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Journal of the American Academy of... May 2022The aim of this study is to present a rare case of chordoma in the odontoid process in which the tumor involved the odontoid process and compressed the spinal cord at... (Review)
Review
The aim of this study is to present a rare case of chordoma in the odontoid process in which the tumor involved the odontoid process and compressed the spinal cord at the craniocervical junction. We report on the effectiveness and successful outcome of anterior microscopic tumor resection combined with posterior occipitocervical fixation and review the current standard treatment. A 39-year-old man presented with sudden dyspnea and quadriparesis caused by an unknown tumor compression at C2. Radiographic examination revealed a large destructive mass at C2 and heterogeneous enhancement. The patient received urgent surgical intervention by microscopic-assisted anterior tumor resection and posterior spinal fixation from the occiput to the C5 level. The pathohistologic reports for cytokeratins, epithelial membrane antigen, and S-100 protein were positive. The final diagnosis was chordoma of the odontoid process. At the 2-year follow-up, the patient's condition had improved, and a postoperative MRI showed no indication of tumor regrowth. Chordoma of the odontoid process or C2 body is very rare. The current standard management is wide tumor resection to prevent recurrence. The combined approach of anterior tumor resection with microscopic assistance and posterior stabilization of the occiput to C5 is the optimal treatment for this condition.
Topics: Adult; Cervical Vertebrae; Chordoma; Humans; Magnetic Resonance Imaging; Male; Odontoid Process
PubMed: 35584249
DOI: 10.5435/JAAOSGlobal-D-22-00018 -
European Spine Journal : Official... Mar 2006During the past 30 years various treatment protocols for hangman's fractures have been attempted. In order to guide the management of hangman's fractures, different... (Meta-Analysis)
Meta-Analysis Review
During the past 30 years various treatment protocols for hangman's fractures have been attempted. In order to guide the management of hangman's fractures, different classifications have been introduced. However, opinions on operative or nonoperative treatment have not yet been solidified. To evaluate both conservative and operative management of hangman's fractures in the published literature and to provide appropriate guidelines for treatment of hangman's fractures, a systematic review of the literature regarding the management of hangman's fractures was performed. An English literature search from January 1966 to January 2004 was completed with reference to treatment of hangman's fractures. The classification for treatment guidance from the literature was also reviewed. Regarding a primary therapy for hangman's fractures, there were 20 papers (62.5%) that advocated for a conservative treatment and 11 of the remaining 12 papers suggested that conservative treatment was suitable for some stable fractures. The classification of Effendi et al. modified by Levine and Edwards was used widely. Most hangman's fractures could be managed successfully with traction and external immobilization, especially in Effendi Type I, Type II and Levine-Edwards Type II fractures. It is necessary for Levine-Edwards Type IIa and III fractures to be treated with rigid immobilization. Only for some stable Type I and Levine-Edwards Type II injuries, nonrigid external fixation alone was sufficient. Rigid immobilization alone was necessary for most cases. Surgical stabilization is recommended in unstable cases when there is the possibility of later instability, such as Levine-Edwards Type IIa and III fractures with significant dislocation. The classification system proposed by Effendi et al. and modified by Levine and Edwards provided a clinically reasonable guideline for successful management of hangman's fractures.
Topics: Axis, Cervical Vertebra; Cervical Vertebrae; Evidence-Based Medicine; Fracture Fixation; Humans; Spinal Fractures; Spondylolisthesis
PubMed: 16235100
DOI: 10.1007/s00586-005-0918-2 -
Surgical and Radiologic Anatomy : SRA Dec 2016The knowledge of the developing cervical spine and its individual vertebrae, including their neural processes may be useful in the diagnostics of congenital vertebral...
PURPOSES
The knowledge of the developing cervical spine and its individual vertebrae, including their neural processes may be useful in the diagnostics of congenital vertebral malformations. This study was performed to quantitatively examine the neural ossification centers of the atlas and axis with respect to their linear, planar and volumetric parameters.
METHODS
Using the methods of CT, digital-image analysis and statistics, the size of neural ossification centers in the atlas and axis in 55 spontaneously aborted human fetuses aged 17-30 weeks was studied.
