-
Neurosurgery Clinics of North America Jan 2017Odontoid fractures are the most common cervical fracture type among the elderly population. Several treatment options exist for these patients, ranging from... (Review)
Review
Odontoid fractures are the most common cervical fracture type among the elderly population. Several treatment options exist for these patients, ranging from immobilization with a semirigid orthosis to surgical arthrodesis. This report reviews the key points in the management of odontoid fractures in the aged patient, including diagnosis, the various forms of conservative therapies, and the options for surgical intervention.
Topics: Age Factors; Aged; Aged, 80 and over; Clinical Decision-Making; Humans; Magnetic Resonance Imaging; Odontoid Process; Spinal Fractures; Spinal Fusion; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27886873
DOI: 10.1016/j.nec.2016.07.001 -
Revista Da Associacao Medica Brasileira... Feb 2019To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
OBJECTIVE
To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
METHODS
Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws.
RESULTS
Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series.
CONCLUSION
Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used.
Topics: Adolescent; Adult; Aged; Axis, Cervical Vertebra; Bone Screws; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Spinal Fusion; Treatment Outcome; Young Adult
PubMed: 30892444
DOI: 10.1590/1806-9282.65.2.198 -
Revista Medico-chirurgicala a... 2016to gather clinical and laboratory data on rheumatoid arthritis patients with cervical spine damage (incidence and prevalence, correlation between duration of disease and...
AIM OF THE STUDY
to gather clinical and laboratory data on rheumatoid arthritis patients with cervical spine damage (incidence and prevalence, correlation between duration of disease and the time of lesion onset, to assess signs and symptoms and the role of laboratory investigations). The spine is an axial organ with an important role in support and resistance. It is a pillar with a very complex morphological and functional structure. The vertebral column is crossed by many kinematic chains. The main problem of the cervical spine caused by rheumatoid arthritis is cervical instability which describes all cervical lesions that can lead to neurovascular damage or major disturbance of pain generating statics at movement. The evolving disease shows chronic inflammation of the synovium, which is a self-maintained process and an immunologically induced phenomenon. The chronic inflammation of the synovium forms granulation tissue that invades peripheral joints towards the center and causes ligament cartilage and bone damage.
MATERIAL AND METHODS
The present paper investigated cervical spine lesions in 107 rheumatoid arthritis patients who were admitted to the 1st Rheumatology Clinic of Iasi Rehabilitation Hospital between January 2013 and December 2014. Our study focused on assessing signs and symptoms seen in spine affected by rheumatic disease.
RESULTS AND DISCUSSIONS
the disease causes destructive lesions due to granulomatous infiltration of rachidian structures and medullary sheaths. These lesions lead to damaged discs and instability that produces subluxations and dislocations. The suboccipital region is most affected; in other regions of the spine, high lesions of C4-C5 prevail, where osteolysis damage of spinal apophyses are found. In atlas and axis joints, rheumatoid arthritis causes the inflammation of bursa, synovium and joint capsule and leads to synovial pannus formation. This causes the destruction of cartilage and subchondral bone. Atlantoaxial dislocation is caused by erosive synovitis of atlanto-epistrophic joint, atlanto-odontoid joint and serous bursitis separating the odontoid process from the transverse ligament.
CONCLUSIONS
The dominant symptom of cervical spine damage was pain associated with stiffness and limited joint mobility, muscle stiffness, poor posture.
Topics: Aged; Arthritis, Rheumatoid; Atlanto-Axial Joint; Axis, Cervical Vertebra; Cervical Vertebrae; Female; Hospitals, University; Humans; Incidence; Joint Dislocations; Joint Instability; Male; Middle Aged; Osteolysis; Prevalence; Radiography; Rehabilitation Centers; Retrospective Studies; Romania; Synovial Membrane
PubMed: 27125075
DOI: No ID Found -
British Medical Bulletin Sep 2015Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures. (Review)
Review
INTRODUCTION
Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures.
SOURCES OF DATA
A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score.
AREAS OF AGREEMENT
Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach.
AREAS OF CONTROVERSY
The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined.
GROWING POINTS
Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures.
AREAS TIMELY FOR DEVELOPING RESEARCH
Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.
