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Acta Bio-medica : Atenei Parmensis Sep 2021Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate...
BACKGROUND AND AIM
Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate and effective intervention are crucial. Cervical vertebral injury classifications guide treatment choice through a severity grade based on radiological information. The purpose of the present study was to define which imaging classification system could provide the best morphological and clinical-surgical correlations for cervical spine traumas.
METHODS
We retrospectively analyzed patients evaluated for cervical spine trauma at our Institution in the period 2015-2020. Information regarding the morphological examination (using CT and MRI), the neurological evaluation, and the therapeutic management were collected. C3-C7 fractures were classified according to the SLIC and AOSpine criteria; axial lesions were classified according to the modified AOSpine for the C1-C2 compartment and through the Roy-Camille and the Anderson D'Alonzo system for the odontoid process of the axis.
RESULTS
29 patients were included in the final study population. Nine patients with axial spine trauma and 21 with subaxial cervical spine trauma. A conservative approach was applied in 16 patients while nine patients underwent neurosurgery. Considering the therapeutical indications provided by the SLIC system, a 76.9% accordance was found for patients with a <4 score, while a 100% concordance was calculated for patients with a >4 score undergoing neurosurgery. Regarding the AOSspine classification, a 28.6% concordance was observed for patients classified group B being treated with a posterior neurosurgical approach, while for patients belonging to subgroup C, considered for anterior neurosurgical approach, a 66.7% accordance was calculated.
CONCLUSIONS
The study demonstrated a better morphological correlation for the AOSpine classification in subaxial trauma and the AOSpine and Anderson D'Alonzo in axial trauma. The therapeutic indication found a better correlation in the SLIC classification for subaxial trauma and the Anderson D'Alonzo for axial ones.
Topics: Clinical Decision-Making; Humans; Odontoid Process; Radiography; Retrospective Studies; Spinal Injuries
PubMed: 34505843
DOI: 10.23750/abm.v92iS5.11877 -
Acta Ortopedica Mexicana 2020The is a variable oval or round ossicle with a smooth cortical border, which partially corresponds to the odontoid process, without having continuity with the rest of...
The is a variable oval or round ossicle with a smooth cortical border, which partially corresponds to the odontoid process, without having continuity with the rest of C2 bone. The multifactorial etiology causes instability and clinically translates into pain and compression data into neural structures. The treatment of choice is surgical and techniques have been developed that focus on preserving the stability of the segment. We present the case of a 23-year-old female patient, who begins to suffer at 8 years of age, refers to moderate to severe cervicalgia, which develops with paresthesias in the left hemisphere and later paresis of the left thoracic limb. Physical examination showed hypoaesthesia of the left hemisphere, as well as paresis of the left thoracic limb. Extension studies demonstrate chronic axonal lesion from C1 to C3, predominantly left, imaging studies showing axial instability and magnetic resonance bulbar compression. The patient receives surgical treatment consisting of posterior fixation C1-C2, evolving satisfactorily.
Topics: Adult; Atlanto-Axial Joint; Axis, Cervical Vertebra; Female; Humans; Joint Instability; Odontoid Process; Spinal Fusion; Young Adult
PubMed: 33535281
DOI: No ID Found -
The Journal of Spinal Cord Medicine Mar 2020Odontoid fractures easily lead to instability, causing spinal cord injury. The aim of this study was to measure and analyze the micro-architecture and morphometric...
Odontoid fractures easily lead to instability, causing spinal cord injury. The aim of this study was to measure and analyze the micro-architecture and morphometric parameters of the normal odontoid with high-resolution three-dimensional (3D) micro-computed tomography (micro-CT). Micro-CT scans were obtained from five normal odontoid processes. The scanned data were reconstructed with micro-CT software, and the nutrient foramina and the ossification center of the base of the odontoid were revealed. The trabeculae of the odontoid were measured and divided into four parts to obtain the volume fraction of regions of interest. High-resolution 3D images of the micro-structures' parameters were obtained from the odontoid using micro-CT software. The images demonstrated sponge-like trabecular bone, with the trabeculae showing a complex, net-like micro-construction. The subchondral bone plate was of lamella-like, compact construction and extended and transformed into a net-like structure with rod-shaped trabeculae arranged radially in all directions. There was a statistically significant difference in the volume fraction compared with the region of interest in the fourth part of the trabeculae and the first part of the odontoid (P < 0.05). The nutrient foramina and the ossification center of the odontoid were also observed. It is feasible to use high-resolution 3D micro-CT to evaluate the micro-architecture of the normal odontoid. Other studies can benefit from use of the micro-CT images, such as finite element evaluations.
Topics: Humans; Imaging, Three-Dimensional; Odontoid Process; X-Ray Microtomography
PubMed: 30277847
DOI: 10.1080/10790268.2018.1519995 -
Journal of Orthopaedic Surgery and... Jan 2023There are many classification systems for atlantoaxial dislocation (AAD). Among these systems, the definitions of irreducible AAD remain vague, and its treatments are...
