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Acta Neurochirurgica. Supplement 2019Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus... (Review)
Review
Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus specifically on the history of atlantoaxial stabilization. Examining the history of instrumentation allows us to evaluate the impact of early influences on current modern stabilization techniques. It also provides inspiration to further develop the techniques and prevents repetition of mistakes. This paper reviews the evolution of C1-C2 instrumentation techniques over time and provides insights into the future of these practices.We did an extensive literature search in PubMed, Embase and Google Scholar, using the following search terms: 'medical history', 'atlantoaxial', 'C1/C2', 'stabilization', 'instrumentation', 'fusion', 'arthrodesis', 'grafting', 'neuroimaging', 'biomechanical testing', 'anatomical considerations' and 'future'.Many different entry zones have been tested, as well as different constructs, from initial attempts with use of silk threads to use of hooks and rod-wire techniques, and handling of bone grafts, which eventually led to the development of the advanced screw-rod constructs that are currently in use. Much of this evolution is attributable to advancements in neuroimaging, a wide range of new materials available and an improvement in biomechanical understanding in relation to anatomical structures.
Topics: Atlanto-Axial Joint; Axis, Cervical Vertebra; Bone Screws; Bone Wires; Cervical Atlas; Forecasting; History, 20th Century; History, 21st Century; Humans; Joint Instability; Neuroimaging; Spinal Fusion
PubMed: 30610332
DOI: 10.1007/978-3-319-62515-7_38 -
Clinical Radiology Oct 2018The craniovertebral junction (CVJ) is the bony transition between the cranium and cervical spine. It is a biomechanically complex articulation comprising the occipital... (Review)
Review
The craniovertebral junction (CVJ) is the bony transition between the cranium and cervical spine. It is a biomechanically complex articulation comprising the occipital condyles (Oc) the atlas (C1) and axis (C2). Pathologies affecting the CVJ in children are myriad with clinical features resulting from biomechanical instability, deformity, or neuraxial compression. Establishing the natural history and clinical burden of a condition is challenging in infants and young children, often complicated by co-existing neuromuscular and cognitive impairment. This makes investigation and treatment planning difficult. Each disease entity has a predilection for a particular biomechanical abnormality. Investigation using dynamic imaging is most appropriate in instability, computed tomography examination in abnormalities of deformity and magnetic resonance imaging examination in neuraxial compression. Treatment comprises reduction and immobilisation of instability, re-alignment of deformity, or decompression of the neuraxis. We present a review of disease entities affecting the CVJ in children categorised according to a simple mechanistic approach to aid investigation and treatment planning.
Topics: Axis, Cervical Vertebra; Biomechanical Phenomena; Cervical Atlas; Child; Down Syndrome; Humans; Incidental Findings; Joint Instability; Magnetic Resonance Imaging; Occipital Bone; Range of Motion, Articular; Spinal Diseases; Tomography, X-Ray Computed; Torsion Abnormality
PubMed: 29914689
DOI: 10.1016/j.crad.2018.05.020 -
Surgical Anatomy of Vertebral Artery in Relation to Atlantoaxial Instrumentation: A Cadaveric Study.Cureus Mar 2023With the advent of pedicle screws and advanced instrumentation techniques, internal fixation and stabilization of upper cervical vertebrae are possible in fractures of...
BACKGROUND
With the advent of pedicle screws and advanced instrumentation techniques, internal fixation and stabilization of upper cervical vertebrae are possible in fractures of an axis. However, the proximity of vertebral arteries (VAs) poses a unique challenge to surgeons during these procedures and can result in profound physical impairment to patients. Cadaveric studies contributing to fine anatomical details necessitate conducting such studies.
METHODS
After receiving due ethical permission, this descriptive cross-sectional study was carried out on 10 cadavers in the department of Anatomy, All India Institute of Medical Science (AIIMS) Rishikesh. Twenty VAs were dissected along their course, and measurements of parameters related to the axis and atlas vertebra were noted.
