-
PloS One 2016The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical...
The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation.
Topics: Adolescent; Adult; Age Determination by Skeleton; Cephalometry; Cervical Vertebrae; Child; Cone-Beam Computed Tomography; Female; Humans; Male; Occipital Bone; Osteogenesis; Sphenoid Bone; Young Adult
PubMed: 27513752
DOI: 10.1371/journal.pone.0161104 -
Acta Neurochirurgica Jun 2017We present a rare fatal complication of an occipital condylar fracture. The patient was initially neurologically intact, but showed secondary clinical deterioration....
We present a rare fatal complication of an occipital condylar fracture. The patient was initially neurologically intact, but showed secondary clinical deterioration. Imaging revealed extensive extra-axial hemorrhage at the craniocervical junction and an acute obstructive hydrocephalus. MR imaging demonstrated a T2 hyperintens signal in both the lower brainstem and upper cervical spinal cord, likely caused by the extra-axial hemorrhage. As prognosis was estimated infaust, supportive treatment was discontinued and the patient died soon thereafter. This case report illustrates a rare, delayed complication and unexpected death in a patient having sustained an occipital condylar fracture.
Topics: Aged; Brain Stem; Cervical Atlas; Fatal Outcome; Female; Humans; Occipital Bone; Skull Fractures; Tomography, X-Ray Computed
PubMed: 28432520
DOI: 10.1007/s00701-017-3165-5 -
Neurology India 2012
Review
Topics: Bone Cysts, Aneurysmal; Child; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Occipital Bone; Pediatrics; Tomography, X-Ray Computed
PubMed: 22406807
DOI: 10.4103/0028-3886.93620 -
Pain Physician 2015Treatment of occipital neuralgia (ON) can be complex, though many treatment options exist. Cryoablation (CA) is an interventional modality that has been used...
BACKGROUND
Treatment of occipital neuralgia (ON) can be complex, though many treatment options exist. Cryoablation (CA) is an interventional modality that has been used successfully in chronic neuropathic conditions and is one such option.
OBJECTIVE
To study and evaluate the efficacy and safety of cryoablation for treatment of ON.
STUDY DESIGN
Retrospective evaluation.
SETTING
Academic university-based pain management center.
METHODS
All patients received local anesthetic injections for ON. Patients with greater than or equal to 50% relief and less than 2 week duration of relief were treated with CA.
RESULTS
Thirty-eight patients with an average age of 49.6 years were included. Of the 38 patients, 20 were treated for unilateral greater ON, 10 for unilateral greater and lesser ON, and 8 for bilateral greater ON. There were 10 men and 28 women, with an average age of 45.2 years and 51.1 years, respectively. The average relief for all local anesthetic injections was 71.2%, 58.3% for patients who reported 50 - 74% relief (Group 1) and 82.75% for patients who reported greater than 75% relief (Group 2). The average improvement of pain relief with CA was 57.9% with an average duration of 6.1 months overall. Group 1 reported an average of 45.2% relief for an average of 4.1 months with CA. In comparison, Group 2 reported an average of 70.5% relief for 8.1 months. The percentage of relief (P = 0.007) and duration of relief (P = 0.0006) was significantly improved in those reporting at least 75% relief of pain with local anesthetic injections (Group 2 vs Group 1). Though no significance in improvement from CA was found in men, significance was seen in women with at least 75% benefit with local anesthetic injections in terms of duration (P = 0.03) and percentage (P = 0.001) of pain relief with CA. The average pain score prior to CA was 8 (0 - 10 visual analog scale, VAS), this improved to 4.2, improvement of 3.8 following CA at 6 months (P = 0.03). Of the 38 patients, 3 (7.8%) adverse effects were seen. Two patients reported post procedure neuritis and one was monitored for procedure-related hematoma.
LIMITATIONS
Study limitations include the retrospective nature of the study. Additionally, only the percentage of relief, pain score, and duration of relief were collected.
CONCLUSIONS
CA is safe, and should be considered in patients with ON.
KEY WORDS
Cryoablation, cryoanalgesia, occipital neuralgia, treatment, adverse effects.
Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Cryosurgery; Female; Humans; Male; Middle Aged; Neck Pain; Nerve Block; Neuralgia; Occipital Bone; Pain Management; Pain Measurement; Retrospective Studies; Treatment Outcome
PubMed: 26000683
DOI: No ID Found -
Scientific Reports Jul 2023The cisterna magna has been defined as the space between the inferior margin of the cerebellar vermis to the level of the foramen magnum, while an enlarged dorsal...
