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Journal of Neurosurgery. Spine Aug 2014
Topics: Humans; Joint Instability; Male; Odontoid Process; Spinal Fractures; Spinal Fusion
PubMed: 25221802
DOI: No ID Found -
Postgraduate Medical Journal Dec 2019
Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Axis, Cervical Vertebra; Calcinosis; Deglutition Disorders; Diagnosis, Differential; Humans; Male; Neck Pain; Neurologic Examination; Range of Motion, Articular; Restraint, Physical; Retroperitoneal Space; Shoulder Joint; Tendinopathy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31363017
DOI: 10.1136/postgradmedj-2019-136750 -
Spinal Cord Series and Cases 2019Some of the most common developmental malformations of the axis include anomalies of the odontoid, for example, hypoplasia or aplasia. Isolated anomalies of the... (Review)
Review
INTRODUCTION
Some of the most common developmental malformations of the axis include anomalies of the odontoid, for example, hypoplasia or aplasia. Isolated anomalies of the posterior arch of the axis rarely occur. This study reports a unique case of congenital anomaly of the neural arch of the axis vertebra, which manifested clinically as progressive hemiparesis.
CASE PRESENTATION
A 33-year-old man presented with progressive weakness of the right upper and lower limbs that had lasted 18 months. The patient reported loss of right-hand dexterity in the 6 months period before he consulted us. Plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) revealed C5-C6 block vertebra, primary canal stenosis and spino-laminar anomaly of the axis, along with invagination of the lamina into the canal causing severe cord compression.
DISCUSSION
The anomalous posterior element of the axis was excised, and the cord was decompressed. The presence of congenital stenosis and block vertebrae at the C5-C6 level necessitated decompression and instrumentation between C2-C6. Simultaneous occurrence of a posterior arch anomaly, primary canal stenosis, and block vertebra has not been previously described. A cervical spine anomaly presenting as hemiparesis is uncommon in clinical practice. Information enabling clinicians to identify causative anomaly and determine the appropriate surgical intervention is useful, and can facilitate a good clinical outcome.
Topics: Adult; Axis, Cervical Vertebra; Cervical Vertebrae; Decompression, Surgical; Humans; Male; Paresis; Spinal Cord Compression; Spinal Stenosis
PubMed: 31632727
DOI: 10.1038/s41394-019-0214-8 -
Journal of Pediatric Orthopedics Oct 2020Occipital plate fixation has been shown to improve outcomes in cervical spine fusion. There is a paucity of literature describing occipital plate fixation, especially in...
BACKGROUND
Occipital plate fixation has been shown to improve outcomes in cervical spine fusion. There is a paucity of literature describing occipital plate fixation, especially in the pediatric population. The authors reviewed a case series of 34 patients at a pediatric hospital who underwent cervical spine fusion with occipital plate fixation between 2003 and 2016. This study describes how occipital plates aid the cervical spine union in a case series of diverse, complex pediatric patients.
METHODS
Our orthopaedic database at our institution was queried for patients undergoing an instrumented cervical spine procedure between 2003 and 2016. Medical records were used to collect diagnoses, fusion levels, surgical technique, and length of hospitalization, neurophysiological monitoring, complications, and revision procedures.
RESULTS
Thirty-four patients met the inclusion criteria. The mean age was 10.9 years (range, 3-21 y). Indications for surgery included cervical instability, basilar invagination, and os odontoideum. These indications were often secondary to a variety of diagnoses, including trisomy 21, Klippel-Feil syndrome, and rheumatoid arthritis. The mean length of hospitalization was 10 days (range, 2 to 80 d). There were no cases of intraoperative dural leak, venous sinus bleeding from occipital screw placement, or implant-related complications. Postoperative complications included 2 cases of nonunion. Eight patients (24%) had follow-up surgery, only 3 (9%) of which were instrumentation revisions. Both patients with nonunion had repeat occipitocervical fixation procedures and achieved union with revision.