RESULTS
The length of the pre-osseous segment related to the axis (VAX-1) on the right and left sides were from 3.8 to 14.5 mm (7.48±3.88 mm) and 4.46 to 10.5mm (6.94±2.01mm) respectively. The length of the osseous segment related to the axis (VAX-2) on the right side and left sides were from 6.82 to 31 mm (17.9±7.84mm) and 7.35 to 20 mm (15.6±4.53). The osseous segment of the VA related to the axis (VAX-2) shows genu (bend), which extends to a variable distance towards the midline. The mean distance of VA genu from the midline of the axis vertebral body on the right and left sides was 15.6mm and 17.5 mm, respectively. The percentage of superior articular facet (SAF) surface area of the axis occupied by the VA was 25-50% in nine and 50-75% in 11 cadavers, reflecting incomplete occupancy.
CONCLUSION
The study suggests that for instrumentation of the axis vertebra in the midline, the minimum distance between the genu of both sides of VA segments, related to an osseous segment of the axis (VAX-2) and medial extent of the VA groove of the atlas, should be considered as a safe zone to minimize inadvertent VA injury. During atlantoaxial fixation through a posterior approach in interarticular, pars, and pedicle screws, the surgical anatomy of the VA in relation to the osseous segment of the VA within the transverse process of the axis should be kept in mind to avoid inadvertent VA injury.
PubMed: 37050984
DOI: 10.7759/cureus.35949 -
The Journal of Craniofacial Surgery Jun 2018Congenital muscular torticollis is a common childhood musculoskeletal anomaly that might result in permanent craniofacial deformity, facial asymmetry, and changes in the...
BACKGROUND
Congenital muscular torticollis is a common childhood musculoskeletal anomaly that might result in permanent craniofacial deformity, facial asymmetry, and changes in the cervical vertebrae, if not treated during early childhood. Although there have been many studies on cervical vertebral changes, their onset in children has not been previously studied.
METHODS
Fifteen patients (aged <8 years) with a confirmed diagnosed of torticollis were included. Three-dimensional computed tomography scans were obtained, and segmentation of the cervical vertebrae was done. Division of the atlas and axis across the midsagittal plane was done to compare the anatomical changes. The volumes of each halves of the atlas and axis were measured.
RESULTS
An apparent change was observed in the axis of the vertebral column when compared with that of the skull. There were progressive anatomical changes affecting the upper cervical vertebrae, which started to develop around the age of 8 months and became more evident in older children. The axis vertebra was the first to be affected. Rotational and bending deformities were the most likely changes to occur. Pearson correlation analysis showed a statistically significant trend in the volume and height changes for both halves of the atlas and axis (P < 0.001 and P < 0.001).
CONCLUSIONS
Children with untreated congenital muscular torticollis show progressive anatomical changes of the cervical vertebrae which started at the age of 8 months. The severity of the deformity increased with the advance of age as well as with the severity of sternocleidomastoid tightness, which might result in permanent deformities.
Topics: Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Tomography, X-Ray Computed; Torticollis
PubMed: 29485556
DOI: 10.1097/SCS.0000000000004357 -
The Journal of Orthopaedic and Sports... Oct 2016A 24-year-old male Marine presented to a direct-access physical therapy clinic with a chief complaint of bilateral hand paresthesia secondary to a parachuting accident...
A 24-year-old male Marine presented to a direct-access physical therapy clinic with a chief complaint of bilateral hand paresthesia secondary to a parachuting accident when his neck was forced into lateral flexion. Due to the positive neurologic findings and history of trauma, the physical therapist ordered cervical spine imaging. The odontoid was not adequately visualized on radiographs, but computed tomography revealed an os odontoideum. J Orthop Sports Phys Ther 2016;46(10):930. doi:10.2519/jospt.2016.0417.
Topics: Aviation; Humans; Male; Military Personnel; Odontoid Process; Paresthesia; Radiography; Spinal Fusion; Tomography, X-Ray Computed; Young Adult
PubMed: 27690833
DOI: 10.2519/jospt.2016.0417 -
Zhongguo Gu Shang = China Journal of... Oct 2019Crowned dens syndrome(CDS) is a major imaging manifestation of "coronary" calcified deposits around the odontoid, with pain, stiffness, fever, and even cervical cord... (Review)
Review
Crowned dens syndrome(CDS) is a major imaging manifestation of "coronary" calcified deposits around the odontoid, with pain, stiffness, fever, and even cervical cord compression in the upper head and neck. It was first described by Bouvet et al. in 1985, and the onset was generally thought to be caused by crystal deposition. The clinical manifestations of CDS are often similar to meningitis and often accompanied by an increase in inflammatory markers in the blood. As a result, it is very easy to obtain missed diagnosis and misdiagnosis, and it is clinically prone to obtain wrong or unnecessary treatment. At present, the diagnosis of CDS is based on the imaging findings in CT as a "golden standard". NASIDs drugs and corticosteroids are the main treatment. The prognosis is also generally good, and the imaging findings of the patients with the disease disappear completely within 3 months.
