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Zhurnal Voprosy Neirokhirurgii Imeni N.... 2016The study objective is to present the tactics of surgical treatment of simple (solitary) bone cysts of the clival region and CII body.
OBJECTIVE
The study objective is to present the tactics of surgical treatment of simple (solitary) bone cysts of the clival region and CII body.
MATERIAL AND METHODS
Two patients were operated on for simple clival and axis cysts.
RESULTS
The first patient with a simple clival cyst underwent transoral clivectomy and bone cyst evacuation. Postoperative control SCT scans revealed that the cyst cavity was lined with a hemostatic material and biological glue. Restoration of bone structures of the clivus occurred after 8 months. The second patient with a simple cyst of the second cervical vertebra (axis) underwent a two-stage surgical treatment: occipitospondylodesis was carried out first, and transoral removal of the pathological process of the CII body was performed at the second stage. Control scans a year after the surgery revealed the formation of bone tissue in the axis body region, an increased cystic cavity in the odontoid process of the axis, and posterior migration of the odontoid process, which caused compression of the brainstem structures. In connection with this, we performed transoral re-intervention with removal of the cystic separated odontoid process. Postoperative control scans revealed complete removal of the cystic odontoid process and decompression of the dural sac. The article provides a detailed analysis of the modern literature that has not reported any cases of a simple bone cyst located in the clivus or upper cervical vertebrae region and, thus, has not described the tactics for surgical treatment of these complex diseases. The article presents illustrative pre-, intra-, and postoperative images and histological specimens.
CONCLUSION
The described cases present successful recurrence-free surgical treatment of simple (solitary) bone cysts located both in the clivus region (1 case) and in the body and odontoid process of the axis (1 case). A feature of the second case was that the patient had an extremely rare combination of a bone cyst of the C2 body and the cystic separated odontoid process of the axis (cystic os odontoideum).
Topics: Adolescent; Bone Cysts; Child; Female; Follow-Up Studies; Humans; Male; Odontoid Process; Skull; Tomography, X-Ray Computed
PubMed: 27029335
DOI: 10.17116/neiro201680188-97 -
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 -
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 -
American Journal of Veterinary Research Dec 2017OBJECTIVE To evaluate and compare morphological characteristics of the dens in atlantoaxial instability (AAI)-predisposed toy-breed dogs (TBDs) with and without AAI and...
OBJECTIVE To evaluate and compare morphological characteristics of the dens in atlantoaxial instability (AAI)-predisposed toy-breed dogs (TBDs) with and without AAI and non-AAI-predisposed healthy Beagles. ANIMALS 80 AAI-affected and 40 nonaffected TBDs and 40 Beagles. PROCEDURES Each dog underwent CT examination of the cervical vertebral column. On median 3-D multiplanar reconstruction images, the dens angle (DA) was measured as were the lengths of the dens and the body of the axis; the dens-to-axis length ratio (ratio of the dens length to the axis body length [DALR]) was calculated. Data were compared among dog groups. RESULTS The DALR in nonaffected TBDs and Beagles did not differ significantly. The mean DALR for AAI-affected TBDs was significantly lower than that for nonaffected TBDs. The mean DA of AAI-affected TBDs was significantly greater than that of Beagles and nonaffected TBDs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that a low DALR might be associated with a high probability of dens abnormalities in TBDs. Additionally, dens length in AAI-affected TBDs appeared to be smaller than that in non-AAI-affected TBDs, given the low DALR in AAI-affected TBDs. Further investigations to determine reference ranges of the DA and DALR and the potential usefulness of those variables as diagnostic markers for AAI in TBDs are warranted.
Topics: Animals; Atlanto-Axial Joint; Cervical Atlas; Cervical Vertebrae; Dog Diseases; Dogs; Female; Joint Instability; Male; Odontoid Process; Reference Values; Retrospective Studies; Species Specificity; Tomography, X-Ray Computed
PubMed: 29182395
DOI: 10.2460/ajvr.78.12.1400 -
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 -
Anatomical Record (Hoboken, N.J. : 2007) Feb 2021The embryonic occipital bone and odontoid process of the axis are attached and connected by the notochord, but become separated in later development and growth. With...
Development and growth of the craniocervical junction with special reference to topographical relationship between the occipital basion, the anterior arch of atlas, and the odontoid process of axis: A study using human fetuses.
