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1.
Coluna/Columna ; 20(2): 144-148, Apr.-June 2021. graf
Article in English | LILACS | ID: biblio-1249661

ABSTRACT

ABSTRACT Objective: The treatment of C1-C2 rotatory dislocation remains controversial and surgery is rare. Surgical treatment is indicated when the injury satisfies the instability criteria or when it cannot be reduced. The objective of this study is to analyze the principles and the adaptations necessary for treating these injuries in the pediatric population. Methods: A retrospective case series study. Three cases of patients diagnosed with traumatic C1-C2 rotatory dislocation and treated surgically in our hospital were studied. Through critical analysis of the available literature, a practical guide was proposed to establish the principles and competencies for the treatment of these injuries. Results: The operated cases were female patients between 8 and 16 years of age, with a diagnosis of traumatic atlantoaxial dislocation. Two patients required preoperative skeletal traction with halo. All patients underwent posterior instrumented arthrodesis, two with a transarticular screw technique and one with mass and C2 isthmic (Göel-Harms) screws. Conclusion:. It is essential to determine if the injury is stable and reducible. We recommend treating this type of injury keeping the criteria and competencies related to the stability, alignment, biology and function of the spine in mind. Level of evidence IV; Case series.


RESUMO Objetivo: O tratamento da luxação rotacional de C1-C2 permanece controverso, e a cirurgia é rara. O tratamento cirúrgico é indicado quando a lesão satisfaz os critérios de instabilidade ou quando não pode ser reduzida. O objetivo deste estudo é analisar os princípios e a adequação necessários para tratar essas lesões na população pediátrica. Métodos: Estudo retrospectivo de série de casos. Foram estudados três casos em pacientes tratados cirurgicamente em nosso hospital com diagnóstico de luxação rotacional traumática de C1-C2. Por meio de análise crítica da literatura disponível, foi proposto um guia prático para estabelecer os princípios e a adequação do tratamento dessas lesões. Resultados: Os casos submetidos à cirurgia foram pacientes do sexo feminino, entre 8 e 16 anos de idade, com diagnóstico de luxação atlantoaxial traumática. Duas pacientes precisaram de tração esquelética pré-operatória com halo. Todas as pacientes foram submetidas à artrodese instrumentada por via posterior, duas com técnica de parafuso transarticular e uma com parafusos de massa e pedículo e lâmina em C2 (técnica de Göel-Harms). Conclusões: É essencial determinar se a lesão é estável e se pode ser reduzida. Recomenda-se tratar esse tipo de lesão tendo em mente os critérios e a adequação relacionados com estabilidade, alinhamento, biologia e função da coluna vertebral. Nível de evidência IV; Série de casos.


RESUMEN Objetivo: El tratamiento de la luxación rotatoria de C1-C2 permanece controversial y la cirugía es rara. Se indica tratamiento quirúrgico cuándo la lesión cumple criterios de inestabilidad o cuándo es considerada irreductible. El objetivo de este estudio es revisar los principios y competencias necesarios para tratar esas lesiones en la población pediátrica. Métodos: Estudio retrospectivo de serie de casos. Se estudian tres casos en pacientes tratados quirúrgicamente en nuestro hospital con diagnóstico de luxación rotatoria de C1-C2 traumática. A través del análisis crítico de la literatura disponible se elabora un esquema práctico para establecer los principios y competencias para el abordaje de estas lesiones. Resultados: Los casos intervenidos fueron pacientes de sexo femenino entre 8 y 16 años, con diagnóstico de luxación atlantoaxoidea traumática. Dos pacientes requirieron tracción esquelética preoperatoria con halo. A todas las pacientes se les practicó artrodesis instrumentada por vía posterior, dos con técnica de tornillos transarticulares y una con tornillos de masa e ístmicos de C2 (Göel-Harms). Conclusiones: Resulta imprescindible determinar si la lesión es estable y reductible. Siempre abordar este tipo de lesiones teniendo presentes los criterios y competencias relacionados con la estabilidad, alineación, biología y función de la columna vertebral. Nivel de Evidencia IV; Serie de casos.


