[Dens axis fracture, spinal pain and hematemesis].
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Adult↗
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Results for “Odontoid Process”
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[Os odontoideum. A neurologic syndrome after orthopedic reduction of a C1-C2 subluxation].
A case of os odontoideum associated with a C1-C2 subluxation is described. During the reduction procedure by external manipulation, bulging of the membrana tectoria resulted into medullary compression followed by a neurological syndrome. An occipito-C2 arthrodesis was performed later on when the neurological status recovered back to normal. The case reported underlines the possibility of neurological damage following closed reduction of a C1-C2 subluxation, while the surgical procedure should not be incriminated. The pathogenic mechanism may not be properly understood if closed reduction is followed by surgical treatment during the same session.
Atlanto-Axial Joint↗
Bivector traction for unstable cervical spine fractures: a description of its application and preliminary results.
The management of acute, displaced odontoid fractures requires the restoration of sagittal alignment and rigid external or internal immobilization to prevent late instability and achieve union. This report introduces a new traction technique for the reduction of posteriorly displaced type 2 odontoid fractures. Seven patients with traumatic injuries to the dens were placed in bivector traction for an awake closed reduction. Sagittal alignment was restored and maintained in all patients with no neurologic deterioration or traction-related complications during an average of 11 days (range, 2-28 days) in traction. The overall sagittal alignment corrected from an initial average of 12.2 mm (range, 5-22 mm) of posterior displacement to an average of 1.1 mm (range, 0-3 mm) at the completion of reduction. Only one patient had residual angulation, which measured 5 degrees. Three patients achieved an osseous union and the remaining four required a posterior C1-C2 fusion for nonunion. Although operative stabilization may be the preferred approach in this patient population and injury pattern, we conclude that bivector traction is a safe and effective technique for the initial management of posteriorly displaced odontoid fractures. In addition, its role can be expanded to the closed reduction of lower cervical spine fractures in patients with fixed flexion deformities secondary to ankylosing spondylitis or disseminated intraosseous segmental hyperostosis.
Accidental Falls↗
Displaced fracture in a hemangiomatous odontoid.
Vertebral hemangioma is a common and usually benign lesion encountered on routine radiographic studies. We report the unusual case of a woman who sustained a displaced fracture of a hemangiomatous odontoid after minimal trauma. Good healing was accomplished with external halo bracing alone.
Female↗
Odontoid osteomyelitis complicating pneumococcal pneumonia.
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Aged↗
[Os odontoideum].
Seventeen patients who had os odontoideum were reviewed. Among them occipito-cervical fusion was performed upon 12 patients with atlanto-axial instability. All of them achieved fusion. The patients were followed up for 2 to 16 years and satisfactory results were demonstrated. We consider that surgical treatment is indicated when os odontoideum is combined with atlanto-axial instability.
Adolescent↗
Treatment of type-two odontoid fractures in halothoracic vests.
We treated 22 patients with type-two odontoid fractures in halothoracic vests for six to eight weeks followed by a Philadelphia collar for four weeks. Eighteen patients were reviewed by questionnaire and radiography at a mean of 40 months after injury. We assessed union, fracture position, the degree of permanent pain and stiffness, satisfaction with the treatment and the outcome. The overall union rate was 82%. Posterior malunion with residual posterior displacement or angulation was associated with a higher incidence of persisting pain. The position at union did not correlate with the residual cervical stiffness. Fractures failed to unite in four patients (18%) none of whom had late neurological sequelae, although they had more late pain. There were associations between the development of nonunion and an extension-type injury, age over 65 years and delay in diagnosis.
Adolescent↗
[An alternative dorsal fusion technique after transoral dens resection in basilar impression with atlas assimilation].
