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Neurology India 2018
Topics: Arnold-Chiari Malformation; Atlanto-Axial Joint; Decompression, Surgical; Humans; Joint Instability; Platybasia; Syringomyelia
PubMed: 30038072
DOI: 10.4103/0028-3886.236992 -
BMC Musculoskeletal Disorders Jan 2016Neck pain is one of the most common musculoskeletal disorders in clinical practice. However neck pain may mask more serious pathology. Although uncommon in most...
BACKGROUND
Neck pain is one of the most common musculoskeletal disorders in clinical practice. However neck pain may mask more serious pathology. Although uncommon in most musculoskeletal physiotherapy practices, it is possible to encounter rare and extremely life-threatening conditions, such as craniovertebral congenital anomalies. Basilar invagination is an abnormality where the odontoid peg projects above the foramen magnum and is the commonest malformation of the craniocervical junction. Its prevalence in the general population is estimated to be 1%. Furthermore, it is a well-recognised cause of neck pain insomuch as it can be easily overlooked and mistaken for a musculoskeletal disorder. Diagnosis is based on the patient's symptoms in conjunction with magnetic resonance imaging (MRI). If life-threatening symptoms, or pressure on the spinal cord are present, the recommended treatment is typically surgical correction.
CASE PRESENTATION
This case report describes the history, relevant examination findings, and clinical reasoning used for a 37 year old male who had the chief complaint of neck pain and occipital headache. After the history and the physical examination, there were several key indicators in the patient's presentation that appeared to warrant further investigation with diagnostic imaging: (1) the drop attack after a triggering event (i.e., heading a football), (2) several episodes of facial numbness immediately and shortly after the trauma, (3) the poorly defined muscle upper extremity muscle weakness, and (4) the modification of symptoms during the modified Sharp-Purser test. Therefore, the decision was made to contact the referring neurosurgeon to discuss the patient's history and his physical examination. The physician requested immediate cervical spine MRI, which revealed a "basilar impression".
CONCLUSION
This case report highlights the need for more research into a number of issues surrounding the prevalence, diagnosis, and the central role of primary care clinicians such as physiotherapists. Furthermore it underlines the importance of including Basilar invagination in the differential diagnosis. Physiotherapists working within a direct access environment must take a comprehensive history and be capable of screening for non-musculoskeletal medical conditions (on a systems, not diagnosis level) in order to avoid providing potentially harmful musculoskeletal treatments (e.g., cervical mobilization or manipulation, stretching, exercise) to patients with sinister medical pathologies, not benign musculoskeletal disorders.
Topics: Adult; Diagnosis, Differential; Humans; Male; Neck Pain; Platybasia; Radiography
PubMed: 26754441
DOI: 10.1186/s12891-015-0847-0 -
Annals of Surgery Aug 1942
PubMed: 17858085
DOI: 10.1097/00000658-194208000-00008 -
Canadian Medical Association Journal Nov 1951
Topics: Bone Diseases; Humans; Hydrocephalus; Occipital Bone; Osteitis Deformans; Platybasia; Skull
PubMed: 14879336
DOI: No ID Found -
Arquivos de Neuro-psiquiatria Jun 2008The Chiari malformation (CM) is characterized by variable herniation of one or both cerebellar tonsils, associated or not with displacement of the hindbrain structures...
The Chiari malformation (CM) is characterized by variable herniation of one or both cerebellar tonsils, associated or not with displacement of the hindbrain structures into the vertebral canal. This is a retrospective study of 29 patients with CM submitted to surgical procedure between 1990 and 2003. There were 14 females and 15 males whose ages ranged from 16 to 65 years. There were seven patients with isolated CM, 12 associated with syringomyelia (SM), three associated with basilar impression (BI) and seven associated with SM and BI. The surgery was based on posterior fossa decompression. In seven patients a catheter was introduced from the subarachnoid space into the III ventricle and five were submitted to tonsillectomy. Twenty-one patients improved, one worsened, one remained unchanged, four missed follow up and two died. We conclude that the best results with CM surgery are obtained by an effective posterior fossa decompression. Those CM cases associated with other abnormalities, such as SM and BI, probably need complementary techniques which will be the theme for new prospective studies.
Topics: Adolescent; Adult; Aged; Arnold-Chiari Malformation; Craniotomy; Decompression, Surgical; Female; Humans; Male; Middle Aged; Platybasia; Retrospective Studies; Syringomyelia; Tonsillectomy; Treatment Outcome
PubMed: 18545779
DOI: 10.1590/s0004-282x2008000200008 -
Results of the treatment of syringomyelia associated with Chiari malformation: analysis of 60 cases.Arquivos de Neuro-psiquiatria Jun 2004We analyze the results of surgical treatment of 60 patients presenting syringomyelia (SM) associated with Chiari malformation (CM) who were operated in the period...