BACKGROUND
There are many classification systems for atlantoaxial dislocation (AAD). Among these systems, the definitions of irreducible AAD remain vague, and its treatments are not unified.
OBJECTIVE
To explore the surgical strategies and efficacy for the treatment of os odontoideum (OO) with AAD.
METHODS
The clinical data of 56 OO patients with AAD who underwent surgery from January 2017 to June 2021 were retrospectively analyzed. AAD was classified into four types, Type I and type II were treated with posterior fixation and fusion. Type III received posterior fixation and fusion after irreducible dislocations were converted to reducible dislocations by translateral mass release or transoral release. Type IV required transoral release for conversion into reducible dislocations before posterior fixation and fusion. The operation time, blood loss, and complications were recorded. The preoperative and postoperative neurological function changes were assessed using the Japanese Orthopedic Association (JOA) score. Postoperative fusion status was assessed by X-ray.
RESULTS
There were 40 cases of type I-II, 14 cases of type III, and two cases of type IV AAD. The operation times of single posterior fixation and fusion, combined translateral mass release and combined transoral release were 130.52 ± 37.12 min, 151.11 ± 16.91 min and 188.57 ± 44.13 min, the blood loss were 162.63 ± 58.27 mL, 235.56 ± 59.94 mL, 414.29 ± 33.91 mL, respectively. One patient with type III died, one with type III underwent revision surgery due to infection, and three patients with type I had further neurological deterioration after operation. fifty-five patients were followed up for 12-24 months. The follow-up results showed that enough decompression was achieved and that fixation and fusion were effective. The JOA score increased from 9.58 ± 1.84 points preoperative to 13.09 ± 2.68 points at 3 months after operation, 14.07 ± 2.83 points at 6 months and 14.25 ± 2.34 at 12 months after operation, all significant differences compared with preoperative results (P < 0.05).
CONCLUSION
OO patients with irreducible AAD can be treated by translateral mass release or transoral release combined with posterior fixation and fusion, while some of those with bony fusion can be treated by transoral release combined with posterior fixation and fusion.
Topics: Humans; Retrospective Studies; Atlanto-Axial Joint; Axis, Cervical Vertebra; Joint Dislocations; Radiography; Spinal Injuries; Spinal Fusion; Treatment Outcome
PubMed: 36639761
DOI: 10.1186/s13018-023-03517-x -
European Spine Journal : Official... Feb 2009Anterior odontoid screw fixation is a safe and effective method for treatment of odontoid fractures. The screw treads should fit into the odontoid medulla, should pass...
Anterior odontoid screw fixation is a safe and effective method for treatment of odontoid fractures. The screw treads should fit into the odontoid medulla, should pass the fracture line, and should pull fractured odontoid tip against body of axis in order to achieve optimum screw placement and treatment. This study has demonstrated optimal anterior odontoid screw thickness, length, and optimal angle for safe and strong anterior odontoid screw placement. Dry bone axis vertebrae were evaluated by direct measurements, X-ray measurements, and computerized tomography (CT) measurements. The screw thickness (inner diameter of the odontoid) was measured as well as screw length (distance between anterior-inferior point body of axis and tip of odontoid), and screw angle (the angle between basis of axis and tip of odontoid). The inner diameter of odontoid bone was measured as 6.5+/-1.9 mm, the screw length was 37.6+/-3.3 mm, and the screw angle was 62.4+/-4.7 on CT. There was no statistical difference between X-ray and CT in the measurements of screw thickness and angle. X-ray and CT measurements are both safe methods to determine the inner odontoid diameter and angle preoperatively. Screw length should be measured on CT only. To provide safe and strong anterior odontoid screw fixation, screw thickness, length, and angle should be known preoperatively, and these can be measured on X-ray and CT.
Topics: Bone Screws; Fracture Fixation, Internal; Humans; Odontoid Process; Radiography; Spinal Fractures
PubMed: 19005694
DOI: 10.1007/s00586-008-0814-7 -
Neurology India Dec 2005Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types... (Review)
Review
Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types depending on the location of the fracture line. Various treatment options are available for each of these fracture types and include application of a cervical orthosis, direct anterior screw fixation, and posterior cervical fusion. If a patient requires surgical treatment of an odontoid process fracture, the timing of treatment may affect fusion rates, particularly if direct anterior odontoid screw fixation is selected as the treatment method. For example, type II odontoid fractures treated within the first 6 months of injury with direct anterior odontoid screw fixation have an 88% fusion rate, whereas fractures treated after 18 months have only a 25% fusion rate. In this review, we discuss the etiology, biomechanics, diagnosis, and treatment (including factors affecting fusion such as timing and fracture orientation) options available for odontoid process fractures.
Topics: Bone Screws; Fracture Fixation; Humans; Odontoid Process; Spinal Cord Injuries; Spinal Fractures; Spinal Fusion
PubMed: 16565532
DOI: 10.4103/0028-3886.22607 -
BMC Musculoskeletal Disorders Feb 2017Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc...
BACKGROUND
Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine.
