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Neurosurgery Mar 2023Craniovertebral junction (CVJ) cysts, including retro-odontoid pseudotumors, are challenging pathologies to treat and manage effectively. Surgical intervention is... (Observational Study)
Observational Study
BACKGROUND
Craniovertebral junction (CVJ) cysts, including retro-odontoid pseudotumors, are challenging pathologies to treat and manage effectively. Surgical intervention is indicated when these lesions result in progressive myelopathy, intractable pain, or instability.
OBJECTIVE
To present a case series of older patients who underwent successful resection retro-odontoid lesions using transdural approach.
METHODS
A single-center, retrospective observation study of older patients who underwent transdural resection of CVJ cysts at a single institution was performed. Summary demographic information, clinical presentation, perioperative and intraoperative imaging, and Nurick scores were collected and analyzed.
RESULTS
Eight patients were included (mean age [±SD] 75.88 ± 9.09 years). All patients presented with retro-odontoid lesions resulting in severe cervical stenosis, cord compression, and myelopathy. The mean duration of surgery was 226 ± 83.7 minutes. The average intraoperative blood loss was 181.2 cc. The average hospital stay was 4.5 days ± 1.3 (range, 3-7 days). The average follow-up time was 12.5 ± 9.5 months. No intraoperative complications were encountered. The Nurick classification score for myelopathy improved at the final postoperative examination (2.38 ± 1.06 vs 1 ± 1.07). Three patients demonstrated a pre-existing deformity prompting an instrumented fusion. Both computed tomography and MRI evidence of complete regression of retro-odontoid cyst were noted in all patients on the final follow-up.
CONCLUSION
Posterior cervical transdural approach for ventral lesions at the CVJ is a safe and effective means of treating older patients with progressive myelopathy. This technique provides immediate spinal cord decompression while limiting neurological complications commonly associated with open or endoscopic anterior transpharyngeal approaches.
Topics: Aged; Aged, 80 and over; Humans; Cervical Vertebrae; Cysts; Odontoid Process; Retrospective Studies; Spinal Cord Compression; Spinal Cord Diseases; Spinal Fusion
PubMed: 36512818
DOI: 10.1227/neu.0000000000002255 -
The Indian Journal of Radiology &... Dec 2022A brown tumor is one of the manifestations of hyperparathyroidism. It is a rare type of bone lesion that most often occurs in mandible, ribs, and large bones. Spinal...
A brown tumor is one of the manifestations of hyperparathyroidism. It is a rare type of bone lesion that most often occurs in mandible, ribs, and large bones. Spinal involvement is extremely rare. We report an unusual case of a brown tumor of the axis vertebra in a 33-year-old male who presented to the orthopaedic clinic with posttraumatic C2 vertebra fracture and myelopathy. To plan further fixation and stabilization of C2 fracture, the patient underwent a plain radiograph and magnetic resonance imaging (MRI) of the cervical spine. The available routine chest radiograph at the time of MRI reporting clinched the diagnosis of primary hyperparathyroidism with a brown tumor of the axis vertebra. Thus, familiarity with subtle radiographic findings of this condition not only led to early diagnosis and appropriate treatment but also avoided unnecessary C2 biopsy and hardware fixation.
PubMed: 36451945
DOI: 10.1055/s-0042-1755266 -
European Review For Medical and... Nov 2022The C2 odontoid fractures represent one of the most common cervical spine injuries. Stabilization and immobility are required for a correct treatment. However, in some...
OBJECTIVE
The C2 odontoid fractures represent one of the most common cervical spine injuries. Stabilization and immobility are required for a correct treatment. However, in some cases surgical treatment is recommended. There are still no guidelines for Type II odontoid fractures management. The present study aims at determining how non-union could impact on mortality, functional and clinical outcomes in octogenarian patients conservatively treated.
MATERIALS AND METHODS
The present investigation is a retrospective case series. All patients with diagnosis of Type II odontoid fractures, over 80 years and conservatively treated in our institution between January 2016 to April 2020 were potentially eligible for the study. The primary outcome was the bony fusion of the fracture after 3 months of conservative treatment. The secondary outcomes were clinical, functional outcomes and mortality.
RESULTS
Sixty-four patients were eligible for the study according to inclusion and exclusion criteria. Computer Tomography (CT) evaluation performed 3 months after trauma showed complete fracture healing in 31 patients (48.4%, Fused), while 33 patients (51.6%) were evaluated as non-fused. Among these, 6 months after the CT evaluation, 14 patients were classified as stable, while 19 were classified as unstable. There were no statistically significant changes in clinical and functional outcomes reported in our patient series between patients with complete radiological healing and patients who reported stable fibrous non-union.
CONCLUSIONS
In a selected group of elderly patients with a high risk for surgery, the conservative treatment of odontoid Type II fractures can be considered a viable management strategy. The achievement of a stable non-union allows for clinical and functional results comparable to complete fracture healing.