Topics: Axis, Cervical Vertebra; Fracture Fixation, Internal; Humans; Patient Selection; Postoperative Complications; Spinal Fractures; Spondylitis, Ankylosing; Treatment Outcome
PubMed: 25800241
DOI: 10.1093/bmb/ldv010 -
Journal of Clinical and Diagnostic... May 2015The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine...
BACKGROUND
The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury.
AIM AND OBJECTIVES
The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies.
MATERIALS AND METHODS
Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed.
RESULTS
The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior and posterior height of axis was 34.33±2.69mm and 30.56±2.78mm respectively. The anterior and posterior height of body of axis was 19.67 mm and 16.67mm respectively. Mean A-P and transverse diameter of inferior surface of axis was 15.42mm and 17.7mm respectively. Mean transverse diameter and mean A-P diameter of odontoid process was 9.32 mm and 10.1 mm respectively. Mean anterior and posterior height of the odontoid process was 14.66 mm and 13.89mm respectively. Mean of dens axis sagittal angle (angle between an axis that was imagined to pass longitudinally through the dens axis and the vertical line on a sagittal plane) was 13.23 degree. The shape of superior articulating facets of C2 varies from oval to circular. In the present study, 84% of SAF were oval and 16% were circular. Inferior articulating facets were circular in shape in 90% cases, and oval in 10% vertebra. Mean pedicle width was 10.07mm on right side and 10.52mm on left side. Mean transverse diameter of vertebral canal was 22.37±1.73mm. Mean of A-P diameter of vertebral canal at inlet was 18.31±2.05mm and mean of A-P diameter of vertebral canal at outlet was 14.84±1.63mm.
CONCLUSION
These results obtained from this study may be helpful for the surgeons in avoiding and minimizing complications such as vertebral artery injury, cranial nerve damage and injury to other vital structures while doing surgery around cranio-vertebral region.
PubMed: 26155467
DOI: 10.7860/JCDR/2015/13118.5931 -
Neuroradiology Dec 2019Because of the complex cervical vertebral embryology and some normal variations, the atlantoadental interval (ADI) was not suitable for the evaluation of the anatomic...
Two novel parameters to evaluate the influence of the age and gender on the anatomic relationship of the atlas and axis in children no more than 8 years old: imaging study.
PURPOSE
Because of the complex cervical vertebral embryology and some normal variations, the atlantoadental interval (ADI) was not suitable for the evaluation of the anatomic relationship between the atlas and axial in children less than 2 years old. And the influence of the age and gender on the anatomic relationship between atlas and axial in children was still unclear. Two novel parameters, atlas-axis anteroposterior distance (AAAD) and atlas-axis lateral distance (AALD), were invented to evaluate the anatomic relationship between the atlas and axis in the children no more than 8 years old with different age and gender.
METHODS
Cross-sectional computed tomography (CT) scans of the atlantoaxial joint for 140 randomly selected pediatric patients no more than 8 years old were analyzed. On the ideal CT reconstruction images, AAAD, AALD, atlantoaxial lateral bending angle (AALB), and atlantoaxial rotation angle (AARA) were measured.
RESULTS
There was no statistically significant difference between the mean AAAD in different age and gender groups. The 99% confidence interval for AAAD was 7.12-7.82 mm. There was no significant correlation between AAAD and AALB/AARA and AALD and AALB/AARA.
CONCLUSION
The AAAD was less than 7.12 mm or much than 7.82 mm that suggested a possible instability in the atlantoaxial joint and could help the diagnosis of the atlantoaxial instability in children no more than 8 years old. There was no difference between the mean AAAD of pediatric patients no more than 8 years old in different age and gender groups.
Topics: Age Factors; Anatomic Landmarks; Axis, Cervical Vertebra; Cervical Atlas; Child; Child, Preschool; Female; Humans; Infant; Male; Sex Factors; Tomography, X-Ray Computed
PubMed: 31511920
DOI: 10.1007/s00234-019-02284-z -
Acta Neurochirurgica Jul 2023The atypical anatomy of the C2 vertebra has led to terminological discrepancies within reports and studies in the literature regarding the location of its pedicle, pars... (Review)
Review
What is the C2 pedicle, pars interarticularis, and isthmus? Anatomical study and review of the literature regarding these confusing terms with proposal of new nomenclature.
