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1.
Article in Chinese | WPRIM | ID: wpr-888309

ABSTRACT

OBJECTIVE@#To investigate the feasibility and clinical effect of hemi-resection of posterior arch of atlas in the upper cervical spinal dumbbell-shaped schwannomas.@*METHODS@#A retrospective analysis was performed on 13 patients with high level cervical dumbbell schwannomas from January 2005 to December 2018, including 10 males and 3 females, aged 19 to 67 years old. The occipital foramen to the C@*RESULTS@#The operation was successfully completed in 13 cases of this group. No vertebral artery injury or spinal cord injury occurred during the operation. All 13 patients were followed up for more than 12 months. No local recurrence was found. Both the VAS and the JOA score were significantly improved compared with those before surgery. The ASIA classification before operation was:1 case of grade C, 6 cases of grade D, 6 cases of grade E;the latest follow up was 3 cases of ASIA grade D and 10 cases of E.@*CONCLUSION@#The posterior arch of the atlas hemisection can remove the upper cervical dumbbell schwannoma in one stage. The short-term clinical effect is good, and there are no complications such as cervical instability.


Subject(s)
Adult , Aged , Cervical Vertebrae , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Neurilemmoma , Retrospective Studies , Treatment Outcome , Young Adult
2.
Article in Chinese | WPRIM | ID: wpr-879436

ABSTRACT

OBJECTIVE@#To explore the treatment strategy and clinical efficacy for os odontoideum complicated with atlantoaxial dislocation.@*METHODS@#The clinical data of 17 patients with os odontoideum complicated with atlantoaxial dislocation surgically treated from January 2006 to January 2015 were retrospectively analyzed, including 7 males and 10 females, aged 17 to 53 (43.1±11.3) years old;course of disease was 3 to 27(10.2±6.9) months. All patients received cranial traction before operation, 12 of 14 patients with reducible dislocation were treated by posterior atlantoaxial fixation and fusion, and 2 patients with atlantooccipital deformity were treated by posterior occipitocervical fixation and fusion;3 patients with irreducible alantoaxial dislocation were treated by transoral approach decompression combined with posterior atlantoaxial fixation and fusion. The operation time, intraoperative blood loss and perioperative complications were recorded. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the change of neck pain and neurological function. Atlantoaxial joint fusion rate was evaluated by CT scan.@*RESULTS@#The operation time of posterior fixation and fusion ranged from 86 to 170 (92.2±27.5) min, and the intraoperative blood loss was 200-350 (250.7±65.2) ml. No vertebral artery injury and spinal cord injury were recorded. Among the patients underwent atlantoaxial fixation and fusion, 1 patient with reducible dislocation fixed by C@*CONCLUSION@#Surgical treatment of os odontoideum complicated with atlantoaxial dislocation can achieve satisfactory results, improve the patient's neurological function and improve the quality of life, however the surgical options needs to be individualized.


Subject(s)
Adolescent , Adult , Atlanto-Axial Joint/surgery , Axis, Cervical Vertebra , Female , Humans , Joint Dislocations/surgery , Male , Middle Aged , Quality of Life , Retrospective Studies , Spinal Fusion , Treatment Outcome , Young Adult
3.
Coluna/Columna ; 18(1): 81-83, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-984324

ABSTRACT

ABSTRACT The first cervical vertebra is subject to numerous anatomical variations. One of these is posterior arch agenesis, which is classified into five distinct morphological types. Together, all types of posterior arch agenesis comprise only 4% of atlas variations. Furthermore, complete agenesis of the posterior arch associated with the presence of the posterior tubercle is rare. This work reports a case of posterior arch agenesis with the presence of the posterior tubercle in a 33 year-old male victim of a motor vehicle collision. Despite being asymptomatic, this anatomical variation can present with headaches and neck pain. It is mostly found as an incidental finding in imaging studies performed by the emergency team and, as a result, it is often misdiagnosed as a C1 fracture. Knowledge of the variations relating to the first cervical vertebra is therefore essential to avoid delays in diagnosis and treatment of polytraumatized patients. Level of evidence V; Case report.


RESUMO A primeira vértebra cervical é alvo de inúmeras variações anatômicas. Uma destas inclui a agenesia do seu arco posterior, que é classificada em cinco tipos morfológicos distintos. Apesar de uma incidência de 4% na população em geral, a agenesia completa do arco posterior, associada à presença do tubérculo posterior do atlas, é rara. Objetivou-se no presente trabalho relatar a agenesia completa do arco posterior com a presença do tubérculo posterior da primeira vértebra cervical em um paciente de 33 anos de idade, que sofreu um acidente automobilístico. Em geral, essa condição é assintomática, porém, essa variação anatômica pode causar sintomas como dores de cabeça. Na maioria dos casos, é um achado acidental em exames de imagem realizados pela equipe de emergência. Como resultado, a agenesia de arco posterior de atlas pode ser interpretada erroneamente como uma fratura. Portanto, o conhecimento das variações anatômicas da primeira vértebra cervical é essencial para evitar erro no diagnóstico e tratamento de pacientes politraumatizados. Nível de Evidência V; Relato de caso.


