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Neurosurgery Mar 2010Traumatic fractures of the second cervical vertebra are common, representing nearly 20% of all acute cervical spinal fracture-dislocation injuries. They are divided into... (Review)
Review
BACKGROUND
Traumatic fractures of the second cervical vertebra are common, representing nearly 20% of all acute cervical spinal fracture-dislocation injuries. They are divided into 3 distinct injury patterns: odontoid fractures, hangman's fracture injuries, and fractures of the axis body, involving all other fracture injuries to the C2 vertebra.
OBJECTIVE
An evidence-based overview of the medical and surgical treatment strategies for each axis fracture injury sub-type.
RESULTS
Current medical and surgical management of traumatic fractures of the axis.
Topics: Atlanto-Axial Joint; Axis, Cervical Vertebra; Bone Screws; Braces; Clinical Protocols; Evidence-Based Medicine; Humans; Joint Instability; Odontoid Process; Radiography; Spinal Cord Compression; Spinal Fractures; Spinal Fusion
PubMed: 20173530
DOI: 10.1227/01.NEU.0000366118.21964.A8 -
Development (Cambridge, England) Jun 2006The past decade or so has seen rapid progress in our understanding of how left-right (LR) asymmetry is generated in vertebrate embryos. However, many important questions... (Review)
Review
The past decade or so has seen rapid progress in our understanding of how left-right (LR) asymmetry is generated in vertebrate embryos. However, many important questions about this process remain unanswered. Although a leftward flow of extra-embryonic fluid in the node cavity (nodal flow) is likely to be the symmetry-breaking event, at least in the mouse embryo, it is not yet known how this flow functions or how the asymmetric signal generated in the node is transferred to the lateral plate. The final step in left-right patterning - translation of the asymmetric signal into morphology - is also little understood.
Topics: Amniotic Fluid; Animals; Axis, Cervical Vertebra; Body Patterning; Calcium; Mice; Signal Transduction; Tibia
PubMed: 16672339
DOI: 10.1242/dev.02384 -
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 -
Neurosurgery Mar 2013
Review
Topics: Adult; Axis, Cervical Vertebra; Humans; Practice Guidelines as Topic; Spinal Fractures
PubMed: 23417186
DOI: 10.1227/NEU.0b013e318276ee40 -
Journal of Neurosurgery. Spine Dec 2013The authors report a case of cervical myelopathy caused by invagination of the bilaterally separated lamina of the axis. They also present a literature review. The... (Review)
Review
The authors report a case of cervical myelopathy caused by invagination of the bilaterally separated lamina of the axis. They also present a literature review. The patient was a previously healthy 68-year-old man with a 1-year history of slowly progressive gait disturbance, right-hand clumsiness, and right dominant sensory disturbance in his trunk and extremities. Both MRI and CT showed that the spinal cord was markedly compressed at the C2-3 level, on the right side, by a deeply invaginated anomalous lamina of the axis. A bilaterally separated lamina was also visible. The patient underwent removal of the anomalous invaginated fragment of the separated lamina and the spinous process of the axis. One year after surgery, his myelopathic symptoms had almost completely resolved. Here, the authors present the case of a patient with an extremely rare anomaly of the lamina of the axis. The underlying pathogenesis of this anomaly could be the failure of the 2 chondrification centers on either side to fuse into a single ossification center. Surgical removal of the anomalous invaginated lamina produced a satisfactory outcome.
Topics: Aged; Axis, Cervical Vertebra; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Spinal Cord Compression; Spinal Cord Diseases; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24074507
DOI: 10.3171/2013.8.SPINE13325 -
World Neurosurgery Sep 2016Cervical myelopathy due to bilateral laminar cleft of the axis is extremely rare, and few cases have been previously reported. However, its treatment is relatively... (Review)
Review
BACKGROUND
Cervical myelopathy due to bilateral laminar cleft of the axis is extremely rare, and few cases have been previously reported. However, its treatment is relatively simple. Surgical removal of the anomalous bony structure compromising the spinal canal can sufficiently achieve a good outcome.
CASE DESCRIPTION
A 56-year-old man presented with a 2-year history of stiffness of the left upper and lower extremities. Cervical spine computed tomography showed a bony cleft at both laminae of the posterior arch of the axis, with obvious cord compression on magnetic resonance imaging. Although absence of right pedicle and spina bifida of C7 were also detected, there was no cord compression at this level. The patient underwent surgical removal of the anomalous laminar cleft and the spinous process of the axis. Postoperatively, he improved rapidly and was discharged on the seventh postoperative day. He was asymptomatic at the 3-year follow-up. After surgery, the preoperative myelopathy status was much improved. About 7 years after surgery, radiographs showed no kyphosis and instability.