CONCLUSIONS
Occipital plate fixation was successful for pediatric cervical spine fusion in this diverse cohort. The only procedure-related complication demonstrated was delayed union or nonunion and implant loosening (4/34, 12%) and there were no plate-related complications. This novel case series shows that occipital plate fixation is safe and effective for pediatric patients with complex diagnoses.
LEVEL OF EVIDENCE
Level IV-case series.
Topics: Axis, Cervical Vertebra; Bone Plates; Bone Screws; Cervical Vertebrae; Child; Female; Humans; Joint Instability; Male; Occipital Bone; Postoperative Complications; Spinal Diseases; Spinal Fusion; Treatment Outcome
PubMed: 32301850
DOI: 10.1097/BPO.0000000000001564 -
Acta Neurochirurgica. Supplement 2017The aim of this review is to provide an update of the technical nuances of microsurgical and endoscopic-assisted approaches to the craniovertebral junction (transnasal,... (Review)
Review
PURPOSE
The aim of this review is to provide an update of the technical nuances of microsurgical and endoscopic-assisted approaches to the craniovertebral junction (transnasal, transoral, and transcervical), and to report on the available clinical results in order to identify the best strategy.
METHODS
A nonsystematic update of the reviews and reporting on the anatomical and clinical results of endoscopic-assisted and microsurgical approaches to the craniovertebral junction (CVJ) was performed.
RESULTS
Pure endonasal and cervical endoscopic approaches still have some disadvantages, including their steep learning curves and their deeper surgical fields. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option compared with standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary to, rather than as an alternative to the traditional transoral-transpharyngeal approach.
CONCLUSIONS
The transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared with the "pure" transnasal and transcervical approaches, due to the wider working channel provided by the former technique. The transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Of particular interest is the evidence that advances in reduction techniques can avoid the ventral approach.
Topics: Axis, Cervical Vertebra; Cervical Atlas; Humans; Microsurgery; Mouth; Nasal Cavity; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Occipital Bone
PubMed: 28120061
DOI: 10.1007/978-3-319-39546-3_17 -
Neurosurgery Oct 2015Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is... (Review)
Review
BACKGROUND
Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is controversial.
OBJECTIVE
To compare the short-term (<3 months) mortality, long-term (≥12 months) mortality, and complication rates of patients >60 years of age with a type II odontoid fracture managed either operatively or nonoperatively.
METHODS
We performed a systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed.
RESULTS
A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30-0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34-0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63-1.63). Surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with hard collar or a halo orthosis immobilization.
CONCLUSION
The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications.
Topics: Aged; Aged, 80 and over; Humans; Middle Aged; Odontoid Process; Spinal Fractures; Treatment Outcome
PubMed: 26378359
DOI: 10.1227/NEU.0000000000000942 -
Surgical and Radiologic Anatomy : SRA Mar 2022Potential asymmetries of the C2 posterior elements pose a problem for the spine surgeon seeking to make the best choice for spinal stabilization while reducing morbidity.
PURPOSE
Potential asymmetries of the C2 posterior elements pose a problem for the spine surgeon seeking to make the best choice for spinal stabilization while reducing morbidity.
METHODS
A digital caliper was used to measure the pars interarticularis height and length on left and right sides of 25 adult C2 vertebrae. The pars interarticularis was defined as the bone between the posterior most aspect of the superior articular process and the anterior most aspect of the inferior articular process of C2. Also, the C2 vertebrae from 49 patients were scanned by CT. Parasagittal images were reviewed and using the same definitions as were used for the skeletal specimens, the length and the height of the C2 pars interarticularis from both the left and right sides were measured using CT. The image slices were acquired at 3 mm intervals. The pars interarticularis height was determined on sagittal CT reconstruction, while the pars interarticularis length was calculated on the basis of the axial images.