RESUMEN La primera vértebra cervical puede presentar numerosas variaciones anatómicas. Una de ellas es la agenesia del arco posterior, que se clasifica en cinco tipos morfológicos distintos. En conjunto, todos los tipos de agenesia del arco posterior comprenden solo el 4% de las variaciones del atlas. Además, la agenesia completa del arco posterior asociada con la presencia del tubérculo posterior es rara. Este trabajo relata un caso de agenesia del arco posterior con presencia del tubérculo posterior en un paciente del sexo masculino de 33 años de edad que sufrió un accidente automovilístico. A pesar de ser asintomática, esta variación anatómica puede causar dolores de cabeza y cuello. Se encontra principalmente como hallazgo incidental en pruebas de imagen realizadas por el equipo de emergencia y como resultado, a menudo se diagnostica erróneamente como una fractura de C1. El conocimiento de las variaciones anatómicas de la primera vértebra cervical es, por lo tanto, esencial para evitar retrasos en el diagnóstico y tratamiento de pacientes politraumatizados. Nivel de Evidencia V; Relato de caso.


Subject(s)
Humans , Male , Adult , Cervical Atlas/abnormalities , Spinal Injuries , Congenital Abnormalities , Anatomic Variation
4.
Asian Spine Journal ; : 949-959, 2019.
Article in English | WPRIM | ID: wpr-785491

ABSTRACT

STUDY DESIGN: A cross-sectional observational study involved the analysis of computed tomography (CT) scan data from 125 Indian subjects of 18 years or older with normal imaging findings. Scans were obtained from patients with head injuries as a part of the screening process along with brain CT scans.PURPOSE: To establish the dimensions of lateral masses of the atlas vertebrae in normal disease-free Indian individuals.OVERVIEW OF LITERATURE: Lateral mass fixation has become the standard of care in fixation of the supra-axial cervical spine. Many studies have investigated the dimensions of lateral masses in cadaveric specimens; however, studies involving the radiological morphometric analysis of the lateral masses of the atlas vertebra in living patients are lacking.METHODS: Subjects underwent craniovertebral junction CT scans during evaluations of head injury. All had normal radiology reports. The CT scans were obtained using a CT Philips Brilliance 64 machine (Philips, Amsterdam, Netherlands) with a slice thickness of 1 mm and then analyzed using Horos software ver. 2.0.2 (Horos Project, Annapolis, MD, USA) on a MacBook.RESULTS: Lateral masses of the atlas vertebrae were found to be larger in males than females and larger on the right than the left side. The angle of permissible medialization was found to be larger on the right side. The analysis of the average dimensions indicated the conventionally described screw positions to be safe.CONCLUSIONS: The present study provides information that may help to establish standard dimensions of lateral masses of the atlas vertebrae among the normal Indian population. We demonstrate that there is no significant difference when compared with the Western population. The results presented here will be of use to clinicians as they may inform preoperative planning for lateral mass fixation surgeries.


Subject(s)
Brain , Cadaver , Cervical Atlas , Craniocerebral Trauma , Female , Humans , Male , Mass Screening , Observational Study , Spine , Standard of Care , Tomography, X-Ray Computed
5.
Chinese Journal of Orthopaedics ; (12): 1311-1319, 2019.
Article in Chinese | WPRIM | ID: wpr-803178

ABSTRACT

Objective@#To evaluate the accuracy of transarticular screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to evaluate the clinical outcomes of this treatment method.@*Methods@#Data of 56 patients(26 males and 30 females) with atlantoaxial instability who were treated by C1, 2 transarticular screw fixation using ITFN from November 2005 to October 2015 were retrospectively analyzed. The mean age of the patients was 44.5 years (range, 9-68 years). There were 44 cases with congenital malformation, 4 with old odontoid fracture, 7 with spontaneous dislocation, and 1 with rheumatoid arthritis. C2 isthmus width and height were measured on preoperatively obtained CT scans, and screw positioning was evaluated on postoperatively obtained CT scans, and classified into three types: ideal position (type I), acceptable position (type II) and unacceptable position (type III). A novel grading system is proposed based on previous study and grading system, and the difficulty of placing C1, 2 transarticular screw using ITFN was classified into three types: easy (total score 0), median (total score 1) and hard (total score 2, 3). Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom’s criteria.@*Results@#The isthmus width was 5.46±1.86 mm on the right side and 5.38±1.36 mm on the left side. The isthmus height was 4.89±1.33 mm on the right side and 4.97±1.17 mm on the left side. According to the grading system, 78, 11, and 23 of the sides were classified into easy, median and hard groups respectively. One hundred and seven transarticular screws were placed in 56 patients, and 71.03% of which were ideal screws, and 28.97% were acceptable screws. Five patients had unilateral screws placed. There was no significant difference in screw positioning among the three groups (χ2=0.46, 0.54, 1.18; P=0.50, 0.46,0.28). The mean follow-up period was 44.7 months (range, 6-120 months). At the latest follow-up, according to Nurick score, there are 30 patients scoring 0, 25 patients scoring 1, and 1 patient scoring 2. According to Odom’s criteria, outcomes were as follows: excellent, 66.1%; good, 26.8%; fair, 7.1%; and poor, 0%. All patients with preoperative neck pain had symptom relief or improvement, with more than 89.33% improvement in visual analogue scale scores. No dural laceration, injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted.@*Conclusion@#ITFN is a safe, accurate, and effective tool for transarticular screw placement in patients with atlantoaxial instability.