Subject(s)
Humans , Joint Dislocations , Cervical Atlas , Axis, Cervical Vertebra , Torticollis
2.
Rev. Cient. CRO-RJ (Online) ; 6(1): 26-33, abr. 2021.
Article in English | LILACS, BBO | ID: biblio-1354405

ABSTRACT

Objective: This study aimed to compare through cone-beam computed tomography (CBCT) the morphology of the cervical vertebrae atlas (C1) and axis (C2) in mouth breathers (MB) and nose breathers (NB), correlating them with the head and neck postures of the two groups. Materials and Methods: CBCT images of 36 subjects aged 11 to 22 years were evaluated using the InVivo Dental 5.1 (Anatomage, San Jose, California) software. The following measurements were used to assess C1 and C2 morphology: posterior height, anterior height, length, and volume. The craniocervical angle (NSL/OPT) was used to evaluate head posture concerning the neck. Results: The posterior height, length, and volume of C1 and C2 were lower in the MB group, but only the posterior size was significantly shorter than the NB group (C1, p=0.01 / C2, =0.05). Mouth breathers also showed a considerably higher craniocervical angle (p=0.04). Spearman test showed a significant positive correlation between C1 and C2 length and craniocervical angle (C1, =0.629, p=0.005 / C2, =0.665, p=0.003). Conclusion: The mouth breathers showed an increased craniocervical angle and decreased posterior height of the C1 vertebra concerning nasal breathers. The hyperextension of the head present is positively correlated with the length of the vertebra.


Objetivo: Este estudo teve como objetivo comparar por meio da tomografia computadorizada de feixe cônico (TCFC) a morfologia do atlas das vértebras cervicais (C1) e do eixo (C2) em respiradores orais (MB) e nasais (RN), correlacionando-os com a cabeça e posturas do pescoço dos dois grupos. Materiais e Métodos: Imagens de CBCT de 36 indivíduos com idades entre 11 e 22 anos foram avaliadas usando o software InVivo Dental 5.1 (Anatomage, San Jose, Califórnia). As seguintes medidas foram usadas para avaliar a morfologia de C1 e C2: altura posterior, altura anterior, comprimento e volume. O ângulo craniocervical (NSL/OPT) foi utilizado para avaliar a postura da cabeça em relação ao pescoço. Resultados: A altura posterior, comprimento e volume de C1 e C2 foram menores no grupo MB, mas apenas o tamanho posterior foi significativamente menor que o grupo RN (C1, p=0,01 / C2, =0,05). Os respiradores orais também apresentaram um ângulo craniocervical consideravelmente maior (p=0,04). O teste de Spearman mostrou correlação positiva significativa entre comprimento de C1 e C2 e ângulo craniocervical (C1, =0,629, p=0,005 / C2, =0,665, p=0,003). Conclusão: Os respiradores orais apresentaram aumento do ângulo craniocervical e diminuição da altura posterior da vértebra C1 em relação aos respiradores nasais. A hiperextensão da cabeça presente está positivamente correlacionada com o comprimento da vértebra.


Subject(s)
Dentistry , Cervical Atlas , Axis, Cervical Vertebra , Cone-Beam Computed Tomography , Mouth Breathing
3.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142107

ABSTRACT

La tendinitis calcificante del músculo largo del cuello es una patología subdiagnsoticada, de baja frecuencia, autolimitada. Se presenta clínicamente como una de las causas de odinofagia en la consulta médica. Se produce debido al depósito de cristales de hidroxiapatita en espacio retrofaríngeo, desencadenándose una respuesta inflamatoria local. En la TMLC el principal diagnóstico diferencial es el absceso retrofaríngeo, ya que puede presentarse clínicamente con odinofagia, disfagia , disminución de la movilidad del cuello y cervicalgia. En nuestro trabajo se analiza un caso clínico sobre dicha patología, en un hombre de 45 años; realizando un análisis de la sintomatología, diagnóstico y tratamiento de esta entidad.


Calcific tendinitis of the long neck muscle is an underdiagnosed, low frequency, self-limited pathology. It is clinically presented as one of the causes of odynophagia in the medical consultation. It occurs due to the deposit of hydroxyapatite crystals in the retropharyngeal space, triggering a local inflammatory response. On This patholgy, the main differential diagnosis is retropharyngeal abscess, since it can present clinically with odynophagia, dysphagia, decreased mobility of the neck, and neck pain. In our work, a clinical case of this pathology is analyzed, in a 45-year-old man; performing an analysis of the symptoms, diagnosis and treatment of this entity.


A tendinite calcificante do músculo longo do pescoço é uma patologia subdiagnsoticada, de baixa frequência, autolimitada. Apresenta-se clinicamente como uma das causas de odinofagia na consulta médica. Ocorre devido ao depósito de cristais de hidroxiapatita em espaço retrofaríngeo, desencadeando-se uma resposta inflamatória local. Na TMLC o principal diagnóstico diferencial é o abscesso retrofaríngeo, já que pode apresentar-se clinicamente com odinofagia, disfagia , diminuição da mobilidade do pescoço e cervicalgia. Em nosso trabalho analisa-se um caso clínico sobre essa patologia, em um homem de 45 anos; realizando uma análise da sintomatologia, diagnóstico e tratamento desta entidade.


