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Journal of the American College of... Jun 2024
PubMed: 38887227
DOI: 10.1002/emp2.13222 -
Is it meaningful and necessary to avoid the seventh cervical vertebra in long level cervical fusion?Turkish Neurosurgery Nov 2023Posterior cervical fusion (PCF) and decompression procedures, which are increasingly performed, can cause multilevel degenerative cervical pathologies or deformities...
AIM
Posterior cervical fusion (PCF) and decompression procedures, which are increasingly performed, can cause multilevel degenerative cervical pathologies or deformities secondary to advanced age. Therefore, while considering the surgical site for multilevel PCF, the inclusion of the C7 vertebra can cause a dilemma. In this study, the clinical and radiological results of patients who underwent multilevel PCF with different end levels (C6 or C7) were compared.
MATERIAL AND METHODS
We collected radiographs and clinical results of all subjects who underwent level 3 or more PCF for degenerative disease from May 2012 to December 2020. Based on the location of the end of fusion during surgery, patients were divided into C6 (group 1) and C7 patients (group 2). The clinical and radiological results of both groups were compared over two years.
RESULTS
A total of 52 patients met the criteria of this study (21 in group 1 and 31 in group 2). The clinical results demonstrated a statistically significant difference with respect to a lower neck visual analog scale score in group 1 than in group 2 at the last follow-up (p=0.03). With regard to the radiological results, the C2-C7 sagittal vertical axis showed significantly greater values in group 2 than in group 1 at the final follow-up (p=0.02). For thoracic kyphosis (TK), group 2 had lower TK values than group 1 (p=0.03), and the T9 spinopelvic inclination was significantly greater in group 2 than in group 1 (p=0.01).
CONCLUSION
In this study, aggravation of cervical kyphosis and neck pain was observed when C7 was included in multilevel PCF surgery. The inclusion of C7 also affected the thoracolumbar parameters and global spine alignment.
PubMed: 38874250
DOI: 10.5137/1019-5149.JTN.44294-23.3 -
Atlantoaxial dislocation due to Os odontoideum in down syndrome: Literature review and case reports.International Journal of Surgery Case... Jul 2024Os odontoideum is a rare condition commonly associated with atlantoaxial instability (AAI) and leading to atlantoaxial dislocation. The incidence of Os odontoideum is...
INTRODUCTION AND IMPORTANCE
Os odontoideum is a rare condition commonly associated with atlantoaxial instability (AAI) and leading to atlantoaxial dislocation. The incidence of Os odontoideum is higher in patients with Down syndrome. Similar to odontoid fractures, atlantoaxial dislocation in patients with Os odontoideum can result in neurological deficits, disability, and even mortality.
CASE PRESENTATION
We present two cases of Os odontoideum accompanied by Down syndrome. Both patients were hospitalized due to progressive tetraparesis after falls several months prior. Upon examination, the patients exhibited myelopathy and were unable to walk or stand. MRI revealed spinal stenosis at the C1-C2 level due to atlantoaxial dislocation. C1-C2 fixation using Harms' technique was performed in both cases. One case experienced a complication involving instrument failure, necessitating revision surgery.
CLINICAL DISCUSSION
Due to the characteristics of transverse ligament laxity, low muscle tone, excessive joint flexibility, and cognitive impairment, children with both Down syndrome and Os odontoideum are at a high risk of disability and even mortality from spinal cord injury. Most authors recommend surgical management when patients exhibit atlantoaxial instability. Additional factors such as low bone density, cognitive impairment, and a high head-to-body ratio may increase the risk of surgical instrument failure and nonunion postoperatively in patients with Down syndrome.
CONCLUSION
Os odontoideum is a cause of AAI in patients with DS. Indication of surgery in the presence of AAI helps to resolve neurological injury and prevent further deterioration. The use of a cervical collar is considered to prevent instrument failure postoperatively.
PubMed: 38852555
DOI: 10.1016/j.ijscr.2024.109888 -
Scientific Reports Jun 2024In forensic commingled contexts, when the disarticulation occurs uniquely at the atlantoaxial joint, the correct match of atlas and axis may lead to the desirable...