Topics: Aged; Aged, 80 and over; Humans; Conservative Treatment; Octogenarians; Odontoid Process; Retrospective Studies; Fractures, Bone; Fracture Healing
PubMed: 36448854
DOI: 10.26355/eurrev_202211_30280 -
Orthopaedic Surgery Feb 2023Neck imbalance negatively affects body aesthetics of adolescent idiopathic scoliosis (AIS) patients. The evaluation of neck imbalance is currently limited to...
OBJECTIVE
Neck imbalance negatively affects body aesthetics of adolescent idiopathic scoliosis (AIS) patients. The evaluation of neck imbalance is currently limited to radiographic parameters, but lacks visual indicators. Therefore, the purpose of this study was to establish indexes of neck imbalance based on body image and to investigate whether these indexes can truly reflect neck imbalance in AIS patients.
METHODS
We performed a cross-sectional study at a single institution between June 2017 and September 2020 and there were 115 subjects involved in this research. All patients were diagnosed with adolescent idiopathic scoliosis, Lenke type I/II. Radiographic parameters measured included cervical axis tilt (CAT), T1 tilt, first rib angle (FRA), clavicle angle (CA), radiographic shoulder height (RSH), proximal thoracic curve (PTC), apical vertebra translation of proximal thoracic (AVT of PT), main thoracic curve (MTC), apical vertebra translation of main thoracic (AVT of MT) and coronal balance (CB/C7PL-CSVL). Neck imbalance indexes were obtained and measured following a standardized manner. Intra-class correlation coefficient (ICC) analysis was performed for neck imbalance indexes to determine their intra-observer and inter-observer reliability, and correlation tests were performed for neck imbalance indexes with the radiographic parameters mentioned above.
RESULTS
Strong intraobserver and interobserver reliability were observed in neck imbalance index (NII) 1 (0.91 and 0.88), neck imbalance index 2 (0.85 and 0.81) and NII 3 (0.82 and 0.80), P < 0.05. Significant correlation was found in cervical axis tilt (R = 0.81 for NII 1, R = 0.77 for NII 2 and R = 0.78 for NII 3), T1 tilt (R = 0.43 for NII 1, R = 0.52 for NII 2 and R = 0.48 for NII 3), first rib angle (R = 0.41 for NII 1, R = 0.48 for NII 2 and R = 0.43 for NII 3), proximal thoracic curve (R = 0.36 for NII 2) and apical vertebra translation of proximal thoracic (R = -0.37 for NII 2 and R = -0.35 for NII 3) with neck imbalance indexes. Neck imbalance index 1 showed the highest correlation with cervical axis tilt (R = 0.81, P < 0.01).
CONCLUSIONS
Neck imbalance indexes established in our study were in good correlation with cervical axis tilt (CAT), At the meantime, they showed significant correlations with T1 tilt and first rib angle (FRA). Our study provides a practical method for measurement of neck imbalance regarding realistic perspective and makes up for the lack of photographic indexes about neck imbalance.
Topics: Humans; Scoliosis; Shoulder; Cross-Sectional Studies; Reproducibility of Results; Thoracic Vertebrae; Spinal Fusion; Retrospective Studies; Kyphosis; Treatment Outcome
PubMed: 36419322
DOI: 10.1111/os.13583 -
Scientific Reports Nov 2022A non-neoplastic mass posterior to the dens is termed a retro-odontoid mass (R-OM). This retrospective study evaluated radiographic and clinical outcomes and R-OM...
A non-neoplastic mass posterior to the dens is termed a retro-odontoid mass (R-OM). This retrospective study evaluated radiographic and clinical outcomes and R-OM changes after upper cervical spine surgery. This study included 69 patients who underwent upper cervical spine surgery, including atlantoaxial fusion, occipitocervical fusion, or decompression. All patients underwent preoperative magnetic resonance imaging (MRI). Six-month follow-up MRI examinations were performed in 30 patients who had preoperative R-OMs. Radiographic outcomes of the anterior and posterior atlantodental intervals were measured using X-rays and computed tomography. The R-OM and space available for the cord (SAC) were measured using MRI. Clinical outcomes were evaluated using neck and arm pain visual analog scales, the Japanese Orthopedic Association score, the neck disability index, and the patient-reported subjective improvement rate. The anterior atlantodental interval decreased, while the posterior atlantodental interval and SAC increased postoperatively. Among the clinical outcomes, the neck and arm pain and the neck disability index decreased postoperatively, while the Japanese Orthopedic Association score increased. All clinical and radiographic outcomes improved postoperatively. The R-OM either decreased in size or disappeared after fusion surgery in all cases, except in one patient who underwent decompression surgery. In conclusion, stabilization through fusion surgery is essential for treating R-OM.
