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Neurology India 2022
Topics: Humans; Neck Pain; Odontoid Process; Syndrome
PubMed: 35864713
DOI: 10.4103/0028-3886.349617 -
The Pan African Medical Journal 2017We aim to establish a complete summary on the Endoscopic Endonasal Approach (EEA) to Cranio Cervical Junction (CCJ): evolution since first description, criteria to... (Review)
Review
We aim to establish a complete summary on the Endoscopic Endonasal Approach (EEA) to Cranio Cervical Junction (CCJ): evolution since first description, criteria to predict the feasibility and limitations, anatomical landmarks, indications and biomechanical evaluation after performing the approach. A comprehensive literature search to identify all available literature published between March 2002 and June 2015, the articles were divided into four categories according to their main purpose: 1- surgical technique, 2- anatomical landmarks and limitations, 3- literature reviews to identify main indications, 4- biomechanical studies. Thereafter, we demonstrate the approach step-by-step, using 1 fresh and 3 silicon injected embalmed cadaveric specimen heads. 61 articles and one poster were identified. The approach was first described on cadaveric study in 2002, and firstly used to perform odontoidectomy in 2005. The main indication is odontoid rheumatoid pannus and basilar invagination. The nasopalatine line (NPL), the superior nostril-hard palate Line (SN-HP), the naso-axial line (NAxL), the rhinopalatine Line (RPL) and other methods were described to predict the anatomical feasibility of the approach. The craniocervical fusion is potentially unnecessary after removal of < 75% of one occipital condyle. A recent cadaveric study stated the possibility of C1-C2 fusion via EEA. This paper reviews all available clinical and anatomical studies on the EEA to CCJ. The approach marked a significant evolution since its first description in 2002. Because of its lesser complications compared to the transoral approach, the EEA became when feasible, the approach of choice to the ventral CCJ.
Topics: Cervical Vertebrae; Endoscopy; Humans; Nose; Odontoid Process; Spinal Fusion
PubMed: 29187946
DOI: 10.11604/pamj.2017.27.277.12220 -
Orthopaedic Surgery Aug 2022This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically...
Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome.
OBJECTIVE
This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.
METHODS
A series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including "lesion perforating", "aspiration", "cutting-and-scraping" and "biopsy forceps utilization" were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.
RESULTS
Eight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow-up period (1-39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.
CONCLUSION
With a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well-tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.
Topics: Aged; Axis, Cervical Vertebra; Biopsy; Cervical Atlas; Endoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 35706342
DOI: 10.1111/os.13366 -
Arquivos de Neuro-psiquiatria Nov 2012Evaluate the surgical results of axis screw instrumentation.
OBJECTIVE
Evaluate the surgical results of axis screw instrumentation.
METHODS
Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws.
RESULTS
Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73). Spinal cord trauma was the most common cause of instability (8 patients - 47%). Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws). Seven patients (41.1%) underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars). There was no neurological worsening or death, nor complications directly related to use axis screws.
CONCLUSION
Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation.
Topics: Adolescent; Adult; Aged; Algorithms; Axis, Cervical Vertebra; Bone Screws; Child; Follow-Up Studies; Humans; Joint Instability; Male; Middle Aged; Retrospective Studies; Spinal Cord Injuries; Spinal Fusion; Young Adult
PubMed: 23175198
DOI: 10.1590/s0004-282x2012001100007 -
Radiographics : a Review Publication of... 2013
Topics: Adult; Axis, Cervical Vertebra; Forecasting; Humans; Magnetic Resonance Imaging; Male; Practice Guidelines as Topic; Sacroiliitis; Spondylarthropathies
PubMed: 24006535
DOI: 10.1148/Radiographics.33.4.135015 -
Radiographics : a Review Publication of... 2013
Topics: Adult; Axis, Cervical Vertebra; Forecasting; Humans; Magnetic Resonance Imaging; Male; Practice Guidelines as Topic; Sacroiliitis; Spondylarthropathies
PubMed: 24006534
DOI: 10.1148/Radiographics.33.4.125100 -
Cell Jan 1999
Review
Topics: Animals; Axis, Cervical Vertebra; Body Patterning; Embryonic and Fetal Development; Functional Laterality; Humans
PubMed: 9988215
DOI: 10.1016/s0092-8674(00)80560-7 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Nov 2017To explore the imaging measurement and clinical significance of the angle between the axis of pedicle and the plane of lamina in lower cervical vertebra. Methods:...