6.
Chinese Journal of Orthopaedics ; (12): 1053-1060, 2019.
Article in Chinese | WPRIM | ID: wpr-802877

ABSTRACT

Objective@#To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diagnostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 developmental canal stenosis in craniovertebral junction (CVJ) anomalies.@*Methods@#From December 2010 to November 2018, 101 patients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were enrolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three subgroups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial dislocation with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diameter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shapiro-Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval (CI) for the mean of the normal group. The C1 morphology of developmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological classification for C1 developmental canal stenosis in CVJ anomalies.@*Results@#The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95%CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter ≤ 25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95%CI: 22.84-30.84), which differed significantly from that in the the normal group (t=10.504, P< 0.01). A total of 33 cases meeting the criteria of C1 inner diameter ≤ 25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST classification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: little atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurving type, 3.0%(1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch.@*Conclusion@#The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter ≤ 25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmental canal stenosis in CVJ anomalies can be classified according to the JST classification system.

7.
Chinese Journal of Orthopaedics ; (12): 201-208, 2019.
Article in Chinese | WPRIM | ID: wpr-745387

ABSTRACT

Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression,so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection.Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed.According to the decompression range,the patients were divided into C2-C7 group and C1-C7 group.There were 25 cases in the C2-C7 group,19 males and 6 females,with an average age of 56.3 years (40-71 years),4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine.All of the 25 patients underwent open-door laminoplasty:20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure).There were 20 cases in C1-C7 group,12 males and 8 females,with an average age of 58A years (44-75 years).All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty,including anchoring procedure in 1 case,titanium miniplate procedure in 4 cases,and titanium cable procedure in 15 cases.Standardized vertebral-cord distance (SVCD) at each level from atlas to level C~ was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position pedormed 3-12 months postoperatively at each individual level.As the main outcomes,the SVCD values obtained at the same level of the two groups were compared between the two groups.Shapiro-Wilk normality test was performed on the SVCD values at C1.2 and C2 levels of two groups.The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups.Results The SVCD obtained at the level of the anterior arch of atlas (C1),the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm,8.35±1.27 mm,and 8.22 ±1.43 mm,respectively.The SVCD at the same levels was 11.02±1.60 mm,9.72±1.24 mm,and 9.12±1.11 mm,respectively.SVCDs differed significantly in the above range between the two groups.However,from level C2,3 to C6,7,there was no significant difference in SVCDs between the two groups.The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006,P<0.001) with a recovery rate of 57.0%±32.2%.The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177,P<0.001) with a recovery rate of 51.9%±32.1%.Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body,but it would not increase the decompression effect at level C2.3 or below.When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body,extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression.

8.
Asian Spine Journal ; : 290-295, 2019.
Article in English | WPRIM | ID: wpr-762923

ABSTRACT

STUDY DESIGN: Retrospective radiological study. PURPOSE: We aimed to determine the prevalence of ponticulus posticus (PP) and high-riding vertebral artery (HRVA) occurring simultaneously on the same side (PP+HRVA) and in cases of PP+HRVA, to assess C2 radio-anatomical measurements for C2 pars length, pedicle width, and laminar thickness. OVERVIEW OF LITERATURE: PP and HRVA predispose individuals to vertebral artery injuries during atlantoaxial fixation. In cases of PP+HRVA, the construct options thus become limited. METHODS: Consecutive computed tomography scans (n=210) were reviewed for PP and HRVA (defined as an internal height of <2 mm and an isthmus height of <5 mm). In scans with PP+HRVA, we measured the ipsilateral pedicle width, pars length, and laminar thickness and compared them with controls (those without PP or HRVA). RESULTS: PP was present in 14.76% and HRVA in 20% of scans. Of the 420 sides in 210 scans, PP+HRVA was present on 13 sides (seven right and six left). In scans with PP+HRVA, the C2 pars length was shorter compared with controls (13.69 mm in PP+HRVA vs. 20.65 mm in controls, p<0.001). The mean C2 pedicle width was 2.53 mm in scans with PP+HRVA vs. 5.83 mm in controls (p<0.001). The mean laminar thickness was 4.92 and 5.48 mm in scans with PP+HRVA and controls, respectively (p=0.209). CONCLUSIONS: The prevalence of PP+HRVA was approximately 3% in the present study. Our data suggest that, in such situations, C2 pedicle width and pars length create important safety limitations for a proposed screw, whereas the translaminar thickness appears safe for a proposed screw.