RESULTS
The lengths and the heights of the left and right pars interarticularis were compared using CTs of patients and skeletal specimens. No significant differences were found in the length and height measurements of the CT images on both sides. However, in the skeletal specimens, the left and right pars interarticularis did not differ significantly in length but differed significantly in height (p = 0.003). The mean height of the left pars interarticularis was approximately two times larger than the right in the skeletal specimens. Absolute differences were calculated between the side with the greater length and height and the side with the lesser length and height irrespective of their left-right orientations. For CT measurements, most differences in length and height between the greater pars interarticularis and lesser pars interarticularis occurred between 0 and 1 mm with each successive disparity interval yielding lower numbers. Skeletal measurements revealed a similar length disparity distribution to the CT measurements. However, height measurements in the skeletal specimens varied widely. Eight pars interarticularis specimens demonstrated a height difference between 0 and 1 mm. No dry bone pars interarticularis specimens demonstrated a height difference between 1 and 2 mm. The pars interarticularis of nine specimens demonstrated a height difference between 2 and 3 mm. Two demonstrated a height difference between 3 and 4 mm. Four demonstrated a height difference between 4 and 5 mm and two demonstrated a height difference greater than 5 mm. The greater pars interarticularis lengths and heights were combined and compared to their lesser counterparts on CT and skeletal measurements. In all measurements of this type, significant differences were found in the pars interarticularis length and height, whether measured through CT or via digital calipers.
CONCLUSION
Asymmetry between the left and right C2 pars interarticularis as shown in the present study can alter surgical planning. Therefore, knowledge of this anatomical finding might be useful to spine surgeons.
Topics: Adult; Axis, Cervical Vertebra; Body Height; Bone Screws; Cervical Vertebrae; Humans; Spinal Fusion
PubMed: 35217894
DOI: 10.1007/s00276-022-02901-2 -
World Neurosurgery Mar 2019
Topics: Fractures, Bone; Humans; Neck Injuries; Odontoid Process; Spinal Fractures
PubMed: 30579013
DOI: 10.1016/j.wneu.2018.12.038 -
Journal of Clinical Orthopaedics and... 2020Morphometric evaluation of the pedicle and isthmus of second cervical vertebra (C2) (Axis) is extremely vital before contemplating any surgical stabilization involving...
INTRODUCTION
Morphometric evaluation of the pedicle and isthmus of second cervical vertebra (C2) (Axis) is extremely vital before contemplating any surgical stabilization involving the Craniovertebral region, in view of its proximity to the vertebral artery and the cervical nerve root. The dimensions of pedicles and isthmuses in C2 vary between individuals and there is paucity of data in the Indian population. This study strives to measure the average pedicle and isthmus dimensions in a sample of population, which would enable selection of screws with safest diameters to be used in C2; thereby avoiding injury to adjacent neurovascular structures.
MATERIALS AND METHODS
One Hundred patients in the age group between 18 and 70 years who underwent CT scan of head and neck region were included in the study. The aim of this study was to assess the anatomic suitability of transarticular and pedicle screw placement in Axis vertebrae of Indian population and determine the maximum safe diameter for screw placement. The following parameters were measured in millimeters: Pedicle width, Pedicle angle, Internal height and Isthmic height.
RESULTS
The Mean maximum diameter of potential pedicle screw was 4.99 ± 1.1 mm for the right side with the left side being slightly wider at 5.20 ± 1.16 mm. Twenty eight (28%; 56 out of 200 pedicles) had a measurement < 4.5 mm. The internal height in sagittal images representing the pedicle height was found to be 4.79 ± 0.96 mm on the right side and 4.75 ± 1.04 mm on the left side. Sixty five (65) out of 200 pedicles (32.5%) had measurements < 4.5 mm in sagittal plane. The Mean maximum diameter of potential Transarticular screw (outer diameter of isthmus) was 5.05 ± 0.78 mm for the right side and 5.18 ± 0.84 mm on the left side.