Topics: Humans; Odontoid Process; Cervical Vertebrae; Retrospective Studies; Atlanto-Axial Joint; Pain
PubMed: 36414738
DOI: 10.1038/s41598-022-24436-7 -
Neurology India 2022Accuracy of screw placement is one of the important factors necessary for adequate union in odontoid fractures with malposition rates as high as 27.2% with standard...
BACKGROUND
Accuracy of screw placement is one of the important factors necessary for adequate union in odontoid fractures with malposition rates as high as 27.2% with standard techniques.
OBJECTIVE
To evaluate efficacy of intraoperative O-arm assistance in improving accuracy of anterior odontoid screw placement and clinco-radiological outcome in type II and III odontoid fractures.
MATERIAL AND METHODS
In this retrospective study, surgery consisted of anterior odontoid screw fixation under intraoperative O-arm assistance over 5 years. Demographical, clinical, radiological, operative details and postoperative events were retrieved from hospital database and evaluated for fusion and surgical outcome.
RESULTS
50 patients (Mean age 34.6 years, SD 14.10, range: 7-70 years; 44 males and 6 females) with Type II and Type III odontoid fracture underwent O-arm assisted anterior screw placement. The mean interval between injury and surgery was 12 days (range 1-65 days). Mean operating time was 132.2 min ± SD 33.56 with average blood loss of 93 ml. ±SD 61.46. With our technique, accurate screw placement was achieved in 100% patients. At the mean follow-up of 26.4 month (SD13.75), overall acceptable fusion rate was 97.8% with non-union in 2.2% patients. Morbidity occurred in two patients; one patient developed fixation failure while other patient had nonunion which was managed with posterior C1-C2 arthrodesis. We had surgical mortality in one patient due to SAH. So overall our procedure was successful in 94% patients and among patients whose follow-up was available, acceptable fusion rates of 97.8% were achieved.
CONCLUSION
We conclude that use of intraoperative three-dimensional imaging using O-arm for anterior odontoid screw fixation improves accuracy and leads to improved radiological and clinical outcomes. It further enables us to extend the indications of odontoid screw fixation to selected complex Type II and rostral Type III odontoid fractures.
Topics: Adult; Female; Humans; Male; Bone Screws; Fracture Fixation, Internal; Imaging, Three-Dimensional; Odontoid Process; Retrospective Studies; Spinal Fractures; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome; Child; Adolescent; Young Adult; Middle Aged; Aged
PubMed: 36412360
DOI: 10.4103/0028-3886.360924 -
Neurology India 2022When there is a complete slippage of facet joints of C1 over C2 such that there is no contact between the articulating surfaces of C1 and C2, the condition is known as...
OBJECTIVE
When there is a complete slippage of facet joints of C1 over C2 such that there is no contact between the articulating surfaces of C1 and C2, the condition is known as atlantoaxial spondyloptosis (AAS). AAS represents an extremely rare manifestation of atlantoaxial instability. This study was performed to highlight the presentation, radiological features, and management of unilateral AAS in pediatric patients.
MATERIAL AND METHODS
We retrospectively identified four pediatric patients with AAS from our hospital records in the last 6 years (2014-2019).
RESULTS
Among the four patients with unilateral AAS, three were posttraumic and one was diagnosed with craniovertebral junction tuberculosis (CVJ TB). All the patients had a varying degree of spastic quadriparesis on presentation. One patient with CVJ TB presented with neck tilt. All patients with traumatic unilateral AAS were associated with an odontoid fracture. These patients underwent C1-C2 fixation with complete reduction of spondyloptosis using the techniques of joint manipulation and joint remodeling with a posterior only approach. Complete reduction of AAS in patients with trauma was also associated with the realignment of the odontoid fracture. All patients improved neurologically after surgery and achieved excellent correction of the deformity on a follow-up imaging.
CONCLUSION
Pediatric unilateral AAS is an extremely rare phenomenon. A single-stage posterior approach with C1-C2 fixation is a feasible technique for the treatment of this seemingly difficult to correct deformity in pediatric patients and the clinical outcomes are excellent.
Topics: Humans; Child; Odontoid Process; Atlanto-Axial Joint; Retrospective Studies; Spondylolisthesis; Spinal Fractures
PubMed: 36412359
DOI: 10.4103/0028-3886.360918 -
Journal of Ayub Medical College,... 2022Klippel-Feil syndrome (KFS) is the congenital fusion of two or more cervical vertebrae which is often associated with various other abnormalities in the cervical spine....