Subject(s)
Axis, Cervical Vertebra , Cervical Atlas , Prevalence , Retrospective Studies , Vertebral Artery
9.
Chinese Journal of Orthopaedics ; (12): 1053-1060, 2019.
Article in Chinese | WPRIM | ID: wpr-755252

ABSTRACT

Objective To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diag?nostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 develop?mental canal stenosis in craniovertebral junction (CVJ) anomalies. Methods From December 2010 to November 2018, 101 pa?tients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were en?rolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three sub?groups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial disloca?tion with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diam?eter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shap?iro?Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval ( CI) for the mean of the normal group. The C1 morphology of de?velopmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological clas?sification for C1 developmental canal stenosis in CVJ anomalies. Results The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95% CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter≤25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95% CI: 22.84-30.84), which differed signifi?cantly from that in the the normal group (t=10.504, P<0.01). A total of 33 cases meeting the criteria of C1 inner diameter≤25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST clas?sification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: lit?tle atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurv?ing type, 3.0% (1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch. Conclusion The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter≤25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmen?tal canal stenosis in CVJ anomalies can be classified according to the JST classification system.

10.
Chinese Journal of Orthopaedics ; (12): 927-934, 2018.
Article in Chinese | WPRIM | ID: wpr-708613

ABSTRACT

Objective To assess the effects of axial spinous process-muscle-vascellum complex transplantation for posterior atlantoarial fusion.Methods Data of 27 cases with altantoarial disease who were treated by posterior atlantoarial fusion using axial spinous process-muscle-vascellum complex transplantation from June 2015 to June 2016 were retrospectively analyzed.There were 19 males and 8 females aged from 9 to 68 years old (mean,41.0±15.4 years old).Two cases were diagnosed with atlanto-axial instability.Fourteen cases were diagnosed with atlas fracture and eleven cases were diagnosed atlanto-axial fracture.All the 27 patients suffered from neck pain or limitations of cervical motion.All patients were assessed clinically by atlantoaxial reduction and bone graft fusion.The pre-operative and post-operative atlanto-dens interval (ADI),visual analogue scale (VAS),Japanese Orthopaedic Association scores (JOA),improvement rate of JOA score and axial symptoms were measured and statistically analyzed.Complications were recorded.Clinical outcome of latest follow-up was evaluated by X-ray and CT scan.Results The time of operation was 2.0-2.5 h and blood loss was 150-300 ml.All the patients were followed-up for 9 to 18 months (mean,11.5±2.1 months).The VAS of neck pain improved from 3.6±2.7 (range,2.0-5.0) pre-operatively to 1.4±0.2 (range,0-2.0) 12 months postoperatively (P=0.000).The JOA score improved from 11.7± 1.9 (range,10.0-15.0) pre-operatively to 15.3±0.6 (range,14.0-17.0)12 months post-operatively (P=0.000).The improvement rate of JOA score at the latest follow-up was 54.1%± 12.4%,including 23 cases (85.19%) excellent,and 4 cases (14.81%) good.The results of axial symptoms were no-symptom in 22 cases (81.48%) and mild symptoms in 5 cases (18.52%).Postoperative cervical spine X-ray and CT showed that the sagittal cervical spine alignment was restored.There was statistically significant difference between ADI of 4.3±1.1 mm (range,3.9-4.5 mm) pre-operatively to 2.5± 0.4 mm (range,2.1-2.6 mm) 12 months post-operatively,which was improved significantly (P=0.000).There were no complications found during the follow-up.Conclusion The application of axial spinous process-muscle-vascellum complex transplantation for posterior atlantoaxial fixation can preserve the dynamic function of muscles and reduce the postoperative pain,as well as avoid donor site morbidity.

11.
J. health sci. (Londrina) ; 19(3)31/10/2017.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-876141

ABSTRACT

O ponticulus posticus (PP) é definido como uma pequena ponte óssea formada entre a porção posterior do processo articular superior e a porção posterolateral da margem superior do arco posterior da vértebra atlas. A fisiopatologia do PP pode ser relatada pela compressão vascular da artéria vertebral e nervo suboccipital, levando a isquemia circulatória e dor de cabeça cervicogênica, ou por disfunção mecânica da articulação atlanto-occiptal, resultando no tracionamento da dura máter ou iniciando um processo neurodinâmico. O objetivo deste estudo foi avaliar a associação entre PP e alterações morfológicas condilares, por meio das radiografias panorâmicas e teleradiografia lateral. Foram selecionados 1200 pacientes que realizaram documentação ortodôntica em uma clínica de radiologia. O PP foi avaliado e classificado em parcial ou completo. Os dados foram tabulados no SPSS e analisados por regressão logística multinomial. Houve diferença estatística significativa na prevalência do PP parcial entre homens e mulheres (P< 0,001), com odds ratio de 1,91 (95% IC 1,34-2,71), e na prevalência do PP complete (P = 0,002), com odds ratio de 1,72 (95% IC 1,21-2,43). Diferença estatística também foi encontrada na associação entre alteração morfológica condilar e PP complete (P = 0,004). Concluiu-se que o PP é mais prevalente em homens e que existe correlação entre a presença do PP completa e alterações morfológicas condilares. (AU).