RESULTS
Without any male-female and right-left significant differences, the best fit growth dynamics for the neural ossification centers of the atlas and axis were, respectively, modelled by the following functions: for length: y = -13.461 + 6.140 × ln(age) ± 0.570 and y = -15.683 + 6.882 × ln(age) ± 0.503, for width: y = -4.006 + 1.930 × ln(age) ± 0.178 and y = -3.054 + 1.648 × ln(age) ± 0.178, for cross-sectional area: y = -7.362 + 0.780 × age ± 1.700 and y = -9.930 + 0.869 × age ± 1.911, and for volume: y = -6.417 + 0.836 × age ± 1.924 and y = -11.592 + 1.087 × age ± 2.509.
CONCLUSIONS
The size of neural ossification centers of the atlas and axis shows neither sexual nor bilateral differences. The neural ossification centers of the atlas and axis grow logarithmically in both length and width and linearly in both cross-sectional area and volume. The numerical data relating to the size of neural ossification centers of the atlas and axis derived from the CT and digital-image analysis are considered specific-age reference values of potential relevance in both the ultrasound monitoring and the early detection of spinal abnormalities relating to the neural processes of the first two cervical vertebrae in the fetus.
Topics: Aborted Fetus; Age Factors; Axis, Cervical Vertebra; Cervical Atlas; Female; Fetal Development; Gestational Age; Humans; Male; Models, Theoretical; Osteogenesis; Pregnancy; Reference Values; Sex Characteristics; Spine; Tomography, X-Ray Computed
PubMed: 27142660
DOI: 10.1007/s00276-016-1681-2 -
Turkish Neurosurgery 2019To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex.
AIM
To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex.
MATERIAL AND METHODS
This study included six formalin-fixed cadaveric head and neck specimens. Radiological images and anatomical measurements included: C1-C2 distance, bony distance between C1 anterior tubercle-nares and superior incisors, height of C1 anterior arch, and height and width of odontoid articular surface.
RESULTS
The mean distance between C1 anterior tubercle-nares and superior incisors on maxilla were 96.16 ± 8.07 mm and 84.14 ± 9.16 mm, respectively. The mean height of C1 anterior arch was 13.89 mm. The meandistance between medial borders of right-left C1 lateral masses was 19.10 ± 1.80 mm. The mean distance between medial border of lateral midline on mass right and left sides were 9.43 ± 0.88 mm and 9.68 ± 0.97 mm, respectively. The mean height of C1 anterior arch at midline was 13.89 ± 2.48 mm, and the mean distance between ventral surface of anterior arch and ventral joint of odontoid at midline was 6.43 ± 1.29 mm. The anteroposterior, horizontal diameters of odontoid on its base were 12.12 ± 0.38 mm, and 11.12 ± 0.94 mm, respectively. The angles of transoral and transnasal approaches to C1 were 32.67 ± 4.59° and 32.00 ± 2.10°, respectively.
CONCLUSION
A safe transoral or transnasal odontoidectomy requires accurate measurements and imaging regarding ventral C1-C2 relationships, distances of odontoid, lateral mass and midline.
Topics: Axis, Cervical Vertebra; Cervical Atlas; Female; Humans; Male; Radiography
PubMed: 30649780
DOI: 10.5137/1019-5149.JTN.23499-18.1 -
Journal of Neurology, Neurosurgery, and... Nov 2001
Topics: Accidents, Traffic; Adolescent; Automobile Driving; Female; Humans; Odontoid Process; Tomography, X-Ray Computed
PubMed: 11606691
DOI: 10.1136/jnnp.71.5.706 -
European Spine Journal : Official... Feb 2011Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures. There is uncertainty regarding the consequences of... (Review)
Review
Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures. There is uncertainty regarding the consequences of non-union. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. The objective of the study was to evaluate the published literature and determine the current evidence for the management of type II odontoid fractures in elderly. A search of the English language literature from January 1970 to date was performed using Medline and the following keywords: odontoid, fractures, cervical spine and elderly. The search was supplemented by cross-referencing between articles. Case reports and review articles were excluded although some were referred to in the discussion. Studies in patients aged 65 years with a minimum follow-up of 12 months were selected. One-hundred twenty-six articles were reviewed. No class I study was identified. There were two class II studies and the remaining were class III. Significant variability was found in the literature regarding mortality and morbidity rates in patients treated with and without halo vest immobilisation. In recent years several authors have claimed satisfactory results with anterior odontoid screw fixation while others have argued that this may lead to increased complications in this age group. Lately, the posterior cervical (Goel-Harms) construct has also gained popularity amongst surgeons. There is insufficient evidence to establish a standard or guideline for odontoid fracture management in elderly. While most authors agree that cervical immobilisation yields satisfactory results for type I and III fractures in the elderly, the optimal management for type II fractures remain unsolved. A prospective randomised controlled trial is recommended.