CONCLUSION
Invaginated bilateral laminar cleft of the axis is a rare cause of cervical myelopathy. The findings in our case should broaden the radiographic differential diagnosis in patients with cervical myelopathy. Surgical removal is an appropriate and simple treatment for this patient, resulting in a satisfactory outcome.
Topics: Axis, Cervical Vertebra; Cervical Vertebrae; Decompression, Surgical; Humans; Laminectomy; Male; Middle Aged; Radiculopathy; Spinal Cord Compression; Treatment Outcome
PubMed: 27389941
DOI: 10.1016/j.wneu.2016.06.115 -
The New England Journal of Medicine May 2017
Topics: Adult; Axis, Cervical Vertebra; Cervical Vertebrae; Humans; Male; Radiography; Spinal Fractures; Spondylolisthesis; Tomography, X-Ray Computed
PubMed: 28467872
DOI: 10.1056/NEJMicm1405867 -
Archives of Orthopaedic and Trauma... 1998We describe a case of fracture of the axial neural arch that occurred after a dome-like cervical laminoplasty and caused dural compression. Cervical laminoplasty with... (Review)
Review
We describe a case of fracture of the axial neural arch that occurred after a dome-like cervical laminoplasty and caused dural compression. Cervical laminoplasty with dome-like laminoplasty of the axis was performed on a patient with cervical myelopathy due to ossification of the posterior longitudinal ligament extending from C2 to C6. After temporary neurological remission, the patient experienced unanticipated neurological deterioration with posterior cervical pain. Radiographs, magnetic resonance imaging and computed tomography of the cervical vertebrae showed a fractured axial lamina that was compressing the cervical cord. After total axial laminectomy, permanent neurological improvement was obtained. Our experience suggests that care should be taken to avoid an excessive dome-like laminoplasty and that the possibility of axial fracture should be borne in mind.
Topics: Aged; Axis, Cervical Vertebra; Cervical Vertebrae; Emergencies; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Neurologic Examination; Postoperative Complications; Reoperation; Spinal Cord Compression; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 9833120
DOI: 10.1007/s004020050324 -
Neurosurgery Mar 2002There is insufficient evidence to support treatment standards. (Comparative Study)
Comparative Study Review
STANDARDS
There is insufficient evidence to support treatment standards.
GUIDELINES
There is insufficient evidence to support treatment guidelines.
OPTIONS
Treatment of atlas-axis combination fractures based primarily on the specific characteristics of the axis fracture is recommended. External immobilization of most C1--C2 combination fractures is recommended. C1--Type II odontoid combination fractures with an atlantodens interval of 5 mm or more and C1--hangman's combination fractures with C2--C3 angulation of 11 degrees or more should be considered for surgical stabilization and fusion. In some cases, the surgical technique must be modified as a result of loss of the integrity of the ring of the atlas.
Topics: Adult; Axis, Cervical Vertebra; Cervical Atlas; Evidence-Based Medicine; Humans; Immobilization; Odontoid Process; Practice Guidelines as Topic; Spinal Fractures; Spinal Fusion
PubMed: 12431298
DOI: 10.1097/00006123-200203001-00022 -
Treating Huge Tear-Drop Fracture of Axis With Trapezoidal Bone: A Case Report and Literature Review.Spine Nov 2015Case report and review of relevant literature. (Review)
Review
STUDY DESIGN
Case report and review of relevant literature.
OBJECTIVE
To discuss the surgical strategies and clinical outcome of managing huge tear drop fracture of axis.
SUMMARY OF BACKGROUND DATA
Teardrop fracture of axis is rarely seen, especially the huge type. The surgical technique is demanding because of the special anatomical structure and difficulty with bone grafting. Moreover, the surgical approach is controversial in the literature.
METHODS
A 51-year-old male patient suffered from neck pain after falling from the bicycle, neck movement was limited with no neurological compromise. X-ray suggested huge tear-drop fracture of anterior-inferior corner of axis, narrowing of C2/3 intervertebral disc. Fusion with self-designed tricortical trapezoidal iliac bone was performed.
RESULTS
Treating huge teardrop fracture of axis by anterior bone grafting with self-designed tricortical trapezoidal iliac bone is effective and stable. A 3-month follow-up showed fusion was achieved, upper cervical curvature was restored, and neck pain disappeared.
CONCLUSION
Self-designed tricortical trapezoidal iliac bone provided adequate fusion area of bone grafting, restoring the normal intervertebral height and cervical alignment, and the midterm outcome is satisfactory.
LEVEL OF EVIDENCE
5.
Topics: Axis, Cervical Vertebra; Bone Transplantation; Humans; Male; Middle Aged; Radiography; Spinal Fractures; Spinal Fusion; Trapezoid Bone; Treatment Outcome
PubMed: 26267825
DOI: 10.1097/BRS.0000000000001118