DISCUSSION
Isthmic height < 4.5 mm could potentially violate the vertebral foramen when a 3.5 mm screw is used. In our study 22.5% isthmuses were narrow (<4.5 mm). The mean maximum safe diameter for a potential transarticular screw in the present study was 5.11 mm. Though our patients had smaller isthmus dimensions compared with literature, 77.5% of C2 could take a 4 mm transarticular screw quite comfortably considering the 0.5 mm margin on either side. In the present study, 28% of pedicles were found to be inappropriately sized (<4.5 mm) to accommodate the standard 3.5 mm screw. The mean maximum diameter of a potential pedicle screw in our study was 5.09 mm; and in 72% of patients a 4 mm screw could be placed with confidence. Though our patients on an average can accommodate a 4 mm screw comfortably, we suggest a protocol of obtaining CT measurements of C2 prior to operative intervention for identifying those individuals at risk of neurovascular injury; 22.5% for transarticular screw and 28% for pedicle screw.
PubMed: 32879573
DOI: 10.1016/j.jcot.2020.06.026 -
The Spine Journal : Official Journal of... Jul 2018During placement of C2 pedicle and pars screws, intraoperative fluoroscopy is used so that neurovascular complications can be avoided, and screws can be placed in the... (Comparative Study)
Comparative Study
BACKGROUND CONTEXT
During placement of C2 pedicle and pars screws, intraoperative fluoroscopy is used so that neurovascular complications can be avoided, and screws can be placed in the proper position. However, this method is time consuming and increases radiation exposure. Furthermore, it does not guarantee a completely safe and accurate screw placement.
PURPOSE
The objective of this study was to evaluate the safety of the C2 pedicle and pars screw placement without fluoroscopic or other guidance methods.
STUDY DESIGN
This is a retrospective comparative study.
PATIENT SAMPLE
One hundred ninety-eight patients who underwent placement of C2 pedicle or pars screws without any intraoperative radiographic guidance were included in the study.
OUTCOME MEASURES
Medical records and postoperative computed tomography (CT) scans were evaluated.
MATERIALS AND METHODS
Clinical data were reviewed for intraoperative and postoperative complications. The accuracy of screw placement was evaluated with postop CT scans using a previously published cortical-breach grading system (described by the location and the percentage of the screw diameter over the cortical edge [0=none, Grade I≤25% of the screw diameter, Grade II=26%-50%, Grade III=51%-75%, and Grade IV=76%-100%]).
RESULTS
A total of 148 pedicle screws and 219 pars screws were inserted by two experienced surgeons. There were no cases of cerebral spinal fluid leakage and no neurovascular complications during screw placement. Postoperative CT scans were available for 76 patients, which included 52 pedicle screws and 87 pars screws. For cases with C2 pedicle screws, there were 12 breaches (23%); these included 10 screws with a Grade I breach (19%), 1 screw with a Grade II breach (2%), and 1 screw with a Grade IV breach (2%). Lateral breaches occurred in seven screws (13%), inferior breaches occurred in three screws (6%), and superior breaches occurred in two screws (4%). For cases with C2 pars screws, there were 10 breaches (11%); these included 6 screws with a Grade I breach (7%), 2 screws with a Grade II breach (2%), and 2 screws with a Grade IV breach (2%). Medial breaches were found in four (5%), lateral breaches in two (2%), inferior breaches in two (2%), and superior breaches in two (2%). Two of the cases with superior breaches (one for pedicle and one for pars) experienced occipital neuralgia months after surgery. There was no statistically significant difference in the incidence of overall and high-grade breaches between the groups (p=.07 and 1.0, respectively).
CONCLUSIONS
Although even in experienced hands up to 23% of C2 pedicle screws and 11% of C2 pars screws placed using a freehand technique without guidance may be malpositioned, a clear majority of malpositioned screws demonstrated a low-grade breach, and only 2 of 198 patients (1%) experienced complications related to screw placement.
Topics: Adult; Aged; Aged, 80 and over; Axis, Cervical Vertebra; Female; Fluoroscopy; Humans; Incidence; Male; Middle Aged; Pedicle Screws; Postoperative Complications; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 29155344
DOI: 10.1016/j.spinee.2017.11.010