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Il Fracastoro 1967
Topics: Adult; Hemiplegia; Humans; Male; Myelography; Neurologic Manifestations; Pain; Platybasia
PubMed: 5617711
DOI: No ID Found -
Clinical Orthopaedics and Related... Feb 1999Severe basilar impression leads to an upward translocation of the upper cervical spine and clivus into the foramen magnum and is a diagnosis best made with computed... (Review)
Review
Severe basilar impression leads to an upward translocation of the upper cervical spine and clivus into the foramen magnum and is a diagnosis best made with computed tomography or magnetic resonance imaging scans. Basilar impression may be a primary condition or secondary to bone softening disorders. Symptoms relating to direct neuraxial compression, obstruction to cerebral spinal fluid outflow, and vascular compromise all have been described. Management depends on the exact nature of the abnormality seen, but it is now firmly accepted that those with anterior neuraxial compression should have an anterior decompression. The severe basilar impression and craniofacial abnormalities seen in osteogenesis imperfecta together with the progressive nature of the condition have led to the development of a specific surgical response, the open door maxillotomy combined with a contoured loop fixation of the cervical spine. Little is known of the long term outcome of severe basilar impression, and long term studies undertaken by centers familiar with the condition and its management are required if definitive care is to be delivered to these patients.
Topics: Decompression, Surgical; Humans; Magnetic Resonance Imaging; Maxilla; Platybasia; Postoperative Complications; Prognosis; Tomography, X-Ray Computed
PubMed: 10078134
DOI: 10.1097/00003086-199902000-00012 -
Child's Nervous System : ChNS :... Nov 2000The discovery of a craniocervical junction malformation requires management in three steps: (1) The patterns must be recognized using tomographic measurements...
The discovery of a craniocervical junction malformation requires management in three steps: (1) The patterns must be recognized using tomographic measurements (Chamberlain's line, Wackenheim's line). Dynamic flexion-extension studies are necessary to assess stability or instability. Stable patterns range from platybasia to basilar invagination, with gradual deformation, and are frequently associated with Chiari malformation. Unstable patterns characterized by odontoid instability are the equivalent of an odontoid fracture. The origin is malformative (hypoplasia, aplasia of the dens, os odontoidum), but the last may be difficult to distinguish from an old odontoid fracture. They are found in many syndromes (Down, Morquio, etc.). Unstable atlantoaxial patterns with atlas assimilation are hardly reducible; they evolve toward progressive instability. (2) The neurological consequences must be defined from the clinical features of the spinal cord and the cranial nerves. Both static and dynamic MRI scans must be performed; in this way identification of the neural abnormalities (hydromyelia, Chiari, etc.) and of the osseous compression is possible. (3) The most appropriate operative procedure must be selected: stable platybasia with a nervous compression by Chiari is cured only by posterior decompression; odontoid instability is cured by reduction and posterior fixation, using hooks and autologous bone grafts on the posterior arches of C-1 and C-2. Sometimes a transarticular screw fixation of C1-2 is necessary if there is a defect on the C-1 posterior arch. Craniocervical dislocations with assimilation of the atlas require posterior occipito-vertebral bony fixation with grafts and external halo immobilization or internal fixation with hooks or screws, with anterior transoral decompression in a second step.
Topics: Arnold-Chiari Malformation; Axis, Cervical Vertebra; Cervical Atlas; Child; Humans; Joint Dislocations; Occipital Bone; Platybasia; Prognosis; Spinal Fusion
PubMed: 11151719
DOI: 10.1007/s003810000324 -
Clinical Neurology and Neurosurgery Sep 2023In economically undeveloped areas, surgery for basilar invagination (BI) is still a serious economic burden for people. This study introduces a modified interfacet...
PURPOSE
In economically undeveloped areas, surgery for basilar invagination (BI) is still a serious economic burden for people. This study introduces a modified interfacet technique for the treatment of BI using shaped autologous occipital bone mass to reduce BI and to save economical expenditure.
METHODS
The data of 6 patients with BI who underwent modified interfacet technique using shaped autologous occipital bone mass in our hospital from April 2020 to February 2021 were retrospectively analyzed. During the operation, osteotomy at the external occipital protuberance was performed using ultrasonic osteotome, followed by interfacet release and implantation of shaped autologous occipital bone mass to complete vertical reduction. The atlantodental interval (ADI), Chamberlain's line violation (CLV), clivo-axial angle (CXA) and cervico-medullary angle (CMA) were compared before and after surgery. Additionally, we observed implant stability during the follow-up period to assess the long-term success of the modified interfacet technique.
