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Results for “Odontoid Process”

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At least 1,153 records · Page 64Linked to original sources
PubMed1994

Cervicovertebral anomalies and basilar impression in Goldenhar syndrome.

Although previously unreported, neurologic compromise may occur secondary to anomalies of the cervical spine in the oculoauriculovertebral spectrum. Medical records and cephalograms were reviewed from 18 patients with classic Goldenhar syndrome and from 18 normal adults. One patient, a 22-year-old man, had experienced a 5-year history of progressive neurologic compromise from basilar impression; the remaining 17 patients were asymptomatic. Radiographic evidence of cervicovertebral fusion was documented in 11 of 18 patients (61 percent). Fusion occurred at every cervical level other than the atlantoaxial joint. Radiographic indices that characterize the cranial base were not significantly different between asymptomatic Goldenhar patients and normal adults. Posterior inclination of the odontoid with respect to the foramen magnum appears to be the best indicator that a patient is at risk for basilar impression. Careful radiographic evaluation may indicate which patients require more careful surveillance with periodic neurologic examination and CT and/or MRI scans.

Adolescent↗
PubMed1993

[Ventral or dorsal spondylodesis in dens basal fracture--a new classification for choice of surgical approach].

The conservative treatment of the fracture of the densbasis (type 2 according to Anderson and D'Alonzo) bears the risk of developing a pseudarthrosis in about 30%. Therefore the anterior screw fixation according to Magerl/Böhler is general accepted. When the fracture line runs from top back to front base in this method the risk of developing a pseudarthrosis increases. With an own classification in accordance to the run of fracture line type A, B and C is differentiated. In Type A and B the anterior screw fixation is recommended. In case of type C the posterior fusion of the arches C1 and C2 is biomechanically more advisable--it results an axial compression on the fracture fissure. The usefulness of the classification is demonstrated with clinical cases.

Adult↗
PubMedDate not supplied

[Cold retropharyngeal abscess associated with cervical vertebral tuberculosis].

A 38-year-old man, parenteral drug user affected by vertebral tuberculosis with involvement of the first, second and third cervical vertebrae associated with a cold retropharyngeal abscess is presented. Treatment and main clinical and histopathologic features of this very unusual location of tuberculosis are discussed.

Adult↗
PubMed1994

[Dens fracture in elderly patients and surgical management].

The problems of surgical therapy in seven patients aged over 70 years are discussed. Clinical and radiological findings as well as operative treatment (anterior transaxial screw osteosynthesis or posterior atlanto-axial arthrodesis) are analysed in detail. Five out of 7 patients treated in this way could be early mobilised. Two patients died on multiorgan failure after an initial uneventful postoperative course (28.6% mortality rate). A stable osteosynthesis was obtained in all cases; a complete bony fusion as could be radiologically demonstrated, occurred in four out of the five survivors. We feel that despite this relatively high mortality rate surgical treatment provides better recovery chances and a higher quality of life to such patients.

Aged↗
PubMedDate not supplied

Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up.

Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had transoral resection of the odontoid. Follow-up consisted of a subjective questionnaire, standard radiographs, and physical examination, including a neurologic exam. This information was compared to preoperative data available in the patient's medical record, postoperative data, and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, eighteen underwent the full examination, including physical exam and radiographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considered the operation a success. Only one patient at follow-up had a non-union. This was stable over time. No patient had a deterioration in neurologic function. There was no significant degeneration or instability seen at levels adjacent to the fused segments as compared to the rest of the cervical spine. Posterior cervical spine arthrodesis for rheumatoid involvement of the neck is a safe, efficacious procedure with no significant deterioration of effects over time.

Arthritis, Rheumatoid↗
PubMed1993

Os odontoideum.

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Adult↗
PubMed1993

Os odontoideum: chronic neck pain after car accident; failure of two posterior atlantoaxial arthrodeses--medicolegal issues in the occupational setting.

OBJECTIVE: To present the case of a woman with previously asymptomatic os odontoideum (OO) who developed chronic neck pain after a car accident. CLINICAL FEATURES: A 32-yr-old woman developed slight constant neck pain following a car accident. Radiographs revealed OO with 12-mm atlantoaxial subluxation on neck flexion. There was no spinal cord compression clinically or on magnetic resonance imaging. INTERVENTION AND OUTCOME: Posterior atlantoaxial arthrodesis was performed twice but the bone graft resorbed for no apparent reason. The patient was treated with analgesics, physiotherapy and a Philadelphia collar to prevent accidental spinal cord compression. CONCLUSION: OO patients may remain asymptomatic if "space available for cord" is sufficient. Even low velocity rotational injury can precipitate chronic neck pain in adults with OO. Posterior atlantoaxial arthrodesis can fail inexplicably even under the best circumstances. Medicolegal issues in the occupational setting are discussed.

Accidents, Traffic↗
PubMed1993

Anatomical and roentgenographic features of atlantooccipital instability.