The ponticulus posticus (PP) is defined as an abnormal small bony bridge formed between the posterior portion of the superior articular process and the posterolateral portion of the superior margin of the posterior arch of the atlas. The pathophysiology may be related to pressure applied on the vertebral artery and the suboccipital nerve root, and may be a possible cause of posterior circulation ischaemia and cervicogenic headache, or mechanical dysfunction at the atlanto-occipital joint resulting in traction of the dura mater or initiation of neurodynamic processes. The objective was to determine the prevalence of PP and to assess whether there is an association between this condition and changes in condylar morphology, evaluated using digital panoramic and lateral cephalometric radiographs. A sample of 1200 patients was selected. The patients were referred to a radiology clinic for orthodontic evaluation. PP was classified as either partial or complete PP. Data were entered into an SPSS spreadsheet and analysed by multinomial logistic regression. There was a significant difference in the prevalence of partial PP between males and females (P< 0.001), with an odds ratio of 1.91 (95% CI 1.34-2.71), and in the prevalence of complete PP (P = 0.002), with an odds ratio of 1.72 (95% CI 1.21-2.43). A significant difference was found for the association between condylar morphological changes and complete PP (P = 0.004). It was concluded that PP is more prevalent in men, and there is a correlation between the presence of complete PP and changes in condylar morphology. (AU).

12.
Chinese Journal of Orthopaedics ; (12): 1511-1520, 2017.
Article in Chinese | WPRIM | ID: wpr-708495

ABSTRACT

Objective To explore the accuracy and clinical efficacy of advanced 3D printing navigation templates in assisting placement of atlantoaxial pedicle screw.Methods A retrospective analysis was carried out on 49 cases of patients with atlanto-axial vertebral fractures and dislocations between June 2013 and June 2016,and all of them were given posterior incision,reduction and internal fixation of atlantoaxial pedicle screw.The patients were divided into advanced 3D printing navigation template group (14 cases),early 3D printing navigation template group (16 cases),and routine pedicle screw placement group (19 cases).Atlantoaxial CT data of patients in advanced 3D printing navigation template group and early 3D printing navigation template group were input into Mimics 17.0,then advanced 3D printing navigation template group and early 3D printing navigation which were used in clinic surgery were designed and printed.The relationship between positions of pedicle screw with the pedicle and bone cortex in plain CT image was observed after operation.The quality of the screw position was assessed and the accuracy of three kinds of screwing methods was compared.The accuracy of the screwing angle was assessed by comparing with the differences between the preoperative designed channel inclination angle and postoperative actual screwing angle.Three groups were compared for differences between operation time,intraoperative blood loss,and scores of cervical nerve scale and visual analogue scale (VAS) of neck and shoulder pain by Japanese Orthopaedic Association (JOA).Results All 49 cases of patients successfully completed the surgery.Patients of the routine pedicle screw placement group,early 3D group and advanced 3D group correspond operation time for 141.2±20.7 min,112.5±12.1 min and 103.1±10.4 min,intraoperative blood loss for 314.0±81.4 ml,243.6±71.2 ml and 181.0+59.1 ml;total accuracy of screwing for 75.0% (54/72),93.75 % (60/64) and 96.43 % (54/56).There were statistically significant differences among the routine group,3D group and advanced 3D group in the mentioned programs.There were no statistical differences between advanced 3D group and 3D group in the inclination angle and head tilt angle with the pre-designed values,while there was statistically significant difference between the routine group and the pre-designed value.The accuracy of the inclination angle and bead tilt angle screwing angle were obviously superior in the advanced 3D group and early 3D group to that of the routine group.There were statistically significant differences between preoperative with postoperative VAS scores and JOA scores in the same group,while there were no statistically significant differences among groups in JOA.But there was statistically significant difference between the routine group and the advanced 3D in VAS,and there was no statistically significant difference between the routine pedicle screw placement group and the early 3D in VAS.All three groups of patients had bony fusion of atlantoaxial vertebral body,without loosening,dislocation and fracture of the internal fixators.Conelusion Advanced 3D printing templates in assisting the surgical treatment for atlantoaxial fracture and dislocation can improve the accuracy of pedicle screwing and safety of the surgery,reduce the surgery risk,and obtain satisfied clinical curative effects.