Topics: Aged; Aged, 80 and over; Evidence-Based Medicine; Fracture Fixation; Humans; Odontoid Process; Spinal Fractures; Treatment Outcome
PubMed: 20835875
DOI: 10.1007/s00586-010-1507-6 -
European Spine Journal : Official... Jan 2013Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The... (Review)
Review
PURPOSE
Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The optimal treatment of this condition is still the subject of controversy. The objective of this review is to summarize and compare the outcome of surgical and conservative interventions in the elderly (≥ 65 years).
METHODS
A comprehensive search was conducted in nine databases of medical literature, supplemented by reference and citation tracking. Clinical status was considered the primary outcome. Fracture union and stability rates were considered secondary outcomes.
RESULTS
A total of nineteen studies met the inclusion criteria. All studies were performed retrospectively and were of limited quality. There was insufficient data, especially from direct comparisons, to determine the difference in clinical outcome between surgical and conservative interventions. Osseous union was achieved in 66-85 % of surgically treated patients and in 28-44 % of conservatively treated patients. Fracture stability was achieved in 82-97 % of surgically patients and in 53-79 % of conservatively treated patients.
CONCLUSIONS
There was insufficient data to determine a potential difference in clinical outcome between different treatment groups. Surgically treated patients showed higher osseous union rates compared to conservatively treated patients, possibly because of different selection mechanisms. The majority of patients appears to achieve fracture stability regardless of the applied treatment. A prospective trial with appropriate sample size is needed to identify the optimal treatment of odontoid fractures in the elderly and predictors for the success of either one of the available treatments.
Topics: Aged; Aged, 80 and over; Female; Fracture Fixation, Internal; Humans; Male; Odontoid Process; Spinal Fractures
PubMed: 22941218
DOI: 10.1007/s00586-012-2452-3 -
The Cochrane Database of Systematic... Oct 2008Fractures of the odontoid process of the second cervical vertebra can result in instability, neurological damage and death. Treatment includes conservative management... (Review)
Review
BACKGROUND
Fractures of the odontoid process of the second cervical vertebra can result in instability, neurological damage and death. Treatment includes conservative management (external immobilisation devices) or surgical treatment (internal fixation by posterior fusion or anterior screw fixation).
OBJECTIVES
To compare surgical with conservative treatment for fractures of the odontoid process.
SEARCH STRATEGY
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to February 2008), EMBASE (1988 to February 2008), LILACS (accessed February 2008), reference lists of articles and registries of ongoing trials.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing surgical versus conservative management of odontoid fractures.
DATA COLLECTION AND ANALYSIS
Two review authors independently examined the search results to identify trials for inclusion.
MAIN RESULTS
We did not identify any studies that met our inclusion criteria. We excluded one ongoing and registered study that is comparing surgery versus conservative treatment because it does not involve randomisation of treatment allocation.
AUTHORS' CONCLUSIONS
There is no evidence available from adequately controlled trials to inform the decision on whether the surgical treatment of odontoid fractures gives a better outcome. A sufficiently powered good quality multicentre randomised controlled trial comparing surgery versus conservative treatment is warranted.