An anatomical study using six fresh, human cadaveric cervical spine specimens was performed. After the dissection of all soft tissue, flexion-extension radiographs were obtained to verify initial stability. A sagittal plane bone cut was then made, centered on the odontoid and sparing the alar ligaments, the tectorial membrane, and the atlantooccipital (AO) ligaments. Repeat flexion-extension radiographs and photographs were taken to document maintenance of stability of these hemisections. The occipital-atlantoaxial ligaments were then individually and sequentially incised, maintaining all other structures each time. After the sectioning of each ligament, flexion-extension radiographs and photographs were obtained to identify subsequent motion patterns. Both gross anatomical and roentgenographic examinations demonstrated the important stabilizing role of the tectorial membrane in flexion. Additionally, contact between the posterior arch of C1 and the occiput limited hyperextension as a secondary restraint once the tectorial membrane was sectioned. Furthermore, the AO ligaments proved to play an insignificant role in the preservation of AO stability through a flexion-extension arc of motion. Under normal circumstances, the AO articulation is not excessively stressed. However, acute AO injury, as well as the insidious failure of these ligaments, has been documented in several cases involving various pathologies. This study demonstrates a mechanism of instability and highlights the essential role of the tectorial membrane in maintaining upper cervical spine stability.

Atlanto-Occipital Joint↗
PubMed1995

The odontoid synchondrotic slip: an injury unique to young children.

We report seven children (three female, four male) diagnosed with traumatic synchondrotic slip of the odontoid. The clinical records, plain films and CT scans were evaluated retrospectively. The patients ranged in age between 3 and 5 years. Their injuries resulted from a motor vehicle accident in four cases and from a fall from a height in three. The injury was isolated in five; it was associated with a closed head injury in one and with facial and brachial plexus trauma in another. Radiographs showed anterior angulation with or without displacement in all seven cases. Axial CT with sagittal reformation and 3D reconstructions were performed in six cases. This confirmed the synchondrotic slip and, in addition, identified a rotary component to the injury in three cases, with compromise of the canal in two. Other additional injuries were also noted. All cases were treated conservatively and the injuries healed. Only one child had a neurological deficit attributable to her head injury rather than her cervical injury (MR of the cervical cord was normal). The presence of the synchondrosis between the dens and the body of C-2 makes this injury unique to children under 7 years of age; by the age of 7 the synchondrosis has fused.

Child, Preschool↗
PubMed1996

[Isolated ossicle of the dens axis. Case reports and differential diagnosis].

Two patients with an incidental finding of isolated ossicles adjacent to the dens axis are presented. One case was thought to be based on an isolated part of the dens axis, possibly due to trauma; the second case could be a true ossiculum terminale. Such ossicles can be confused with acute fractures, initiating treatment that is not indicated.

Adolescent↗
PubMed1996

Screw fixation for odontoid fracture; a comparison of the anterior and posterior technique.

Surgical treatment of atlantoaxial instability resulting from Type II odontoid fracture has evolved in recent years with newer approaches offering the surgeon more options. Our experience with anterior odontoid screw fixation and transarticular C1-2 fusion has exposed us to complications, indications, and contraindications different from those of more traditional posterior arch fixation and fusion procedures. The value and versatility of these two approaches were recently demonstrated in one case: a patient with a Type II odontoid fracture was treated with anterior odontoid screw fixation, suffered a second injury with dislocation and neurologic deficit and responded well to transarticular C1-2 fusion with decompression. A description of our surgical technique and a comparison of the two procedures is presented.

Aged↗
PubMed1996

Vertical fractures of the dens.

PURPOSE: To establish the mechanism of injury that causes vertical fractures of the dens. METHODS: Over a 3-year period, 30 patients with dens fractures were seen at our institution. From these records, we identified and retrospectively reviewed the radiographs (n = 3), CT scans (n = 3), and MR images (n = 1) of three patients with vertical fractures of the dens to assess the characteristics of these fractures and other associated injuries. Medical records of these three patients were also reviewed in an attempt to elucidate the mechanism of injury. Additionally, we reviewed three cases reported in the literature and compared them with findings in our patients. RESULTS: In all patients, radiographs showed fractures involving the base of the dens (type 2), but they did not show the vertical fractures. Axial CT scans and sagittal reformations clearly showed the vertical dens fractures. One patient also had a unilateral Jefferson-type fracture. The atlantodental space was preserved in all patients. In one patient, there was posterior displacement of the fractured dens. All three patients were neurologically normal. After a 6-month period of external fixation, two patients healed adequately. CONCLUSION: Vertical dens fractures probably result from axial loading and slight extension of the head. In our cases, vertical dens fractures were accompanied by other fractures of C-1 and C-2. CT with sagittal reformations is the ideal imaging method to detect vertical dens fractures.

Adult↗
PubMed1996

[Effendi fracture].

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Cervical Vertebrae↗