13.
Chinese Journal of Orthopaedics ; (12): 1505-1510, 2017.
Article in Chinese | WPRIM | ID: wpr-708494

ABSTRACT

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.Methods From January 2011 to December 2015,15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated,including 6 males and 9 females,aged 35 to 75 years (mean 55 years).All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction,fixation and autogenous bone grafting under general anesthesia.Atlantodental interval (ADI) was measured and collected before and after surgery.Visual Analogue Scale/Score (VAS),American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect.1 week,3,6,12 months postoperatively and the annual review of the X-ray and CT were checked,in order to evaluate the reduction,internal fixation and bone graft fusion.Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery.The patients were followed up for 3 to 24 months (average,15 months).Atlantoaxial solid bony fusion was obtained from 3 to 6 months.ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm,VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0,ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery,JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery,and the statistical significance was revealed between preoperation and postoperation.Nine cases were in D grade of ASIA,3 cases improved from D to E grade after surgery,2 cases reached E grade in the other 6 cases after 6 months,2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery.Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre.Posterior screw-rod fixation and autogenous bone grafting can gain satisfying clinical efficacy.

14.
Coluna/Columna ; 15(4): 330-333, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-828622

ABSTRACT

ABSTRACT Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.


RESUMO O tratamento cirúrgico da patologia da charneira crânio-cervical tem evoluído consideravelmente nos últimos anos com a implementação de técnicas de fixação curta em detrimento de longas fixações occipito-cervicais (sub-axiais). Frequentemente é difícil e por vezes enganador determinar as variações ósseas e vasculares (artéria vertebral high-riding p.e.) apenas pelas imagens convencionais em três planos ortogonais (axial, sagital e coronal). Os autores descrevem um caso clínico raro de malformação congénita da charneira crânio-cervical constituída por hipoplasia/agenésia da odontoide e atlas bipartido, associado a instabilidade atlanto-axial e diagnosticado tardiamente em doente com antecedentes reumáticos prévios. Descreve-se o processo diagnóstico, incluindo novas técnicas de imagiologia e de reconstrução multiplanar tridimensional. Discute-se a técnica cirúrgica utilizada e possíveis alternativas.


RESUMEN El tratamiento quirúrgico de la patología de la región craneocervical ha evolucionado considerablemente en los últimos años con la aplicación de técnicas de fijación cortas en lugar de fijación occipito-cervical larga (sub-axial). A menudo es difícil y hasta engañoso determinar las características óseos y vasculares (arteria vertebral high-riding, por ejemplo) usando sólo imágenes convencionales en tres planos ortogonales (axial, sagital y coronal). Los autores describen un caso clínico poco frecuente de malformación congénita de la unión craneocervical que consiste en la hipoplasia/agenesia de la apófisis odontoides y atlas bipartito, asociado con la inestabilidad atlantoaxial, diagnosticado tardiamente en pacientes con enfermedades reumatológicas previas. Los autores relatan el proceso de diagnóstico, incluyendo nuevas técnicas de imagen y la reconstrucción multiplanar tridimensional. Los autores también discuten la técnica quirúrgica y las posibles alternativas.


Subject(s)
Humans , Congenital Abnormalities , Cervical Atlas , Cervical Vertebrae/abnormalities , Cervical Vertebrae/surgery , Occipital Bone , Odontoid Process
15.
Arch. méd. Camaguey ; 20(5): 536-545, sep.-oct. 2016.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-827811

ABSTRACT

Fundamento: las lesiones combinadas del atlas y el axis son los traumatismos más frecuentes de la columna cervical en el adulto mayor, con una incidencia que se acerca al 70 %. Su diagnóstico demanda de estudios imaginológicos de avanzada y las opciones de tratamiento van del conservador a complejas intervenciones para restablecer la estabilidad de la región occipitocervical. Objetivo: presentar una lesión combinada de la primera y segunda vértebra cervical con una forma poco frecuente de fractura de odontoides. Caso clínico: paciente de 79 años de edad, que después de la caída de un caballo, sufre trauma craneal variedad posterior, seguido de cervicobraquialgia bilateral con parestesias. El examen físico no demostró signos de compresión radicular ni cordonal. Las imágenes de tomografía axial computarizada con reconstrucciones tridimensionales evidenciaron una fractura bilateral y simétrica del arco posterior del atlas, asociado a una fractura longitudinal y oblicua del odontoides próxima a su istmo. No se observó luxación, por lo que se conservó la estabilidad del raquis cervical superior. Se trató de manera conservadora con una órtesis externa y tuvo una evolución favorable. Conclusiones: para el diagnóstico de las lesiones traumáticas atlantoaxiales es imprescindible el uso de la tomografía axial computarizada, asociada o no con la resonancia magnética nuclear. La estabilidad de esta región en correspondencia con el estado neurológico del paciente, son los factores más importantes para decidir la mejor opción de tratamiento.


Background: combined lesions of atlas and axis are the most common cervical spine traumas in elderly people, with an incidence of about 70 %. The diagnosis demands the use of advance radiologic procedures and the treatment options runs through conservative to complex surgical interventions to restore the stability of the occipito-cervical region. Objective: to present a combined lesion of the first and second cervical vertebra as a less frequent shape of odontoid fracture. Clinical case: a 79-year-old patient who suffered a posterior cranial trauma followed by bilateral cervicobrachialgia and paresthesias after a horse fall. At physical exploration no signs of radicular or cordonal compression were demonstrated. Computarized axial tomography with tridimentional reconstructions showed a bilateral and symmetrical fracture of the posterior arch of the atlas, associated with longitudinal and oblique fracture of odontoid next to the isthmus. No dislocation was observed that is why the upper cervical spine stability was preserved. Conservative treatment was achieved by an external orthesis with a favourable evolution. Conclusions: for atlantoaxial traumatic lesions diagnosis, the use of computerized axial tomography is important associated or not with nuclear magnetic resonance. The stability of this region in correspondence with neurological status are the most important factors to select the best treatment choice.