Subject(s)
Humans , Male , Middle Aged , Cervical Atlas/pathology , Axis, Cervical Vertebra/pathology , Calcinosis/diagnostic imaging , Tendinopathy/drug therapy , Tendinopathy/diagnostic imaging , Neck Muscles/pathology , Deglutition Disorders/etiology , Neck Pain/etiology , Diagnosis, Differential , Analgesics/therapeutic use
4.
Ortodoncia ; 84(168-169): 70-73, jul. 2020 -jun.2021. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1292503

ABSTRACT

A partir de una radiografía lateral de cráneo y una radiografía transoral se puede, mediante la realización del cefalograma de Rocabado y la evaluación atlantoaxoidea, respectivamente, evaluar posturalmente a nuestros pacientes. La cefalometría de Rocabado analiza: el ángulo craneovertebral, los espacios funcionales suboccipitales, la posición del hueso hioides y la lordosis cervical. Por medio de la radiografía transoral puede evaluarse la posición de las dos primeras vértebras cervicales. Esta mirada integral de nuestros pacientes nos permitirá arribar a un diagnóstico más certero y a un plan de tratamiento que tenga en cuenta su salud articular y oclusal y el equilibrio craneovertebral, necesarios para obtener resultados beneficiosos y estables en el tiempo(AU)


Based on a lateral skull x-ray and a transoral x-ray, it is possible, by performing Rocabado's cephalogram and the atlantoaxial evaluation respectively, to evaluate our patients posturally. Rocabado's cephalometry analyses: the craniovertebral angle, the suboccipital functional spaces, the position of hyoid bone and the cervical lordosis. By the transoral radiography, the position of the first two cervical vertebrae can be evaluated. This comprehensive view of our patients will allow us to arrive at a more accurate diagnosis and a treatment plan that takes account of their joint and occlusal health and the craniovertebral balance necessary for getting beneficial and stable results over time(AU)


Subject(s)
Posture , Cervical Atlas , Skull , Spine , Cephalometry , Hyoid Bone
5.
Rev. medica electron ; 42(2): 1735-1742, mar.-abr. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1127031

ABSTRACT

Resumen Las fracturas del Atlas representan el segundo tipo más común de lesiones de la columna cervical alta. Con este trabajo se persigue describir la fijación occipito-cervical como tratamiento de la fractura de atlas tipo Jefferson inestable. Se presenta paciente que sufre trauma raquimedular, después de aplicarle un minucioso examen físico y la tomografía axial computada de columna cervical se detecta una fractura tipo Jefferson de atlas con más de 7 mm de separación de sus fragmentos. Al ser esta una fractura inestable de la región cervical alta se decide realizar una fijación occipito-cervical como método de tratamiento de esta lesión. La evolución postquirúrgica del paciente transcurrió sin complicaciones (AU).


Summary Atlas fractures represent the second most common type of upper cervical spine injury. This work aims to describe the occipito-cervical fixation as a treatment for the unstable Jefferson-type atlas fracture. A patient suffering from spinal cord trauma is presented, after applying a thorough physical examination and the computed tomography of the cervical spine, a Jefferson type fracture of atlas with more than 7 mm of separation of its fragments is detected. As this is an unstable fracture of the upper cervical region, it was decided to perform an occipito-cervical fixation as a treatment method for this lesion. The postoperative evolution of the patient was uneventful (AU).


Subject(s)
Humans , Male , Adult , Cervical Atlas/injuries , Therapeutics/methods , Orthopedic Fixation Devices , Tomography/methods , Methods , Fractures, Bone/diagnosis , Fractures, Bone/therapy
6.
Int. j. morphol ; 38(2): 477-480, abr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056465

ABSTRACT

This study aimed to examine the differences in bone microarchitecture between different regions of the atlas in 28 dry atlas specimens using micro-CT, in order to explain the mechanism of the predilection sites of atlas fractures from the morphological point of view. A total of 28 dry specimens of intact adult atlas were randomly selected, scanned by micro-CT, and divided into a region from the anterior arch midpoint (AAM) to the lateral masses (LM), a LM region, and a region from the LM to the posterior arch midpoint (PAM). Trabecular thickness, separation, number, connectivity, and structure model index were measured for each of the three regions using the built-in software of the CT scanner. Trabecular thickness was all measured to be 0.11 ± 0.00 mm for AAM to LM, LM, and LM to PAM. Trabecular separation: AAM to LM > LM to PAM > LM. Trabecular number: LM > LM to PAM > AAM to LM. Connectivity: LM > LM to PAM > AAM to LM. Structure model index: LM > LM to PAM > AAM to LM. A lower trabecular number and connectivity and higher trabecular separation were seen in the anterior and posterior arches of the atlas, in which higher fracture rates were reported. By contrast, a higher trabecular number and connectivity and lower trabecular separation were seen in the lateral masses, in which lower fracture rates were reported.