The cisterna magna has been defined as the space between the inferior margin of the cerebellar vermis to the level of the foramen magnum, while an enlarged dorsal subarachnoid space at the occipito-cervical junction extending from the foramen magnum to the upper border of the axis (C2) is still ignored. Recently, the myodural bridge complex is proved to drive the cerebral spinal fluid flowing via this region, we therefore introduce the "occipito-atlantal cistern (OAC)" to better describe the subarachnoid space and provide a detailed rationale. The present study utilized several methods, including MRI, gross anatomical dissection, P45 sheet plastination, and three-dimensional visualization. OAC was observed to be an enlarge subarachnoid space, extending from the foramen magnum to the level of the C2. In the median sagittal plane, OAC was a funnel shape and its anteroposterior dimensions were 15.92 ± 4.20 mm at the level of the C0, 4.49 ± 1.25 mm at the level of the posterior arch of the C1, and 2.88 ± 0.77 mm at the level of the arch of the C2, respectively. In the median sagittal plane, the spino-dural angle of the OAC was calculated to be 35.10 ± 6.91°, and the area of OAC was calculated to be 232.28 ± 71.02 mm. The present study provides OAC is a subarachnoid space independent from the cisterna magna. Because of its distinctive anatomy, as well as theoretical and clinical significance, OAC deserves its own name.
Topics: Subarachnoid Space; Foramen Magnum; Neck; Spinal Cord; Cisterna Magna
PubMed: 37495633
DOI: 10.1038/s41598-023-38825-z -
The Journal of the American Osteopathic... Nov 2017
Topics: Humans; Infant; Manipulation, Osteopathic; Occipital Bone; Pediatrics
PubMed: 29084327
DOI: 10.7556/jaoa.2017.139 -
BMC Musculoskeletal Disorders Mar 2021A novel implant for occipitocervical fusion consisting of a median plate with an additional hook inserting in the foramen magnum was tested. Aim of this study was to...
BACKGROUND
A novel implant for occipitocervical fusion consisting of a median plate with an additional hook inserting in the foramen magnum was tested. Aim of this study was to test the stability of a new implant for occipitocervical fusion against the already available and employed median plate implant without hook.
MATERIAL AND METHOD
36 rigid polyurethane foams occipital artificial bones were used. The two occipital implants, namely the occipital plate with hook (Group 1) and the one without hook (Group 2), were applied to the artificial occiput trough three occipital screws and ensured into the experimental setup trough a crossbar. The test parameters were set using the testing machine software as follows: (1) test speed: 10 mm/ min, with 25 mm/ min maximum; (2) preload: 5 N; (3) force switch-off threshold: 90% force drop from F_max. Failure force and path were recorded. Failure force is defined as the maximum reaction force under which failure occurs (F_max), while failure path is the travel path during which failure occurs (dL).
RESULTS
Group 1 (plate with hook) showed a mean failure force of 459.3 ± 35.9 N and a mean failure path of 5.8 ± 0.3 mm Group 2 (plate without hook) showed a mean failure force of 323.9 ± 20.2 N and a mean failure path of 7.2 ± 0.4 mm. The Shapiro-Wilk test score was not significant (P > 0.1), assuming that data were normally distributed. Group 1 had a statistically significant greater F_max (+ 135.37; P > 0.0001) and less dL (- 1.52; P > 0.0001) compared to group 2.
CONCLUSIONS
Medial plates with foramen magnum hooks showed to be more stable that plates without a hook. These new implants may represent a new tool in OCJ fixation, but further studies are required to investigate their behavior in an anatomical setting.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Humans; Occipital Bone; Spinal Fusion
PubMed: 33676483
DOI: 10.1186/s12891-021-04112-z -
AJNR. American Journal of Neuroradiology Apr 2021
Topics: Cadaver; Cranial Sinuses; Humans; Occipital Bone; Radiology
PubMed: 33664103
DOI: 10.3174/ajnr.A6977 -
European Spine Journal : Official... Jun 2009The surgical management of cervical instability in children is a challenging issue. Although the indications for internal fixation are similar to those for adults,...