16.
Article in English | WPRIM | ID: wpr-629446

ABSTRACT

The commonly used examination procedures of the upper cervical spine depend upon the symmetry for comparison and interpretation of joint functions. If symmetry is not normal, then these assessments may mislead the examiners, allowing them implementation of incorrect treatment plans. Objectives of this study are to explore the possibility that asymmetry is more common than symmetry and, if it is true, to find out the effects of asymmetry on the biomechanics of these joints. The study was carried out on 30 atlas vertebrae of cadavers of Indian origin. The different intra-atlas distances were measured on both sides by digital vernier calliper. All the parameters studied showed statistically significant differences between the right and left side i.e. a p value of < 0.05. The anteroposterior diameter of the foramen transversarium, the transverse diameter of the foramen transversarium, the distance from the midline to medial edge of the vertebral artery groove (inner as well as outer cortex) and the length of the superior articular facets were more on the right side as compared to the left side. The breadth as well as the length of the inferior articular facet, the breadth of the superior articular facet and the difference of posterior arch thickness at the site of vertebral artery groove were more on the left side as compared to the right side. These differences may be explained by the handedness of an individual, which influences the intra-osteal asymmetry in a characteristically distinct manner, which needs to be confirmed or refuted in a further study.


Subject(s)
Cervical Atlas
17.
Chinese Journal of Orthopaedics ; (12): 598-604, 2016.
Article in Chinese | WPRIM | ID: wpr-488613

ABSTRACT

Objective To explore the surgical method and effects of posterior expansive open-door laminoplasty extended to C1,2 levels.Methods 16 cervical spinal stenosis patients with cervical myelopathy were posterior cervical surgery in our hospital from February 2013 to September 2015,including 11 males and 5 females;aged 51-76,average 62.8.4 cases merged C1spinal stenosis,the line which operated by C1~7 spinal posterior open-door expansion of the forming with mini titanium fixation;12 cases merged C2 spinal stenosis,which had the operation of C2~7 posterior open-door laminoplasty with Micro Titanium fixation plate.According to the patient imaging data to assess the stability of the cervical spine,and spinal cord compression fixation position before and after their surgery evaluated;the preoperative and postoperative pain using visual analog scale (VAS);application Japanese Orthopaedic Association (JOA) score spinal cord score was used to evaluated spinal cord function,and calculates the rate of improvement of neurological function;surgery patients before and after application Frankel grading was used to evaluate neurological function.Results All patients were followed up,for an average of 11.58 months (2-33 months).16 patients showed no loosening,fracture fixation and related complications,C1,2 showed no instability;cerebrospinal fluid surrounding the spinal cord with in the C1-7 range of the signal on MRI T2WI showed continuous recovery;preoperative VAS score was 6.7 points,postoperative VAS score was 1.8 points;the first 16 cases of patients with preoperative JOA score average (8.3± 1.6) points,postoperative JOA score was (14.6±1.4) points,postoperative neurological improvement rate was 91.6%;Frankel grade C before operation and grade E in postoperation;postoperative follow-up neurological improvement rate excellent 7 cases,good 7 cases,general 2 cases.Conclusion Treatment of cervical spinal stenosis combined with cervical myelopathy may use a C 1-7 posterior spinal expand within the single door molding fixation with mini titanium plate,which can release the compression of the cervical spinal cord nerve and reconstruct a stable structure of posterior of cervical spine.

18.
Int. j. morphol ; 33(3): 895-901, Sept. 2015. ilus
Article in English | LILACS | ID: lil-762561

ABSTRACT

The aims of this study were to determine the frequency of the Ponticulus posticus (PP) in the C1 vertebra and the Sella Turcica Bridge (STB) and Clinoid enlargement (CLEN) variants in two samples of Peruvian cleft lip and palate patients (CLP), determine if there are significant differences between sexes and compare the results with two samples of non-cleft controls. The digital images of the lateral cephalometric radiography of 163 and 150 CLP patients were utilized to determine the frequency of PP and, STB-CLEN respectively. The controls were composed of 1056 and 417 radiography of non-cleft patients. The chi-square statistic was utilized to determine if there were significant differences between genres for the CLP patients, and between the CLP and control samples. The confidence level was set at p<0.05. The frequency of PP (partial and complete) in CLP patients was 11.04% (18 cases) and 6.13% (10 cases) respectively; both of them were more frequent in males and there were no significant differences between sexes and between the CLP and control groups (p>0.05). The frequency of STB and CLEN in CLP patients was 6% (9 cases) and 8.7% (13 cases) respectively; both of them were more frequent in males and there were no significant differences between sexes and between the CLP and control samples for the STB (p>0.05). The frequency of CLEN was significantly lower (p<0.05) in the cleft group and in the female cleft group when compared to the control group. The frequencies of the Ponticulus Posticus, Sella Turcica Bridge and Clinoid Enlargement were similar to the control group and should not be considered as Cleft Lip and Palate associated anomalies; the frequency of the Clinoid Enlargement was significantly lower in cleft patients and this could be confirmed through studies centered on the Clinoid apophysis.