Topics: Calcinosis; Humans; Neck Pain; Odontoid Process; Syndrome; Tomography, X-Ray Computed
PubMed: 32512974
DOI: 10.3969/j.issn.1003-0034.2019.10.021 -
European Spine Journal : Official... Oct 2023Odontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Odontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the outcome of surgical and conservative treatments in elderly (≥ 65 years), by updating a systematic review published by the authors in 2013.
METHODS
A comprehensive search was conducted in seven databases. Clinical outcome was the primary outcome. Fracture union- and stability were secondary outcomes. Pooled point estimates and their respective 95% confidence intervals (CIs) were derived using the random-effects model. A random-effects multivariable meta-regression model was used to correct for baseline co-variates when sufficiently reported.
RESULTS
Forty-one studies met the inclusion criteria, of which forty were case series and one a cohort study. No clinical differences in outcomes including the Neck Disability Index (NDI, 700 patients), Visual Analogue Scale pain (VAS, 180 patients), and Smiley-Webster Scale (SWS, 231 patients) scores were identified between surgical and conservative treatments. However, fracture union was higher in surgically treated patients (pooled incidence 72.7%, 95% CI 66.1%, 78.5%, 31 studies, 988 patients) than in conservatively treated patients (40.2%, 95% CI 32.0%, 49.0%, 22 studies, 912 patients). This difference remained after correcting for age and fracture type. Fracture stability (41 studies, 1917 patients), although numerically favoring surgery, did not appear to differ between treatment groups.
CONCLUSION
While surgically treated patients showed higher union rates than conservatively treated patients, no clinically relevant differences were observed in NDI, VAS pain, and SWS scores and stability rates. These results need to be further confirmed in well-designed comparative studies with proper adjustment for confounding, such as age, fracture characteristics, and osteoporosis degree.
Topics: Humans; Aged; Cohort Studies; Spinal Fractures; Odontoid Process; Fractures, Bone; Pain; Treatment Outcome
PubMed: 37439865
DOI: 10.1007/s00586-023-07779-1 -
Journal of Neurosurgery. Spine Aug 2014
Topics: Humans; Joint Instability; Male; Odontoid Process; Spinal Fractures; Spinal Fusion
PubMed: 24785971
DOI: 10.3171/2014.1.SPINE1443 -
Pediatric Emergency Care Mar 2015
Topics: Adolescent; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Neck Injuries; Odontoid Process; Spinal Injuries; Tomography, X-Ray Computed
PubMed: 25738246
DOI: 10.1097/PEC.0000000000000411 -
World Neurosurgery May 2019Bony anomaly of axis (C2) vertebra is well known. However, expansion of the posterior element is less documented. We describe a case of additional bony ring attached to...
Bony anomaly of axis (C2) vertebra is well known. However, expansion of the posterior element is less documented. We describe a case of additional bony ring attached to the posterior spinous process in a 10-year-old male who presented with the complaint of progressive swelling at the upper cervical region. On physical examination a firm swelling approximately 8 × 5 cm was present at the back of the neck just below the hair line. There was no focal neurologic deficit. Computed tomography scan of the cervical spine showed an additional bony arch attached to the spinous process of the C2 vertebra. Magnetic resonance imaging revealed a soft tissue mass within the additional bony ring without involvement of neural structures. Complete surgical excision of the mass was done. Anomalous expansion of the spinous process of the C2 vertebra may remain silent. Surgery may be necessary for cosmetic purposes.
Topics: Axis, Cervical Vertebra; Child; Decompression, Surgical; Humans; Male; Spinal Cord Compression
PubMed: 30780036
DOI: 10.1016/j.wneu.2019.01.256