The surgical management of cervical instability in children is a challenging issue. Although the indications for internal fixation are similar to those for adults, accurate pre-surgery study and sharp surgical techniques are necessary because of the size of such patients' anatomy, their peculiar tissue biology and the wide spectrum of diseases requiring cervical fusion. Our case study is made up of 31 patients, 15 male and 16 female, with an average age of 7 years and 6 months (2 years and 6 months to 18 years) who underwent cervical fusion for instability. Their physical condition presented various different pathologies ranging from congenital deformity, systemic skeletal disease, tumors, trauma, post-surgery instability. We performed occipito-cervical fusion in 11 cases, 5 of which involved stabilization at the cranium-vertebral junction. We used instrumentation in 13 cases (3 sublaminar wiring, 10 rigid adult instrumentation). We used rigid adult instrumentation in three patients under 10 years of age, treated by rod, occipital screws and sublaminar hook instrumentation in steel C0-C2 (9-year-old male, affected by os odontoideum in Down's syndrome; male of 7 years and 10 months, affected by os odontoideum in Down's syndrome; female of 4 years and 6 months with occipito-cervical stenosis and C0-C2 instability in Hurler's syndrome). We operated on two patients under 3 years of age, using sublaminar wiring with bone precursors and allograft at level C0-C2 (one of these was a 30-month-old male with post-traumatic instability C0-C2, while the other was a 17-month-old male with C0-C2 instability in Larsen's syndrome). The average follow-up age was 7 years and 1 month (between 1 and 18 years). Cervical fusion was assessed by X-ray examinations at 4th and 12th weeks and at 6th and 12th months after surgery. Where implants could allow, RMN examination was performed at 1st month after surgery. In the other cases, in which implants do not allow RMN to be performed, CT scan and standard X-rays were carried out, and new X-rays were performed every other year. We experienced two cases of sublaminar wiring rupture without impairment of bone fusion. No patient suffered major complications (infection and osteomyelitis, rigid instrumentation mobilization, incomplete fusion with instability, neurologic impairment, insufficient cervical spine range of movement to cope with everyday life activities, cervical pain). Even though most authors still indicate that rigid instrumentation should be performed in cases over 10 years of age and sublaminar wiring in cases over 3 years of age, our findings demonstrate that this age limit can be lowered. We have treated children under 10 years of age by rigid adult instrumentation and under 36 months of age by wiring. The anatomic size of the patient is the most important factor in determining the use of instrument arthrodesis to treat pediatric cervical spine instability. Although not easy, it is possible and preferable in many cases to adapt fixation to child cervical spine even in very young patients.
Topics: Adolescent; Age Factors; Atlanto-Occipital Joint; Axis, Cervical Vertebra; Body Size; Cervical Atlas; Child; Child, Preschool; Down Syndrome; Female; Humans; Internal Fixators; Male; Occipital Bone; Odontoid Process; Postoperative Complications; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Spinal Fusion; Syndrome; Wound Healing
PubMed: 19404690
DOI: 10.1007/s00586-009-0980-2 -
Journal of Anatomy Jul 2023The craniocervical junction (CCJ) of humans and other vertebrates is a developmental restless region. Due to complex phylogenetic and ontogenetic processes, many...
The craniocervical junction (CCJ) of humans and other vertebrates is a developmental restless region. Due to complex phylogenetic and ontogenetic processes, many anatomical variations can be found in that transitional area. Therefore, newly described variants must be registered, named, and classified into existing concepts explaining their genesis. This study aimed to describe and classify anatomical peculiarities that have not or rarely been reported on before in the literature. This study is based on the observation, analysis, classification, and documentation of three rare phenomena of three different human skull bases and upper cervical vertebrae, which come from the body donor program of the RWTH Aachen. As a result, three osseous phenomena (accessory ossicles, spurs, and bridges) at the CCJ of three different body donors could have been documented, measured, and interpreted. Due to extensive collecting efforts, careful maceration, and accurate observation, it is still possible to add new phenomena to the long list of Proatlas-manifestations. Further on, it could have been shown again that these manifestations can cause damage to the elements of the CCJ due to altered biomechanic conditions. Finally, we have succeeded in showing that phenomena can exist that can imitate the presence of a Proatlas-manifestation. Here, a precise differentiation between Proatlas-based supernumerary structures and the results of fibroostotic processes is necessary.
Topics: Humans; Occipital Bone; Phylogeny; Cervical Vertebrae; Skull Base
PubMed: 36863846
DOI: 10.1111/joa.13851