To explore the imaging measurement and clinical significance of the angle between the axis of pedicle and the plane of lamina in lower cervical vertebra. Methods: Three dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the angle between the axis of pedicle and the plane of lamina was measured with the specific reconstructed CT image of C3-C7. Results: 1) The left and right transverse angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 98.3°±6.3°, 98.0°±5.1°, 97.5°±6.9°, 95.1°±5.0°, 85.8°±5.4° and 96.7°±8.2°, 98.7°±7.1°, 97.8°±3.6°, 93.2°±6.2°, 86.8°±5.7°, respectively, which showed a gradual decreasing trend. Meanwhile the angle of C3-C6 was more than 90 degrees and C7 was less than 90 degrees. In addition to C6 with C3 and C7 with other segments, the rest of the differences between the sections was not statistically significant (all P>0.05). 2) The left and right transverse angle of C3-C7 between the axis of pedicle and the pedicle of vertebral arch of lamina were 0.2°±4.5°, 1.2°±7.2°, -0.8°±6.8°, -3.3°±5.4°, -14.7°±4.0° and -1.6°±5.4°, 1.9°±4.6°, -0.5°±6.0°, -4.6°±5.3°, -13.7°±3.4°, respectively, which showed a first increasing and then reducing trend. Meanwhile the angle of C4 was maximum angle. In addition to C6 with C3, C6 with C4, and C7 with other segments, the differences between the sections was not statistically significant (all P>0.05). 3) The left and right sagittal angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 77.7°±7.6°, 77.0°±7.1°, 85.3°±8.4°, 94.1°±2.2°, 94.9°±3.8° and 78.5°±7.1°, 76.2°±6.2°, 86.4°±6.4°, 94.0°±2.7°, 95.6°±3.8°, respectively, which showed a gradual increasing trend. The angle of C3-C4 was less than 90 degrees. C5 showed large variation and C6-C7 was more than 90 degrees. In addition to C3 with C4 and C6 with C7, the differences between the sections was statistically significant (all P<0.05). There was no significant difference between the two sides of the above indexes (all P>0.05). Conclusion: In low cervical vertebra, there is a certain angle relationship between the axis of pedicle and the plane of lamina, which can provide reference for the clinical determination of angle of pedicle screw insertion.
Topics: Cervical Vertebrae; Humans; Imaging, Three-Dimensional; Pedicle Screws; Tomography, X-Ray Computed
PubMed: 29187655
DOI: 10.11817/j.issn.1672-7347.2017.11.007 -
Folia Morphologica 2017Uncinate processes (UPs) are distinct features unique to cervical vertebrae. They are consistently found on posterolateral aspect of the superior end plate of 3rd to 7th...
BACKGROUND
Uncinate processes (UPs) are distinct features unique to cervical vertebrae. They are consistently found on posterolateral aspect of the superior end plate of 3rd to 7th cervical vertebrae. In this study, we investigated the morphology of the UPs with a particular emphasis on the regional anatomy and clinical significance.
MATERIALS AND METHODS
The study included 63 vertebrae. The width, height and length of UPs were measured with a digital calliper. We also assessed inclination angle of UP relative to sagittal plane, angle between medial surface of UP and superior surface of vertebra, angle between long axis of the UP and frontal plane, angle between long axis of UP and sagittal plane.
RESULTS
Average width of the UPs ranged from 4.25 mm at C3 to 6.33 mm at T1; average height ranged from 4.88 mm at T1 to 7.54 mm at C4; and average length ranged from 6.88 mm at T1 to 11.46 mm at C4. We measured the inclination angle of UP relative to sagittal plane, and found it to be relatively constant with T1 having the largest value. The average angle was 41.39°, and the range was 17° to 85°. The angle between the long axis of the UP and the sagittal plane was increasing signifi-cantly from C5 to T1. The average angle was 20.74° and the range was 6° to 65°.
CONCLUSIONS
Anatomy of UPs is significant for surgeon who operates on the cervical spine. Hopefully, the information presented herein would decrease complications during surgical approaches to the cervical spine.
Topics: Aged; Cervical Vertebrae; Humans
PubMed: 28198524
DOI: 10.5603/FM.a2017.0010 -
Revista Da Associacao Medica Brasileira... Feb 2019To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
OBJECTIVE
To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
METHODS
Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws.
RESULTS
Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series.
CONCLUSION
Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used.
Topics: Adolescent; Adult; Aged; Axis, Cervical Vertebra; Bone Screws; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Spinal Fusion; Treatment Outcome; Young Adult
PubMed: 30892444
DOI: 10.1590/1806-9282.65.2.198