In forensic commingled contexts, when the disarticulation occurs uniquely at the atlantoaxial joint, the correct match of atlas and axis may lead to the desirable assembly of the entire body. Notwithstanding the importance of this joint in such scenarios, no study has so far explored three-dimensional (3D) methodologies to match these two adjoining bones. In the present study, we investigated the potential of re-associating atlas and axis through 3D-3D superimposition by testing their articular surfaces congruency in terms of point-to-point distance (Root Mean Square, RMS). We analysed vertebrae either from the same individual (match) and from different individuals (mismatch). The RMS distance values were assessed for both groups (matches and mismatches) and a threshold value was determined to discriminate matches with a sensitivity of 100%. The atlas and the corresponding axis from 41 documented skeletons (18 males and 23 females), in addition to unpaired elements (the atlas or the axis) from 5 individuals, were superimposed, resulting in 41 matches and 1851 mismatches (joining and non-joining elements). No sex-related significant differences were found in matches and mismatches (p = 0.270 and p = 0.210, respectively), allowing to pool together the two sexes in each group. RMS values ranged between 0.41 to 0.77 mm for matches and between 0.37 and 2.18 mm for mismatches. Significant differences were found comparing the two groups (p < 0.001) and the highest RMS of matches (0.77 mm) was used as the discriminative value that provided a sensitivity of 100% and a specificity of 41%. In conclusion, the 3D-3D superimposition of the atlanto-axial articular facets cannot be considered as a re-association method per se, but rather as a screening one. However, further research on the validation of the 3D approach and on its application to other joints might provide clues to the complex topic of the reassociation of crucial adjoining bones.
Topics: Humans; Male; Female; Imaging, Three-Dimensional; Cervical Atlas; Adult; Middle Aged; Axis, Cervical Vertebra; Atlanto-Axial Joint; Forensic Anthropology; Aged
PubMed: 38849396
DOI: 10.1038/s41598-024-63029-4 -
Turkish Journal of Medical Sciences 2023Craniocervical junction (CCJ) can be involved in inflammatory arthritis. We aimed to define types of CCJ involvement in rheumatoid arthritis (RA), spondyloarthritis...
BACKGROUND/AIM
Craniocervical junction (CCJ) can be involved in inflammatory arthritis. We aimed to define types of CCJ involvement in rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) and compare them with patients without inflammatory arthritides.
MATERIALS AND METHODS
In this retrospective analysis, cervical CT or MRIs of patients with RA, SpA, or PsA, taken for any reason between 2010 and 2020, according to ICD-10 codes, were scanned. Demographic data of the patients were recorded. CCJ involvements (atlantoaxial, vertical, or subaxial subluxation, odontoid process involvement) were reevaluated by an experienced radiologist. The control group consisted of consecutive patients without inflammatory arthritis.
RESULTS
Exactly 459 patients (204 RA, 200 SpA, and 55 PsA) and 78 patients in the control group were included in the study. CCJ involvement was detected in 101 (49.5%) RA, 53 (26.5%) SpA, 10 (18.2%) PsA, and 4 patients (5.1%) in the control group (p < 0.001). The odontoid process was one of the main targets, especially in RA patients (69 (33.8%)), which was significantly higher than in the SpA, PsA, and control groups. Although vertical subluxation (VS) was numerically higher in the RA and SpA groups compared to the control group, VS-related brainstem compression was relatively uncommon: 6 (2.9%) in RA, 1 (0.5%) in AS, and none in the PsA and control groups.
CONCLUSION
CCJ involvement can often be detected in patients with inflammatory arthritis, especially in RA and SpA patients. The odontoid process is the main target of inflammation.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Arthritis, Rheumatoid; Adult; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Spondylarthritis; Aged; Arthritis, Psoriatic; Atlanto-Axial Joint; Cervical Vertebrae; Odontoid Process
PubMed: 38813511
DOI: 10.55730/1300-0144.5740 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2024To investigate the imaging characteristics of cervical kyphosis and spinal cord compression in cervical spondylotic myelopathy (CSM) with cervical kyphosis and the...
OBJECTIVE
To investigate the imaging characteristics of cervical kyphosis and spinal cord compression in cervical spondylotic myelopathy (CSM) with cervical kyphosis and the influence on effectiveness.