Los objetivos del estudio fueron determinar la frecuencia del Ponticulus Posticus (PP) y Puente selar - Alargamiento clinoideo (PS­AC) en dos muestras de pacientes Peruanos con fisura labiopalatina, junto con determinar si hay diferencias significativas entre sexos y comparar los resultados con dos muestras de controles sin fisura labiopalatina. Imágenes de radiografías cefalométricas laterales fueron utilizadas para determinar la frecuencia de PP (n= 163) y PS­AC (n=150). Los controles estuvieron conformados por 1056 y 417 radiografías de pacientes sin fisura labiopalatina. La prueba chi-cuadrado fue utilizada para determinar si existen diferencias significativas entre los sexos de los pacientes con fisura labiopalatina, y también entre las muestras de fisura labiopalatina y los controles. El nivel de confianza se determinó en p<0,05. En pacientes con fisura labiopalatina, la frecuencia de PP (parcial y completo) fue de 11,04% y 6,13% respectivamente; fue más frecuente en hombres y no se encontraron diferencias significativas entre sexos y entre la comparación entre muestras (p>0,05). La frecuencia de PS y AC fue de 6% y 8,7%, respectivamente; ambos fueron más frecuentes en hombres y no se encontraron diferencias significativas entre sexos; no se encontró diferencias significativas entre las muestras de fisura labiopalatina y los controles en el caso del PS. La frecuencia de AC fue significativamente menor en el grupo de fisura labiopalatina y en las mujeres con fisura labiopalatina respecto a la población sin fisura labiopalatina (p<0,05). Las frecuencias de PP y PS fueron similares a las del grupo control y no deberían ser consideradas como anomalías asociadas a la fisura labiopalatina; la frecuencia del AC fue significativamente menor en pacientes con fisura labiopalatina, y tampoco debería considerarse como una anomalía asociada; este hallazgo podría ser confirmado en futuros estudios centrados en las apófisis clinoides.


Subject(s)
Humans , Cleft Lip/pathology , Cleft Palate/pathology , Sella Turcica/pathology , Cephalometry , Cervical Atlas/pathology , Ossification, Heterotopic , Peru/epidemiology
19.
Article in Korean | WPRIM | ID: wpr-647827

ABSTRACT

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor.


Subject(s)
Cervical Atlas , Fractures, Stress , Motor Vehicles , Neurologic Manifestations , Spinal Cord Diseases , Spine
20.
Chinese Journal of Orthopaedics ; (12): 556-564, 2015.
Article in Chinese | WPRIM | ID: wpr-669913

ABSTRACT

Objective To investigate the selection of surgery and clinical outcomes of upper cervical injuries.Methods 25 upper cervical injury patients were involved in this retrospective study from November 2011 to June 2014.Including 20 males and 5 females with mean age of 37.1 years old (range,14-55 years old).Individual operation methods were based on the comprehensive evaluation of specific situations including the clinical manifestation,the type of the injuries and the imaging data.HaloVest distraction was applicated before operation.The surgery by anterior approach were performed for 7 patients and posterior approach were performed for 18 patients.Preoperative and postoperative American Spinal Injury Association (ASIA) grade and Functional Independence Measurement (FIM) score were studied to evaluate the nerve functional restoration.Imaging data before and after the operation were contrasted to evaluate the reduction of the fracture,the bone union,the fusion of the bone graft and the condition of the internal fixation.Wilcoxon Singed Rank Test was applied to compare the FIM score between pre-operation and last follow-up.Results 15 patients presented neurological function deficit because of cervical spinal cord compromise.All cases were followed up for 6-35 months (mean 18.2 months),showing good clinical and radiological effects.Solid fusion was obtained in all patients among 3-12 months.The ASIA grade improved by an average of 1.1 (6 months after operation) and 1.2 (12 months after operation).There was significant difference in FIM score between pre-operation and last follow-up.One patient got cerebrospinal fluid leakage.Conservative treatment was implemented with the Trendelenburg position,rehydration fluids and so on.Removal of drainage tube 8 days later when the drainage was less than 30 ml/24 h.No incision infection,cerebrospinal fluid leakage,migration or breakage of internal fixation was observed at the last follow-up.Conclusion The type of upper cervical injuries are complicated,the characteristics of fracture,dislocation and nerve injury in different patients are different.The specific situation should be evaluated comprehensively to make individual operation methods.The success of the operation requires the proficiency of the anatomic basis,the biomechanical characteristics,precise entrance point and direction in operation,appropriate diameter of the screw and suitable depth of the screw road.

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