RESULTS
The surgical procedure was successful in all six patients, with no reported incidents of vascular injury, spinal cord injury, or dural tear. Following the operation, improvements were observed in the ADI, CLV, CXA, and CMA. Throughout the follow-up period, the implants remained stable, demonstrating no complications such as bone resorption of the autologous occipital bone mass, implant fracture, or displacement.
CONCLUSION
The utilization of shaped autologous occipital bone mass in atlantoaxial interfacet bone grafting has demonstrated effectiveness and feasibility. This technique offers simplicity, ease of preparation, and cost-effectiveness, making it a viable option for treating BI.
Topics: Humans; Retrospective Studies; Joint Dislocations; Atlanto-Axial Joint; Platybasia; Occipital Bone; Spinal Fusion
PubMed: 37419081
DOI: 10.1016/j.clineuro.2023.107848 -
Revista de Neurologia Apr 1997Based on medullary traction as responsible for idiopathic syringomyelia (SMI), idiopathic scoliosis (ESCID), Arnold Chiari malformation (ARCH), platybasia (PTB), basilar... (Comparative Study)
Comparative Study
[A new surgical treatment for syringomyelia, scoliosis, Arnold-Chiari malformation, kinking of the brainstem, odontoid recess, idiopathic basilar impression and platybasia].
INTRODUCTION
Based on medullary traction as responsible for idiopathic syringomyelia (SMI), idiopathic scoliosis (ESCID), Arnold Chiari malformation (ARCH), platybasia (PTB), basilar impression (IMB), odontoid recess (RTO) kinking of the brain stem (KTC) and considering the medullary traction to be transmitted by the filum terminale (FT), a surgical technique for the section of FT (SFT) is described in three cases of SMI, one of ESCID, and one of ARCH with no lumbar dysraphia.
MATERIAL AND METHODS
A 34-year-old woman with cervico-brachialgias, paresthesias, bilateral babinski and a centro-medullary cavity C3-C7. A 26-year-old male with cervico-brachialgias, hypoestesia in left hemybody, and cervicobulbar cavity. A 19-year-old female with ESCID since the age of 14th, with episodes of reacuting, and 38o of dorsolumbar curvature. A 67-year-old woman with intense headache, hypoesthesia of the hands, paraparesia and ARCH. A 23-year-old man with marked tetraparesia, bilateral babinski, anesthesia of both legs, SMI, ESCID, ARCH and hydrocephaly.
RESULTS
After SFT: in the SMIs the thermo-algesic, disesthetic and algic dissociation disappeared. In ESCID there was a reduction to 31o in the curvature in nine months. On ARCH the headaches ceased and there was recovery of touch and paraparesia.
CONCLUSIONS
SFT is a useful etiological treatment for SMI, ESCID, ARCH. Also, in ESCID it is possible to avoid stress on the medulla due to its surgical reduction.
Topics: Adult; Aged; Arnold-Chiari Malformation; Brain Stem; Cauda Equina; Female; Humans; Magnetic Resonance Imaging; Male; Medulla Oblongata; Platybasia; Scoliosis; Syringomyelia
PubMed: 9172910
DOI: No ID Found -
BMJ Case Reports Jun 2012A teenage girl presented with progressively worsening neck and occipital pain since 8 months ago that was associated with restriction of neck movements, low to moderate...
A teenage girl presented with progressively worsening neck and occipital pain since 8 months ago that was associated with restriction of neck movements, low to moderate grade fever, anorexia and weight loss followed by gradually progressive quadriparesis since 3 months ago. Neurological examination revealed spastic quadriparesis without cranial nerve palsy. MRI of the cervical spine revealed prevertebral and paravertebral abscess from clivus to C2/C3 level, which extended into the anterior epidural space at C1-C3 level, causing atlantoaxial dislocation. There was evidence of basilar invagination. The dislocated dens caused compression over the cervicomedullary junction. On this basis, a diagnosis of craniovertebral junction Pott's disease was made. The patient was given neck immobilisation with cervical collar, and antitubercular treatment was started. She showed significant improvement in her neurological deficit during follow-up.