We analyze the results of surgical treatment of 60 patients presenting syringomyelia (SM) associated with Chiari malformation (CM) who were operated in the period 1982-2000. For each case, analysis covered 15 signs and 16 symptoms included in a protocol that separated SM signs and symptoms from those of CM. A score system was established in parallel with the protocol to make the evaluation of treatment results easier. All cases were submitted to craniovertebral decompression by C1 and eventually C2 laminectomy and cerebellar tonsillectomy with duramater graft. To evaluate the results, statistical proportion difference tests and variance analyses were made to a reliability index of 95% (p=0.05). We conclude that the statistical improvement of CM signs and symptoms was very significant (p=0). Syringomyelia signs and symptoms also improved significantly, except for "upper limb hyporeflexia", which did not improve. No statistical difference in the improvement of SM symptoms as compared to CM symptom was found. Syringomyelia signs improved statistically more than CM signs. In half of patients, the percent improvement of signs and symptoms ranged between 40% and 60%.
Topics: Adolescent; Adult; Analysis of Variance; Arnold-Chiari Malformation; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Platybasia; Postoperative Care; Postoperative Period; Preoperative Care; Syringomyelia; Treatment Outcome
PubMed: 15235724
DOI: 10.1590/S0004-282X2004000200009 -
Medicine Apr 2018Rod breakage after occipitocervical fusion (OCF) has never been described in a patient who has undergone surgery for basilar invagination (BI) and atlantoaxial...
RATIONALE
Rod breakage after occipitocervical fusion (OCF) has never been described in a patient who has undergone surgery for basilar invagination (BI) and atlantoaxial dislocation (AAD). Here, we present an unusual but significant case of revision surgery to correct this complication.
PATIENT CONCERNS
A 32-year-old female presented with neck pain, unstable leg motion in walking, and also BI with AAD. Her first surgery was planned to correct these conditions and for fusion at the occipital junction (C3-4) using a screw-rod system. At the 31-month follow-up after her first operation, the patient complained of severe neck pain and limitation of motion, suggesting rod breakage.
DIAGNOSES
Rod breakage after occipitocervical fusion for BI and AAD.
INTERVENTIONS
The patient underwent reoperation for replacement of the broken rods, adjustment of the occipitocervical angle, maintenance of the bone graft bed, and fusion.
OUTCOMES
At follow-up, the hardware was found to be in good condition, with no significant loss of cervical lordosis. At the 37-month follow-up after her second operation, the patient was doing better and continuing to recover.
LESSONS
We concluded that nonideal choice of occipitocervical angle may play an important role in rod breakage; however, an inadequate bone graft and poor postoperative fusion may also contribute to implant failure.
Topics: Adult; Atlanto-Axial Joint; Bone Transplantation; Cervical Vertebrae; Equipment Failure; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Joint Dislocations; Kyphosis; Occipital Bone; Odontoid Process; Platybasia; Postoperative Complications; Reoperation; Spinal Fusion; Tomography, X-Ray Computed
PubMed: 29642217
DOI: 10.1097/MD.0000000000010441 -
Annals of Surgery Apr 1951
Topics: Humans; Nystagmus, Pathologic; Occipital Bone; Physical Examination; Platybasia
PubMed: 14819987
DOI: 10.1097/00000658-195104000-00008 -
The Yale Journal of Biology and Medicine May 1941
PubMed: 21433972
DOI: No ID Found -
Neurology India 2008A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft...
OBJECTIVE
A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft that is additionally placed within the appropriately prepared atlantoaxial joint and posterior to the arch of atlas and lamina of C2 provides bony fusion.
MATERIALS AND METHODS
Between December 2002 and April 2007, 11 patients underwent the discussed method of fixation at the Department of Neurosurgery, King Edward Memorial Hospital in Mumbai, India. All 11 patients had "congenital" basilar invagination and the symptoms were progressive in nature.
RESULTS
The mean follow-up period was 21 months (range 8-40 months). Neurological improvement and successful distraction with atlantoaxial stabilization and ultimate bone fusion was achieved in all the patients and was documented with dynamic radiography. There were no neurological, vascular, or infective complications.
CONCLUSIONS
We conclude that the described method of atlantoaxial joint distraction and fixation provides an alternative treatment strategy for cases with basilar invagination. "Joint distraction" as a stand-alone method could provide reduction of basilar invagination and firm stabilization in such cases.
Topics: Adolescent; Adult; Atlanto-Axial Joint; Bone Screws; Child; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Platybasia; Prospective Studies; Retrospective Studies; Spinal Cord Compression; Tomography, X-Ray Computed; Young Adult
PubMed: 18688138
DOI: 10.4103/0028-3886.41991