METHODS
The clinical data of 36 patients with single-segment CSM with cervical kyphosis who were admitted between January 2020 and December 2022 and met the selection criteria were retrospectively analyzed. The patients were divided into 3 groups according to the positional relationship between the kyphosis focal on cervical spine X-ray film and the spinal cord compression point on MRI: the same group (group A, 20 cases, both points were in the same position), the adjacent group (group B, 10 cases, both points were located adjacent to each other), and the separated group (group C, 6 cases, both points were located >1 vertebra away from each other). There was no significant difference between groups ( >0.05) in baseline data such as gender, age, body mass index, lesion segment, disease duration, and preoperative C angle, C sagittal vertical axis (C SVA), C slope (C S), kyphotic Cobb angle, fusion segment height, and Japanese Orthopedic Association (JOA) score. The patients underwent single-segment anterior cervical discectomy with fusion (ACDF). The occurrence of postoperative complications was recorded; preoperatively and at last follow-up, the patients' neurological function was evaluated using the JOA score, and the sagittal parameters (C angle, C SVA, C S, kyphotic Cobb angle, and height of the fused segments) were measured on cervical spine X-ray films and MRI and the correction rate of the cervical kyphosis was calculated; the correlation between changes in cervical sagittal parameters before and after operation and the JOA score improvement rate was analyzed using Pearson correlation analysis.
RESULTS
In 36 patients, only 1 case of dysphagia occurred in group A, and the dysphagia symptoms disappeared at 3 days after operation, and the remaining patients had no surgery-related complications during the hospitalization. All patients were followed up 12-42 months, with a mean of 20.1 months; the difference in follow-up time between the groups was not significant ( >0.05). At last follow-up, all the imaging indicators and JOA scores of patients in the 3 groups were significantly improved when compared with preoperative ones ( <0.05). The correction rate of cervical kyphosis in group A was significantly better than that in group C, and the improvement rate of JOA score was significantly better than that in groups B and C, all showing significant differences ( <0.05), and there was no significant difference between the other groups ( >0.05). The correlation analysis showed that the improvement rate of JOA score was negatively correlated with C angle and kyphotic Cobb angle at last follow-up ( =-0.424, =0.010; =-0.573, <0.001), and positively correlated with the C S and correction rate of cervical kyphosis at last follow-up ( =0.336, =0.045; =0.587, <0.001), and no correlation with the remaining indicators ( >0.05).
CONCLUSION
There are three main positional relationships between the cervical kyphosis focal and the spinal cord compression point on imaging, and they have different impacts on the effectiveness and sagittal parameters after ACDF, and those with the same position cervical kyphosis focal and spinal cord compression point have the best improvement in effectiveness and sagittal parameters.
Topics: Humans; Cervical Vertebrae; Kyphosis; Spondylosis; Spinal Cord Compression; Magnetic Resonance Imaging; Spinal Fusion; Treatment Outcome; Spinal Cord Diseases; Decompression, Surgical; Retrospective Studies; Male; Female; Middle Aged
PubMed: 38752239
DOI: 10.7507/1002-1892.202402018 -
Journal of Craniovertebral Junction &... 2024To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome.
AIMS
To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome.
SETTINGS AND DESIGN
Retrospective case series.
SUBJECTS AND METHODS
A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from 2007 to 2018.
STATISTICAL ANALYSIS USED
Chi-squared/Fisher's exact test.
RESULTS
There were 4 males and 5 females (n = 9). The median age was 14 years (interquartile range [IQR]: 7-15.5). 77.7% (7/9) of patients had severe spasticity (Nurick Grades 4 and 5). The median duration of symptoms was 9 months (IQR: 5-39). The AAD was reducible in all (n = 9) cases. Eight (88.8%) patients had os odontoideum. The mean atlantodental interval (ADI) was 8.5 mm (±2.9). T2W cord hyperintensity was seen in 66.6% (6/9). Posterior C1-2 transarticular fixation was done in 8 and occipitocervical fusion in 1 patient. Follow-up of more than 6 months (7-57 months) was available in 8/9 (88.9%) patients. There was a significant improvement in spasticity (n = 8, mean Nurick Grade 1.7 (±1.1), = 0.003). Follow-up radiographs (n = 8) showed good reduction and fusion. A preoperative bedbound patient with poor respiratory reserve expired at 10 months following surgery. There were no other complications.
CONCLUSIONS
Posterior surgical approach for AAD in Down syndrome resulted in good alignment and fusion, with excellent clinical improvement. Patients with elevated PCO are poor surgical candidates and require home ventilation facility.
PubMed: 38644917
DOI: 10.4103/jcvjs.jcvjs_171_23 -
Journal of Craniovertebral Junction &... 2024This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a...
This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients.
PubMed: 38644913
DOI: 10.4103/jcvjs.jcvjs_183_23