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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 -
Journal of Clinical and Diagnostic... May 2015The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine...
BACKGROUND
The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury.
AIM AND OBJECTIVES
The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies.
MATERIALS AND METHODS
Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed.
RESULTS
The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior and posterior height of axis was 34.33±2.69mm and 30.56±2.78mm respectively. The anterior and posterior height of body of axis was 19.67 mm and 16.67mm respectively. Mean A-P and transverse diameter of inferior surface of axis was 15.42mm and 17.7mm respectively. Mean transverse diameter and mean A-P diameter of odontoid process was 9.32 mm and 10.1 mm respectively. Mean anterior and posterior height of the odontoid process was 14.66 mm and 13.89mm respectively. Mean of dens axis sagittal angle (angle between an axis that was imagined to pass longitudinally through the dens axis and the vertical line on a sagittal plane) was 13.23 degree. The shape of superior articulating facets of C2 varies from oval to circular. In the present study, 84% of SAF were oval and 16% were circular. Inferior articulating facets were circular in shape in 90% cases, and oval in 10% vertebra. Mean pedicle width was 10.07mm on right side and 10.52mm on left side. Mean transverse diameter of vertebral canal was 22.37±1.73mm. Mean of A-P diameter of vertebral canal at inlet was 18.31±2.05mm and mean of A-P diameter of vertebral canal at outlet was 14.84±1.63mm.
CONCLUSION
These results obtained from this study may be helpful for the surgeons in avoiding and minimizing complications such as vertebral artery injury, cranial nerve damage and injury to other vital structures while doing surgery around cranio-vertebral region.
PubMed: 26155467
DOI: 10.7860/JCDR/2015/13118.5931 -
Medicina (Kaunas, Lithuania) Sep 2022Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused...
Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. The purpose of this study is to characterize imaging findings of NRROPs and compare them with those of RA. Material and Methods: From January 2015 to December 2019, 27 patients (14 women and 13 men) with NRROPs and 19 patients (15 women and 4 men) with RA were enrolled in this study. We evaluated various imaging findings, including atlantoaxial instability (AAI), and measured the maximum diameter of preodontoid and retro-odontoid spaces with magnetic resonance imaging (MRI) and computed tomography (CT). Results: Statistical significance was considered for p < 0.05. AAI was detected in eight patients with NRROPs and in all patients with RA (p < 0.0001). Seventeen patients with NRROPs and six patients with RA showed spinal cord compression (p = 0.047). Compressive myelopathy was observed in 14 patients with NRROPs and in 4 patients with RA (p = 0.048). Subaxial degeneration was observed in 25 patients with NRROPs and in 9 patients with RA (p = 0.001). Moreover, C2-3 disc abnormalities were observed in 11 patients with NRROPs and in 2 patients with RA (p = 0.02). Axial and longitudinal diameter of retro-odontoid soft tissue and preodontoid and retro-odontoid spaces showed significant differences between NRROP and RA patients (p < 0.0001). Furthermore, CT AAI measurements were differed significantly between NRROP and RA patients (p < 0.05). Conclusions: NRROPs showed prominent retro-odontoid soft tissue thickening, causing compressive myelopathy and a high frequency of subaxial and C2-3 degeneration without AAI.
Topics: Arthritis, Rheumatoid; Atlanto-Axial Joint; Female; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Odontoid Process; Spinal Cord Compression; Spinal Diseases
PubMed: 36143984
DOI: 10.3390/medicina58091307 -
Neurology India 2015
Topics: Humans; Odontoid Process; Spinal Fractures
PubMed: 25751462
DOI: 10.4103/0028-3886.152657 -
The American Journal of the Medical... Jun 2013The concept of inflammatory back pain (IBP) evolved in the 1970s, coincident with the discovery of the HLA-B27 association with ankylosing spondylitis (AS), leading to... (Review)
Review
The concept of inflammatory back pain (IBP) evolved in the 1970s, coincident with the discovery of the HLA-B27 association with ankylosing spondylitis (AS), leading to the development of criteria to determine the presence of IBP. The concept of IBP and it relationship with AS and axial spondyloarthritis (AxSpA) has further evolved, and an instrument developed (the Spondylitis Association of America Back Pain Tool), which was further modified and field tested for use in the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES). This has shown the frequency of chronic back pain to have risen to 19.4%, with nearly one third having IBP. The prevalence of AxSpA has been defined at 1.0% to 1.4% and AS at 0.52% to 0.55%. The national prevalence of HLA-B27 in the United States is 6.1%, and intriguing data from NHANES 2009 suggest a decreasing frequency with increasing age. From this arise new questions and a work agenda ahead.
Topics: Adult; Aged; Axis, Cervical Vertebra; Back Pain; Female; HLA-B27 Antigen; Humans; Male; Middle Aged; Nutrition Surveys; Prevalence; Spondylarthritis; United States
PubMed: 23841117
DOI: 10.1097/maj.0b013e318294457f -
Medicina (Kaunas, Lithuania) 2005The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis,... (Review)
Review
The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. Injuries to this region are relatively common and can be easily overlooked because patients with the upper cervical injury may have an associated head injury, which can alter their level of consciousness and complicate obtaining an accurate history and physical examination. The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries.
Topics: Atlanto-Axial Joint; Atlanto-Occipital Joint; Axis, Cervical Vertebra; Cervical Atlas; Cervical Vertebrae; Diagnosis, Differential; Humans; Joint Dislocations; Odontoid Process; Spinal Fractures; Spinal Injuries; Spondylolisthesis; Tomography, X-Ray Computed
PubMed: 16227714
DOI: No ID Found -
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 -
AJNR. American Journal of Neuroradiology Nov 2012Development of the CVJ is a complex process rarely analyzed by CT. Cartilaginous remnants within the atlas and axis have been shown to variably persist throughout...
BACKGROUND AND PURPOSE
Development of the CVJ is a complex process rarely analyzed by CT. Cartilaginous remnants within the atlas and axis have been shown to variably persist throughout childhood and may be mistaken for fractures. The purpose of this study was to better estimate the fusion timeline of the synchondroses at the CVJ.
MATERIALS AND METHODS
We retrospectively reviewed singular CT scans in 550 children without known skeletal dysplasia or maturation delay (from neonate to 17 years) and analyzed the ossification of atlas and axis. Normal closing age for synchondroses was defined as soon as a complete ossification rate of 80% or more per age category was achieved.
RESULTS
No separate OC was observed in 38 of 230 incompletely ossified AAAs, whereas single, bipartite, or multiple OCs were observed in, respectively, 196, 86, and 16 of 298 AAAs in which OCs could be identified. Synchondroses at the AAA closed after 12 years (range 4.5-17 years). Posterior midline synchondrosis of the atlas closed after 4 years (range 2-13 years). The axis ossified from 6 OCs and 4 synchondroses. Subdental and neurocentral synchondroses closed simultaneously after 9 years (range 7-9.5 years). Apicodental synchondrosis and chondrum terminale were completely ossified after 10.5 years (range 5.5-13.5 years).
CONCLUSIONS
Analysis of the CVJ using triplanar CT reconstructions allows secure identification of characteristic developmental features of the atlas and axis, and helps to separate normal variants from true osseous lesions.
Topics: Adolescent; Aging; Axis, Cervical Vertebra; Cervical Atlas; Child; Child, Preschool; Female; Humans; Male; Osteogenesis; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 22576894
DOI: 10.3174/ajnr.A3105 -
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 -
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