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BMJ Case Reports Nov 2019Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias,...
Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias, vertebrobasilar arterial disease and vasovagal syncope. We describe the case of a 65-year-old man who presented to our emergency department with symptoms of vertigo and syncope. He was investigated extensively for both cardiac and neurological causes of his symptoms which returned negative results. An outpatient CT scan demonstrated the presence of Os odontoideum and dynamic instability of the atlantoaxial junction, with presumed dynamic obstruction of the vertebral arterial system. This was successfully managed with a posterior atlantoaxial lateral mass fusion with resolution of syncopal symptoms.
Topics: Aged; Atlanto-Axial Joint; Axis, Cervical Vertebra; Humans; Joint Instability; Male; Syncope
PubMed: 31780615
DOI: 10.1136/bcr-2019-230945 -
Child's Nervous System : ChNS :... Apr 2021
Topics: Axis, Cervical Vertebra; Down Syndrome; Humans; Joint Dislocations
PubMed: 32940772
DOI: 10.1007/s00381-020-04886-y -
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 -
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 -
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 -
European Spine Journal : Official... Jan 2013Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The... (Review)
Review
PURPOSE
Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The optimal treatment of this condition is still the subject of controversy. The objective of this review is to summarize and compare the outcome of surgical and conservative interventions in the elderly (≥ 65 years).
METHODS
A comprehensive search was conducted in nine databases of medical literature, supplemented by reference and citation tracking. Clinical status was considered the primary outcome. Fracture union and stability rates were considered secondary outcomes.
RESULTS
A total of nineteen studies met the inclusion criteria. All studies were performed retrospectively and were of limited quality. There was insufficient data, especially from direct comparisons, to determine the difference in clinical outcome between surgical and conservative interventions. Osseous union was achieved in 66-85 % of surgically treated patients and in 28-44 % of conservatively treated patients. Fracture stability was achieved in 82-97 % of surgically patients and in 53-79 % of conservatively treated patients.
CONCLUSIONS
There was insufficient data to determine a potential difference in clinical outcome between different treatment groups. Surgically treated patients showed higher osseous union rates compared to conservatively treated patients, possibly because of different selection mechanisms. The majority of patients appears to achieve fracture stability regardless of the applied treatment. A prospective trial with appropriate sample size is needed to identify the optimal treatment of odontoid fractures in the elderly and predictors for the success of either one of the available treatments.
Topics: Aged; Aged, 80 and over; Female; Fracture Fixation, Internal; Humans; Male; Odontoid Process; Spinal Fractures
PubMed: 22941218
DOI: 10.1007/s00586-012-2452-3 -
Orthopaedic Surgery Feb 2022This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou...
This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.
Topics: Adult; Aged; Bone Screws; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Odontoid Process; Retrospective Studies; Spinal Fractures; Spinal Fusion; Treatment Outcome
PubMed: 34914198
DOI: 10.1111/os.13012 -
European Spine Journal : Official... Oct 2006We report on the case of a 15-year-old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor...
We report on the case of a 15-year-old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor hyperflexion trauma to the cervical spine. Neuroimaging studies revealed atlantoaxial dislocation and ventral compression of the rostral spinal cord with increased cord signal at C1/C2 levels caused by an os odontoideum, as well as anterior and posterior arch defects of the atlas. The patient underwent closed reduction and posterior atlantoaxial fusion. We describe the association of an acquired instability secondary to an os odontoideum with an anteroposterior spondyloschisis of the atlas and its functional result after 12 months. The rare coincidence of both lesions indicates a multiple malformation of the upper cervical spine and supports the theory of an embryologic genesis of os odontoideum.
Topics: Adolescent; Atlanto-Axial Joint; Axis, Cervical Vertebra; Bone Screws; Bone Wires; Cervical Atlas; Cervical Vertebrae; Follow-Up Studies; Humans; Joint Dislocations; Joint Instability; Magnetic Resonance Imaging; Male; Odontoid Process; Spinal Cord Compression; Spinal Fusion; Spinal Injuries; Tomography, X-Ray Computed
PubMed: 16311753
DOI: 10.1007/s00586-005-0017-4 -
Surgical Neurology International 2020The surgical management of cervical spondylotic myelopathy (CSM) attributed to os odontoideum (OO with atlantoaxial instability atlantoaxial instability) and subaxial...
BACKGROUND
The surgical management of cervical spondylotic myelopathy (CSM) attributed to os odontoideum (OO with atlantoaxial instability atlantoaxial instability) and subaxial kyphosis together pose significant surgical challenges.
CASE DESCRIPTION
An elderly male presented with CSM/myelopathy and severe quadriparesis attributed to an unstable OO and 87° fixed, subaxial cervical kyphosis. After performing a 540° spinal cord decompression with atlantoaxial fixation, the patient did well.
CONCLUSION
Double-level CSM due to an unstable OO and subaxial kyphosis is rare and typically requires combined 540° decompression and stabilization.
PubMed: 32494379
DOI: 10.25259/SNI_104_2020 -
The Journal of the Canadian... Jun 2006Acquired anomalies of the craniovertebral junction although rare, may result in serious clinical sequella. The prevalence of craniovertebral anomalies remains unknown...
Acquired anomalies of the craniovertebral junction although rare, may result in serious clinical sequella. The prevalence of craniovertebral anomalies remains unknown since they may remain clinically silent. Os odontoideum is one such anomaly. The etiology remains controversial over whether it is a post-traumatic or congenital condition but the clinical considerations of os odontoideum remain the same. Chiropractors may encounter os odontoideum in the subclinical patient with the potential for deleterious effects with manipulation. Radiography is essential to its detection.
PubMed: 17549176
DOI: No ID Found