The embryonic occipital bone and odontoid process of the axis are attached and connected by the notochord, but become separated in later development and growth. With special attention to the process of separation, we examined sagittal sections of the craniocervical junction in 18 human fetuses at 8-16 weeks and 22 fetuses at 31-37 weeks. At 8-9 weeks, the anterior arch of atlas was always seen overriding the occipital basal part. The odontoid process was close to the occipital with or without a transient joint cavity until 16 weeks. Near term, the top of the odontoid process was usually higher than the anterior arch, but the former was sometimes (7 of 22) at a level almost equal to or lower than the latter. The apical ligament was evident in a few specimens (5 of 22). A distance between the occipital basion and odontoid process was sometimes less than 1.5 mm (8 of 22) or less than half the thickness of the arch (10 of 22). A transient joint cavity between the basion and odontoid process was often (10 of 22). In three fetuses near term, the atlanto-occipital joint cavity was continuous with the median atlanto-axial joint cavity, and the anterior arch was overriding the occipital basal part. Therefore, rather than stage or age, individual differences were evident in the topographical relationship between the three bony elements at the craniocervical junction. An understanding of the embryology and normal development will aid in the correct interpretation of radiologic images of the pediatric cervical spine.
Topics: Atlanto-Occipital Joint; Axis, Cervical Vertebra; Cervical Atlas; Embryonic Development; Humans; Odontoid Process
PubMed: 32396695
DOI: 10.1002/ar.24424 -
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 -
Orthopaedic Surgery Jun 2021To investigate the characteristics of transverse fractures of the C2 axis body diagnosed on sagittal computed tomography (CT) and to propose new classification and...
OBJECTIVE
To investigate the characteristics of transverse fractures of the C2 axis body diagnosed on sagittal computed tomography (CT) and to propose new classification and appropriate treatment strategies.
METHODS
A retrospective study was performed by enrolling 49 patients (26 men and 23 women) with transverse fractures of the C2 axis body who were treated at four national trauma centers of tertiary university hospitals from January 2000 to December 2017. The mean age of the patients was 60.8 years (ranging from 21 to 90 years). We classified 49 transverse fractures of the C2 body into three types based on fracture trajectories involving superior articular facet (SAF) and lateral cortex (LC) of the C2 body on coronal CT as follows: Type 1, involvement of C2 SAF on both sides; Type 2, unilateral involvement of C2 SAF on one side and LC on the other side; Type 3, involvement of LC on both sides. The characteristics, treatment methods, and results of 49 transverse fractures of the C2 body were analyzed. Mean follow-up was 12.6 months (ranging from 12 to 26 months).
RESULTS
Twenty-six (53.1%) patients were Type 1, 21 (42.9%) were Type 2, and 2 (4.0%) were Type 3. Correlation coefficients for intra-observer and inter-observer reliabilities of classification were 0.723 and 0.598 (both, P < 0.001), respectively. About 40.8% (7 Type 1 and 13 Type 2) of the patients had fracture displacement >3 mm; Incidence of fracture displacement >3 mm was higher in Type 2 than Type 1 (61.9% vs 26.9%, P < 0.05). About 79.6% (20 Type 1, 17 Type 2 and 2 Type 3) of the patients were treated conservatively, and 20.4% (6 Type 1 and 4 Type 2) underwent surgery. At last follow-up, 47 out of 49 patients achieved fusion; overall fusion rate was 95.9%. All conservatively treated Type 1 and Type 3 patients achieved fusion. Out of 17 conservatively treated Type 2 patients, 15 achieved fusion but two developed nonunion; however, two nonunion patients opted not to undergo surgery. Subgroup analysis showed that Philadelphia brace caused nonunion significantly in fracture displacement >3 mm compared to Minerva brace/Halovest (100% vs 0%, P < 0.05). All surgically treated Type 1 and 2 patients achieved fusion. In terms of clinical outcomes, neck pain visual analog scale and neck disability index were significantly improved (both, P < 0.01). According to Odom's criteria, 93.9% (46/49) of the patients achieved satisfactory outcomes. No major complications occurred.
CONCLUSIONS
The majority of transverse fractures of C2 body can be treated conservatively. However, surgery or rigid Minerva brace/Halovest should be considered for Type 2 transverse fractures of the C2 body with fracture displacement >3 mm.
Topics: Adult; Aged; Aged, 80 and over; Axis, Cervical Vertebra; Disability Evaluation; Female; Humans; Male; Middle Aged; Pain Measurement; Radiography; Retrospective Studies; Spinal Fractures; Young Adult
PubMed: 34047054
DOI: 10.1111/os.13013 -
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