Current therapy of basilar impression includes transoral dens resection. The essential disadvantage of this procedure is the instability of C1/C2 due to loss of the transverse ligament. We describe two patients in whom this instability was treated by modified screwing. Using MAGERL-screws between C0-C2 an interposition of an iliac graft between the occiput and the arc of C2 was made. Neurological symptoms improved in both patients postoperatively. In both cases stable fusion C0/C2 was achieved with an additional treatment with a HALO-fixateur for eight weeks. In our opinion the combined transoral/dorsal procedure is most suitable and efficient in treatment of basilar impressions. By this approach both, decompression of the myelon as well as stable fusion C0/C2, is achieved.
Adolescent↗
[Surgical therapy of dens fracture].
The use of Anderson/D'Alonso or Aebi/Nazarian classification of dens fractures is the basis for exact selection of therapy. The ventral screw-fixation of Anderson type-II-Fracture is today the common standard of treatment, especially in the elderly. The stabilisation of the fracture with maintenance of atlanto-axial rotation-function, the minimal rate of pseudarthrosis compared with conservative therapy, the minimal operation trauma and the immediate mobilisation with high patient comfort are decisive benefits of this method. Reposition of the fracture, visualisation in two planes and the use of adequate instruments are important conditions to get optimal operation results. In-vitro-experiments have shown that there is no difference of stability in one- or two-screw-technique. Flexion injuries with oblique fracture plane, insufficient stability after anterior screw fixation and typ-III-fractures are indications for dorsal, atlanto-axial screw fixation. The conservative treatment(HALO-vest) is recommended only in otherwise inoperable patients.
Bone Screws↗
Peduncular hallucinosis following a transoral odontoidectomy for cranio-vertebral junction malformation. A case report.
This is a case report of a sixty-two years old man suffering from a cranio-vertebral malformation whose dens epistrophei was removed through a transoral approach. During the postoperative course, he experienced a transient peduncular hallucinosis probably caused by surgical trauma on his brainstem. The possible physiopathological, etiopathological, clinical, and therapeutic aspects of this rare phenomenon are discussed.
Hallucinations↗
Nuchal cord changes in children with os odontoideum: evidence for associated trauma.
We describe nuchal cord changes in four children with os odontoideum who had cervical spine magnetic resonance imaging (MRI) before surgery. In these four children, nuchal cord changes consistent with previous trauma were seen. The presence of the nuchal cord changes supports the concept of trauma as an etiologic factor in these four cases. This study supports trauma as an associated factor in patients with os odontoideum.
Adolescent↗
Os odontoideum: a case report and review.
There are five types of odontoid anomalies: os odontoideum, ossiculum terminale, hypoplasia of the odontoid, aplasia of the odontoid base and aplasia of the odontoid. All five anomalies may lead to atlantoaxial instability. Their clinical signs, symptoms and treatments are identical. Only radiographic findings are distinctive. The incidence of odontoid anomalies is uncertain. A 15-year-old boy was hospitalized with progressive numbness of his limbs on the right side for one month. Os odontoideum was confirmed by cervical radiography and magnetic resonance imaging. The lesion was stabilized with autogenous iliac bone fusion and Halifax interlaminar clamp fixation. Treatment with posterior fusion of the C1-C2 vertebrae proved successful. The clinical variations, etiology, diagnosis and surgical management of odontoid anomalies are discussed.
Adolescent↗
Awake fiberoptic intubation for cesarean section in a parturient with odontoid fracture and atlantoaxial subluxation.
We report on the anesthetic experience of a 38-week pregnant patient in labor with an upper cervical spinal cord injury after an unusual trauma. She was transferred from a district hospital to our medical center with acute quadriplegia and sensory loss. Plain cervical spine x-ray and computed tomographic scan showed a C2 odontoid (dens of axis) process type II fracture and atlantoaxial (C1-C2) subluxation. Due to having regular uterine contractions and labor pain, she was scheduled for an urgent cesarean section. The instability of her cervical spine precluded the use of regional anesthesia; so awake nasal fiberoptic endotracheal intubation followed by general anesthesia was performed. The anesthetic course was uneventful, and the outcome of the parturient and newborn was good. We discuss our anesthetic considerations, intubation techniques and a review of the literature.
Anesthesia, Obstetrical↗
A clinical case of endoscopically assisted anterior screw fixation for the type II odontoid fracture.