INTRODUCTION
The atypical anatomy of the C2 vertebra has led to terminological discrepancies within reports and studies in the literature regarding the location of its pedicle, pars interarticularis, and isthmus. These discrepancies not only limit the power of morphometric analyses, but they also confuse technical reports regarding operations involving C2, and thus confuse our ability to properly communicate this anatomy. Herein, we examine the variations in nomenclature regarding the pedicle, pars interarticularis, and isthmus of C2, and via an anatomical study, propose new terminology.
METHODS
The articular surface and underlying superior and inferior articular processes and adjacent transverse processes were removed from 15 C2 vertebrae (30 sides). Specifically, the areas regarded as the pedicle, pars interarticularis, and isthmus were evaluated. Morphometrics were performed.
RESULTS
Our results indicate that, anatomically, C2 has no "isthmus" and that a pars interarticularis for C2, when present, is very short. Deconstruction of the attached parts allowed for visualization of a bony arch extending from the anterior most aspect of the lamina to the body of C2. The arch is composed almost entirely of trabecular bone and without its attached parts, e.g., transverse process, really has no cortical bone laterally.
CONCLUSIONS
We propose a more accurate terminology, the pedicle, for pars/pedicle screw placement of C2. Such a term more accurately describes this unique structure of the C2 vertebra and would alleviate terminological confusion in the future literature on this topic.
Topics: Humans; Axis, Cervical Vertebra; Pedicle Screws; Spinal Fusion; Cortical Bone; Cervical Vertebrae
PubMed: 37291431
DOI: 10.1007/s00701-023-05655-x -
Neurology India 2015
Topics: Humans; Odontoid Process; Spinal Fractures
PubMed: 25751462
DOI: 10.4103/0028-3886.152657 -
The Journal of Rheumatology Nov 2014Axial involvement in patients with psoriatic arthritis (PsA) remains common and can be defined in terms of spinal disease alone or in combination with peripheral... (Review)
Review
Axial involvement in patients with psoriatic arthritis (PsA) remains common and can be defined in terms of spinal disease alone or in combination with peripheral manifestations. Diagnosis is based upon inflammatory spinal symptoms or the presence of radiological sacroiliitis and other radiographic signs of spondylitis, or by criteria for axial spondyloarthritis (SpA) defined by ASAS (Assessment of SpondyloArthritis International Society). Although recent data are scarce for efficacy of traditional therapies for axial disease (e.g., nonsteroidal antiinflammatory drugs, methotrexate, etc.), limited data are available for targeted biologics and novel agents. We identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA. This review is an update of the axial PsA section of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Psoriatic; Axis, Cervical Vertebra; Biological Products; Clinical Trials, Phase III as Topic; Female; Humans; Male; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Societies, Medical; Spondylarthritis; Treatment Outcome
PubMed: 25362712
DOI: 10.3899/jrheum.140877 -
World Neurosurgery May 2020Little attention has been given to the retroverted dens within the existing medical literature. However, this finding can have a clinical impact, especially in patients... (Review)
Review
BACKGROUND
Little attention has been given to the retroverted dens within the existing medical literature. However, this finding can have a clinical impact, especially in patients with Chiari malformation type I (CM1), as it can have consequences for further treatment.
METHODS
Using standard search engines, we performed a literature review of anatomical, radiologic, and clinical studies as well as pathologic and surgical considerations related to the retroverted dens. Key words for our search included retroverted dens; retroflexed dens; odontoid retroflexion; posterior inclination; and tilted dens.
RESULTS
A retroverted dens is most commonly found in the pediatric population in relation to CM1. Research has demonstrated that high degree of dens angulation can result in significant anterior brain stem compression with the need for both anterior and posterior decompression in patients with symptomatic CM1.
CONCLUSIONS
A greater degree of dens angulation can lead to neurologic symptoms secondary to spinomedullary compression. Therefore, correct measurements are essential as such findings can influence presurgical planning.
Topics: Arnold-Chiari Malformation; Bone Retroversion; Brain Stem; Decompression, Surgical; Humans; Odontoid Process; Terminology as Topic
PubMed: 32058112
DOI: 10.1016/j.wneu.2020.01.231