METHODS
A total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (<3 mm) without joint hypertrophy; grade III, joint hypertrophy secondary to large osteophytes (>3 mm) without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration.
RESULTS
The mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old). There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration.
CONCLUSION
Facet degeneration were more common at C2-C3 level. Older age and facet tropism with respect to the sagittal plane were associated with the facet degeneration.
Topics: Adult; Aged; Axis, Cervical Vertebra; Cervical Vertebrae; Female; Humans; Intervertebral Disc Degeneration; Male; Middle Aged; Retrospective Studies; Tropism; Zygapophyseal Joint
PubMed: 28219354
DOI: 10.1186/s12891-017-1448-x -
African Health Sciences Jun 2018Paediatric cervical spine injuries are uncommon. Traumatic spondylolisthesis of the axis (TSA) is commonly encountered in the trauma setting. The management of TSA may... (Review)
Review
INTRODUCTION
Paediatric cervical spine injuries are uncommon. Traumatic spondylolisthesis of the axis (TSA) is commonly encountered in the trauma setting. The management of TSA may be surgical or non-surgical. Decision making is quite challenging depending on patient presentation and nature of injury, and even more so in the paediatric age group.
OBJECTIVES
To present a case report highlighting the challenges in the management of TSA.
METHODS
We present an 8 year old male, who sustained a bilateral C2 pars fracture with associated unusual C2-C3 posterior subluxation.
RESULTS
Neuroradiological studies identified the fracture/subluxation of C2-C3 and revealed an intact but posteriorly displaced C2-C3 disc causing cord compression. An Extension Halter traction was initially commenced. This seemed to have worsened the patient's neck pains, and caused motor weakness and autonomic dysfunction. An anterior cervical discectomy and fusion was finally decided on and performed after evaluation and brainstorming by our spinal Unit. Intra-operative findings revealed separation of the C2-C3 disc from the C3 superior end plate which probably explains the unusual nature of the subluxation.
CONCLUSION
The case shows that surgical intervention as a primary management for TSA even in the paediatric age group is safe and also avoids risks inherent in conservative management.
Topics: Accidents, Traffic; Atlanto-Axial Joint; Axis, Cervical Vertebra; Cervical Atlas; Cervical Vertebrae; Child; Diskectomy; Fracture Fixation, Internal; Humans; Joint Dislocations; Male; Spinal Fusion; Spinal Injuries; Spondylolisthesis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30602973
DOI: 10.4314/ahs.v18i2.31 -
BMC Musculoskeletal Disorders Jan 2018Metastases to the upper cervical spine were rarely reported in the literature. However, metastases to this area may cause spinal instability and cord compression, which...
BACKGROUND
Metastases to the upper cervical spine were rarely reported in the literature. However, metastases to this area may cause spinal instability and cord compression, which in turn can result in respiratory failure and neurological dysfunction. The present study investigated the efficacy and safety of posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty for this disease.
METHODS
This was a retrospective study that included 10 patients with metastatic involvement of the axis from March 2002 to May 2014. All cases presented with occipitocervical pain: 5 patients with compressive myelopathy and 6 patients with radiculopathy. Japanese Orthopedic Association (JOA) scores and Visual Analogue Scale (VAS) were used to evaluate the improvement of neurological function and pain intensity, respectively.
RESULTS
All patients underwent posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty. The VAS scores and JOA scores both improved postoperatively, from 8.2 ± 0.4 to 2.3 ± 0.2 and from 10.1 ± 2.2 to 14.2 ± 2.9, respectively. Additionally, the improvement rate of JOA was 52.4 ± 1.8%. The mean overall survival was 12.8 months. The median survival time was 7 months. The 6-month and 12-month survival rates were 70% and 40%, respectively. The mean duration of operation was 182 min and blood loss was 450 mL. The mean volume of bone cement injected was 4.0 mL. The cement extravasation was observed in only 1 patient without clinical symptoms. One patient developed tumour recurrence and died 1 month later.
CONCLUSIONS
Posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty was a safe and valuable palliative method with relatively less invasion to treat metastatic involvement of the axis.
Topics: Aged; Aged, 80 and over; Axis, Cervical Vertebra; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Intraoperative Care; Male; Middle Aged; Occipital Bone; Retrospective Studies; Spinal Neoplasms; Vertebroplasty
PubMed: 29325524
DOI: 10.1186/s12891-018-1928-7 -
Spinal Cord Series and Cases 2019Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and... (Review)
Review
INTRODUCTION
Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions.
CASE PRESENTATION
We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries.
DISCUSSION
Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.
Topics: Adult; Axis, Cervical Vertebra; Brain Infarction; Cervical Vertebrae; Computed Tomography Angiography; Diskectomy; Fracture Dislocation; Humans; Longitudinal Ligaments; Male; Multiple Trauma; Nerve Transfer; Platelet Aggregation Inhibitors; Radiculopathy; Spinal Cord Compression; Spinal Fractures; Spinal Fusion; Vertebral Artery; Vertebral Artery Dissection
PubMed: 30675388
DOI: 10.1038/s41394-019-0150-7