STUDY DESIGN: A clinical case using a new surgical technique is reported. OBJECTIVE: To report for the first time an endoscopically assisted anterior screw fixation for the Type II odontoid fracture. SUMMARY OF BACKGROUND DATA: Recently, many endoscopically assisted surgeries have been performed for various spinal surgery because of its minimally invasive character. However, the anterior retropharyngeal approach to the upper cervical spine using endoscopy has not been reported. METHODS: A 76-year-old man was operatively managed for a Type II odontoid fracture. The operation was performed under immobilization of cervical spine using a halo vest apparatus. A skin incision 2 cm long was made on the medial border of the right sternocleidomastoid muscle at the C5-C6 intervertebral level. Blunt dissection between the neurovascular bundle laterally and the trachea and esophagus medially was performed. A processed polyethylene syringe (volume, 10 mL) was used as the tubular retractor. This retractor kept the minimum but sufficient space for the screw fixation and avoided esophageal complication. Using a cannulated screw system, a cancellous screw was inserted from the anteroinferior edge of the C2 vertebral body to the tip of the odontoid process. The drilling and the screwing process was monitored by a two-dimensional image intensifier. The entry point was monitored by endoscopy to avoid soft tissue involvement as well. RESULTS: The operation was completed without any soft tissue complications such as esophageal injury. The blood loss was 30 mL. The procedure resulted in nonunion, partially because of patient's old age or an entry point 2 mm above the anterior caudal margin of the C2 body retrospectively. CONCLUSIONS: Although the reported odontoid fracture ended in nonunion, the authors believe their modification of the approach using an endoscope made anterior screw fixation for the odontoid fracture safer and less invasive than the original anterior retropharyngeal approach.
Aged↗
Pathological cervical fracture after spinal manipulation in a pregnant patient.
OBJECTIVE: To present the rare case of a displaced odontoid fracture after manipulative treatment. CLINICAL FEATURES: A 37-year-old, 15-week pregnant patient was referred with acute neck pain and a diffuse paravertebral swelling that started after cervical manipulation performed by her general medical practitioner 5 days before. Because of pregnancy, a cervical spine radiographic series was not obtained before treatment. Magnetic resonance imaging revealed a displaced odontoid fracture associated with a pathological process in the vertebral body of C2 and a paravertebral hematoma on the left side from C2 to C4. INTERVENTION AND OUTCOME: After initial halo vest immobilization, an anterior-posterior fusion of C1-C2 was performed. The histological analysis showed features of an aneurysmal bone cyst. The patient was discharged and had an undisturbed pregnancy and was without any neurological complications. CONCLUSIONS: Because of the weakening lesion in C2, the spinal manipulation most likely caused the displaced odontoid fracture. Special imaging should be performed, preferably with magnetic resonance imaging, when a patient experiences significant new symptoms after cervical manipulation.
Adult↗
Computer generated odontoid peg "fracture", a cause for concern?
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Artifacts↗
Transcervical approach and screw fixation for upper cervical spine pathology.
The authors report on the use of transcervical approach and screw fixation for upper cervical spine pathology. They describe the direct osteosynthesis for odontoid fractures and atlantoaxial fixation using a screw fixation of the articular processes. The surgical technique is described and its advantages and disadvantages are discussed as are its indications.
Bone Screws↗
Jefferson fractures: the role of magnification artifact in assessing transverse ligament integrity.
Thirty-five consecutive odontoid views were taken using a standardized technique. A 10-mm radiographic marker was positioned lateral to the tip of the C-1 transverse process. Data from three independent readers showed an 18% magnification error inherent to anteroposterior open-mouth odontoid radiographs. Integrity of the transverse ligament after Jefferson fractures has been inferred from the separation of the lateral masses measured on the odontoid view. Spence's anatomic study showed that lateral mass separation of > 6.9 mm implied rupture, but radiograph magnification was not taken into account. Transverse ligament rupture should not be inferred with lateral mass separation of < 8.1 mm.
Artifacts↗