Topics: Fracture Fixation; Humans; Odontoid Process; Spinal Fractures
PubMed: 18843678
DOI: 10.1002/14651858.CD005078.pub2 -
Medicine Nov 2018Case series study.To report the clinical outcomes of posterior temporary C1-2 fixation for 3-part fracture of the axis (Type II odontoid fracture according to Grauer... (Observational Study)
Observational Study
Case series study.To report the clinical outcomes of posterior temporary C1-2 fixation for 3-part fracture of the axis (Type II odontoid fracture according to Grauer classification combined with Hangman fracture).The 3-part fracture of the axis is rare and the treatment is controversy.A total of 8 patients with 3-part fracture of the axis were included in this study. X-rays, CT, and MRI prior to surgery were used to evaluate the cervical spine injury. Grauer classification, fracture angulation, and fracture translation were used to evaluate the fracture of dens. The neck disability index (NDI) and range of neck rotary motion were used to assess the neck function.The preoperative fracture angulation and fracture translation were 4.6 ± 1.3° and 2.4 ± 0.6 mm, respectively. The average operation time and blood loss were 109 ± 27 minutes and 49 ± 15 mL. No infection, vascular injuries or neural structure injuries was observed. All patients acquired bone healing at 5.9 ± 2.0 months. The temporary instrumentation was removed at 10.8 ± 1.3 months. The average NDI before and 2 days after removal of instrumentation were 10.1 ± 4.0 and 7.1 ± 3.0, respectively. At 1-year follow-up after instrumentation removal, the NDI was 1.8 ± 0.7, which was much better than immediate NDI after instrumentation removal. The neck rotary motion (left rotation + right rotation) before and 2-day after instrumentation removal were 70.4 ± 6.3° and 119.6 ± 13.1°, respectively. At 1-year follow-up, the average neck rotary motion was 153.1 ± 9.1°, which had significant different with rotary motion 2-day after the removal of temporary instrumentation.With regard to the high fracture fusion rates, low complications, and excellent predictable outcomes in patients treated with posterior temporary C1-2 pedicle screw fixation, the technique may be a suitable choice for 3-part fracture of the axis.
Topics: Adult; Aged; Axis, Cervical Vertebra; Blood Loss, Surgical; Female; Fracture Fixation, Internal; Fracture Healing; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Odontoid Process; Operative Time; Pedicle Screws; Range of Motion, Articular; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 30508884
DOI: 10.1097/MD.0000000000012957 -
Calcified Tissue International May 2023The odontoid process (dens) of the second cervical vertebra (axis) is prone to fracture. While the importance of its skeletal integrity has been previously noted,...
The odontoid process (dens) of the second cervical vertebra (axis) is prone to fracture. While the importance of its skeletal integrity has been previously noted, representative three-dimensional microarchitecture analyses in humans are not available. This study aimed to determine the bone microarchitecture of the axis using high-resolution quantitative computed tomography (HR-pQCT) and to derive clinical implications for the occurrence and treatment of axis fractures. For initial clinical reference, the apparent density of the axis was determined based on clinical computed tomography (CT) images in patients without and with fractures of the axis. Subsequently, 28 human axes (female 50%) obtained at autopsy were analyzed by HR-pQCT. Analyses were performed in three different regions corresponding to zones I (tip of dens), II (base of dens), and III (corpus axis) of the Anderson and D'Alonzo classification. Lower apparent densities based on clinical CT data were detected in zone II and III compared to zone I in both the group without and with fracture. In the autopsy specimens, cortical thickness and bone volume fraction decreased continuously from zone I to zone III. Trabecular and cortical tissue mineral density was lowest in zone III, with no differences between zones I and II. In conclusion, our clinical and high-resolution ex vivo imaging data highlight a marked regional heterogeneity of bone microarchitecture, with poor cortical and trabecular properties near the dens base. These results may partly explain why zones II and III are at high risk of fracture and osteosynthesis failure.
Topics: Humans; Female; Fractures, Bone; Bone and Bones; Odontoid Process; Tomography, X-Ray Computed; Autopsy; Bone Density; Radius
PubMed: 36826480
DOI: 10.1007/s00223-023-01070-7