cord injury.

Adolescent↗
PubMed1994

[Static-dynamic computerized tomography in the diagnosis of traumatic lesions of alar ligaments. Preliminary results].

The patients affected with cervical injuries often complain of cervical pain, headache and dizziness even when no bone fractures are detected. Such patients are likely to have a post-traumatic injury of the cervical ligaments. Twenty-five symptomatic patients (19 women and 6 men) were examined with upper spine CT and functional CT scans (right and left rotation) to detect ligament injuries and hypermotility of the craniocervical junction, both related to traumatic events. Eleven patients showed no alterations, while unilateral densitometric alterations of the alar ligaments were observed in 14 cases and thought to be related to trauma. On axial CT scans, the normal alar ligaments were identified as paramedian, quadrangular soft-tissue structures at the apex of the dens epistrophei and right above it. In 14 patients with alar ligament injuries, CT showed incomplete ligament interruption and thinning in 12 cases and its total absence on all images in 2 cases. The laterodental space in the affected side was hypodense due to fat tissue replacement. Of 14 patients with alar ligament injuries, only 14 patients with alar ligament injuries, only 4 exhibited rotatory hypermotility at C0-C1 and C1-C2. The low frequency of rotatory hypermotility is probably due to the high rate of incomplete alar ligament injuries as well as to cervical muscle stiffness, which is marked in some subjects. In conclusion, static and functional CT of the upper spine is not only useful to predict trauma outcome, but also allows the detection of the alar ligaments, of their morphodensitometric changes and of the segmental instability of the craniocervical junction.

Adolescent↗
PubMed1994

Halifax interlaminar clamps for posterior atlanto-axial arthrodesis with spinal fusion by "H" bone+graft.

The use of Halifax interlaminar clamps in posterior arthrodesis for atlanto-axial instabilities has recently been reported. The four Anderson II fractures submitted were surgically treated by posterior arthrodesis with Halifax clamps and bilateral "H" shaped bone-grafts obtained from the iliac crest. Only in the first case--initially treated without fusion--a review of the system became necessary due to the loosening of one clamp. No post-operative neurological complications appeared and non malunion or nonunion occurred at follow-up. Posterior arthrodesis with Halifax clamps does not involve any complication connected with the use of metal wire and the association of posterior fusion by lateral "H" shaped bone grafts ensures a stable and physiological reduction of dens fractures and atlanto-axial luxations/subluxations often associated.

Adult↗
PubMed1994

Complete fracture-dislocation of the atlantoaxial complex: case report and recommendations for a new classification of dens fractures.

A 77-year-old man fell and sustained a fracture-dislocation of the atlantoaxial complex with 20 mm of posterior displacement. Initial and repeat examinations failed to diagnose the fracture-dislocation, which was first diagnosed by a magnetic resonance imaging study 16 weeks after the injury and after the patient had developed a profound myelopathy. The patient was treated by a C2 decompressive laminectomy and an in situ posterior fusion with iliac bone graft and internal fixation with gradual resolution of his myelopathy. Postoperatively he developed respiratory problems and persistent difficulties swallowing, believed to be at least partly due to cranial nerve involvement. A new classification system for dens fractures is suggested.

Accidents↗
PubMed1994

[Diagnosis, analysis and evaluation of functional disorders of the upper cervical spine within the scope of whiplash injuries with nuclear magnetic resonance tomography].

We tested the diagnosis of malfunctions in the upper cervical spine after whiplash injury using MRI. In the spinal segments C 0-1 and C 1-2 MRI functional diagnosis showed clear advantages compared to X-ray diagnosis. Apart from data about the normal course of movement in these joints it was possible to classify and reproduce malfunctions exactly. The malfunctions diagnosed can be found in normal volunteers as well, so that in an evaluation no causal link between the very existence of a malfunction and the complaints can be established.

Adult↗