Topics: Adolescent; Atlanto-Occipital Joint; Cervical Vertebrae; Diagnosis, Differential; Female; Humans; Immobilization; Magnetic Resonance Imaging; Platybasia; Spinal Cord Compression
PubMed: 22669923
DOI: 10.1136/bcr.02.2012.5851 -
Zhonghua Yi Xue Za Zhi Nov 2022To assess the clinical impact of direct two-step distraction reduction (TSDR) for basilar invagination (BI) with atlantoaxial dislocation (AAD). Retrospective analysis...
To assess the clinical impact of direct two-step distraction reduction (TSDR) for basilar invagination (BI) with atlantoaxial dislocation (AAD). Retrospective analysis was conducted on the clinical data of patients who underwent TSDR and occipitocervical fusion in West China Hospital between October 2013 and March 2021. Depending on whether the preoperative decrease was greater than 50% on preoperative hyperextension X-rays, the patients were split into two groups. The neurological function [Japanese Orthopedic Association (JOA) score], atlantodens interval (ADI), the distance of odontoid process beyond McRae Line (ML) and Wackenheim Line (WL), cervicomedullary angle (CMA), O-C angle (OC2A), and complications incidence were compared between two groups preoperatively and postoperatively. There were 12 men and 23 women among the 35 patients with BI and AAD, and the age ranged from 28 to 71 years, with an mean age of (52.0±13.4) years. In the preoperative reduction ≥50% group, there were 4 males and 9 females with an average age of (54.0±13.8) years; in the preoperative reduction <50% group, there were 8 males and 14 females with a mean age of (50.9±13.4) years. All the patients were followed-up for a mean time of (23.3±13.4) months. There was no significant difference in age, gender, bleeding, length of hospital stay and follow-up time between the two groups (all >0.05). The JOA score, ADI, WL, ML and CMA of 35 patients were significantly improved when compared with those before operation (all <0.05). The reduction degree of ADI, ML and WL was more than 80% in 31 cases (88.57%), 30 cases (85.71%) and 31 cases (88.57%), respectively. There was no significant difference in postoperative ADI, ML and WL between the two groups (all >0.05). All patients had no incision infection, no loosening or breakage of the internal fixators. Dysphagia occurred in 3 patients, non-fusion happened in 1 patient, but no instability in X-ray of cervical dynamic position was found, no loosening or displacement occurred in internal fixators, and partial spontaneous fusion occurred between atlantoaxial lateral mass joints. For BI with AAD without atlantoaxial bony connection or serious atlantoaxial facet joint inclination, TSDR could obtain satisfactory reduction degree. The reduction degree on preoperative hyperextension X-ray doesn't affect the degree of intraoperative reduction.
Topics: Male; Humans; Female; Adult; Middle Aged; Aged; Retrospective Studies; Decompression, Surgical; Platybasia; Joint Dislocations; Atlanto-Axial Joint; Neck Injuries
PubMed: 36396359
DOI: 10.3760/cma.j.cn112137-20220426-00933 -
Zhonghua Yi Xue Za Zhi Nov 2022Regarding the treatment of type A basilar invagination, there is a debate between the combination of anterior and posterior surgery and posterior fixation. The author's...
Regarding the treatment of type A basilar invagination, there is a debate between the combination of anterior and posterior surgery and posterior fixation. The author's personal opinion on the hot topic of cranial vertebral surgery: the surgical plan of type A basilar invagination is expressed in this article. Overall, the combined anterior-posterior approach is applicable in almost all cases of type A basilar invagination, regardless of how severe atlantoaxial dislocation, and simple posterior surgery is only in cases where atlantoaxial dislocation is not very severe. The anterior-posterior combined surgery has two incisions, and the risk of postoperative infection is higher than for posterior surgery alone. If the patient has no spinal cord symptoms, only posterior surgery is acceptable, even if no anatomical reduction can be achieved. If there is a more severe spinal cord dysfunction, or a large syringomyelia, anterior atlantoaxial release is necessary to ensure achieving anatomical reduction and restoring the normal morphology of the cervical spinal cord.
Topics: Humans; Atlanto-Axial Joint; Platybasia; Joint Dislocations; Spine; Spinal Fusion
PubMed: 36396355
DOI: 10.3760/cma.j.cn112137-20220418-00836 -
Clinical Radiology Jan 1971
Review
Topics: Arnold-Chiari Malformation; Contrast Media; Humans; Italy; Myelography; Neurologic Examination; Platybasia; Spinal Cord Diseases; Syringomyelia; United Kingdom
PubMed: 4927925
DOI: 10.1016/s0009-9260(71)80003-x -
Ryoikibetsu Shokogun Shirizu 2000