Klippel-Feil syndrome (KFS) is the congenital fusion of two or more cervical vertebrae which is often associated with various other abnormalities in the cervical spine. Involvement the upper cervical segments leads to atlanto-axial instability which manifests as progressive neurological symptoms due to compression on the spinal cord. These cases pose a surgical challenge due the abnormal and unique anatomy of each patient. A 37-year-old patient presented with neck pain and cervical myelopathy due to a posterior subluxation of C2-3 fused segment over C4-6 fused segment. The patient had an os odontoideum, incomplete posterior arch of C1, anomalous course of vertebral artery and C3 hemi-vertebra. The patient was successfully managed with transoral odontoidectomy and occipeto-cervical fusion. Irreducible atlanto-axial dislocation in a patient with an abnormal upper cervical spine anatomy may require transoral decompression followed by posterior fusion.
Topics: Humans; Adult; Klippel-Feil Syndrome; Atlanto-Axial Joint; Axis, Cervical Vertebra; Joint Dislocations; Cervical Vertebrae; Spinal Fusion
PubMed: 36377179
DOI: 10.55519/JAMC-03-9848 -
BMC Surgery Nov 2022To evaluate the accuracy of screw placement using the TiRobot surgical robot in the Harms procedure and to assess the clinical outcomes of this technique.
BACKGROUND
To evaluate the accuracy of screw placement using the TiRobot surgical robot in the Harms procedure and to assess the clinical outcomes of this technique.
METHODS
This retrospective study included 21 patients with atlantoaxial instability treated by posterior atlantoaxial internal fixation (Harms procedure) using the TiRobot surgical robot between March 2016 and June 2021. The precision of screw placement, perioperative parameters and clinical outcomes were recorded. Screw placement was assessed based on intraoperative guiding pin accuracy measurements on intraoperative C-arm cone-beam computed tomography (CT) images using overlay technology and the incidence of screw encroachment identified on CT images.
RESULTS
Among the 21 patients, the mean age was 44.8 years, and the causes of atlantoaxial instability were os odontoideum (n = 11), rheumatoid arthritis (n = 2), unknown pathogenesis (n = 3), and type II odontoid fracture (n = 5). A total of 82 screws were inserted with robotic assistance. From intraoperative guiding pin accuracy measurements, the average translational and angular deviations were 1.52 ± 0.35 mm (range 1.14-2.25 mm) and 2.25° ± 0.45° (range 1.73°-3.20º), respectively. Screw placement was graded as A for 80.5% of screws, B for 15.9%, and C for 3.7%. No complications related to screw misplacement were observed. After the 1-year follow-up, all patients with a neurological deficit experienced neurological improvement based on Nurick Myelopathy Scale scores, and all patients with preoperative neck pain reported improvement based on Visual Analog Scale scores.
CONCLUSIONS
Posterior atlantoaxial internal fixation using the Harms technique assisted by a 3D-based navigation robot is safe, accurate, and effective for treating atlantoaxial instability.
Topics: Humans; Adult; Atlanto-Axial Joint; Spinal Fusion; Retrospective Studies; Robotics; Joint Instability; Spinal Diseases
PubMed: 36333797
DOI: 10.1186/s12893-022-01826-2 -
Turkish Journal of Medical Sciences Aug 2022Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern...
BACKGROUND
Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern procedures for treating cervical instability. Despite the fact that numerous innovative techniques for CPS have been proposed, the appropriate screw entry points and screw directions have yet to be thoroughly established. The aim of this study is to determine the screw insertion angles and screw entry point distances based on reference points, pedicle axis lengths, and pedicle axis intersections for each vertebra from cervical (C) C2 to C7 in both right and left by gender and age groups.
METHODS
In this study, computed tomography (CT) images of patients who underwent cervical examination for any reason were evaluated retrospectively. A total of 100 patients (59 men and 41 females), ranging in age from 18 to 79 years (mean 43 years), were randomly selected for the study. Patients with a history of cervical pathology or surgery were excluded. CT images turned into 3D reconstructed images and density settings were made so that bone tissue could be best observed using OsiriX software. Pedicle axis length (PAL), pedicle transverse angle (PTA), pedicle sagittal angle (PSA), distance of screw entry point to lateral notch (DLN), distance of screw entry point to inferior articular process (DIAP), and pedicle axis intersections were measured.
RESULTS
According to our findings, the optimal entry point should be 2-4 mm medial to the lateral notch and 8-12 mm superior to inferior articular process. PTA ranges between 30 to 45°, while PSA ranges between 11 to 15°. Except for the C2 pedicles, which were slightly shorter, the pedicle axis lengths (PAL) were similar from C3 to C7 in the total group. The intersection of the right and left pedicle axes was determined to be the most in C4 (51.21% in females and 72.88% in males).
DISCUSSION
This study has shown that intersections of the pedicle axis must be considered in both genders, especially in C4. Standardizing optimal entry points and trajectories is crucial for improving the CPS technique's safety and effectiveness.
Topics: Humans; Female; Male; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cervical Vertebrae; Retrospective Studies; Bone Screws; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 36326362
DOI: 10.55730/1300-0144.5415