Este estudio tuvo como objetivo examinar las diferencias en la microarquitectura ósea entre diferentes regiones del atlas en 28 muestras de atlas secas utilizando micro-CT, con el fin de informar el área de mayor frecuencia en las fracturas de atlas, desde el punto de vista morfológico. Se seleccionaron al azar un total de 28 muestras secas de atlas adultos intactas las que se escanearon por micro-CT y se dividieron en una región desde el punto medio del arco anterior (MAA) hasta las masas laterales (ML), una región ML y una región desde el ML hasta el punto medio del arco posterior (MAP). Se midió el grosor trabecular, la separación, el número, la conectividad y el índice del modelo de estructura para cada una de las tres regiones utilizando el software incorporado del escáner CT. El grosor trabecular se midió en 0,11 ± 0,00 mm para MAA a ML, ML y ML a MAP. Separación trabecular: MAA a ML> ML a MAP> ML. Número trabecular: ML> ML a MAP> MAA a ML. Conectividad: ML> ML a MAP> MAA a ML. Índice del modelo de estructura: ML> ML a MAP> MAA a ML. Se observó un menor número de estructuras trabeculares y conectividad y una mayor separación trabecular en los arcos anterior y posterior del atlas, en los que se informaron tasas de fracturas más altas. Por el contrario, se observó un mayor número de estructuras trabeculares y conectividad, y una menor separación trabecular en las masas laterales, en las que se observó un número menor de fracturas.


Subject(s)
Humans , Cervical Atlas/diagnostic imaging , X-Ray Microtomography/methods , Cervical Atlas/anatomy & histology
7.
Int. j. morphol ; 37(2): 412-415, June 2019. graf
Article in Spanish | LILACS | ID: biblio-1002236

ABSTRACT

La primera vértebra cervical establece una articulación sinovial con los cóndilos del occipital, sin que haya de por medio disco fibrocartilaginoso. Esta articulación es importante para la anatomía funcional del cuello porque, además de soportar el peso de la cabeza en los humanos, permite movimientos de flexión, extensión e inclinación lateral. La primera vértebra es conocida en la Terminologia Anatomica y en la Nomina Anatomica Veterinaria con el nombre de Atlas [C1]. El nombre de Atlas, asignado a la primera vértebra cervical, fue tomado de uno de los titanes de la mitología griega condenado por el dios Zeus a soportar el cielo con sus manos, cabeza y hombros, y que en términos figurativos es la que sostiene el mundo craneal. Sorprende que en el libro oficial de la Terminologia Anatomica y en el de la Nomina Anatomica Veterinaria se mantenga este epónimo por una simple tradición, constituyéndose en una vergonzosa contradicción que debe ser corregida y eliminada.


The first cervical vertebra establishes a synovial joint with the occipital condyles, without having a fibrocartilaginous disc. This joint articulation is important for the functional anatomy of the neck, because in addition to supporting the weight of the head in humans, it allows movements of flexion, extension and lateral inclination. The first cervical vertebra is known in the Terminologia Anatomica and the Nomina Anatomica Veterinaria with the name of Atlas [C1]. The name Atlas, assigned to the first cervical vertebra, was taken from one of the titans of Greek mythology condemned by the god Zeus to support the world with the hands, head, and shoulders, so in figurative terms said vertebra is the one that sustains the cranial world. It is surprising that in the official book of the Terminolgia Anatomica and in the Nomina Anatomica Veterinaria this eponymous is maintained by a simple tradition, constituting a shameful contradiction that must be corrected and eliminated.


Subject(s)
Humans , Animals , Cervical Vertebrae/anatomy & histology , Eponyms , Terminology as Topic , Cervical Atlas/anatomy & histology
9.
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
10.
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
11.
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
12.
Int. j. morphol ; 37(1): 98-103, 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-990012

ABSTRACT

RESUMEN: Evaluar de manera integral los parámetros morfométricos de la vértebra atlas (C1) en la población mexicana de relevancia en la realización de procedimientos quirúrgicos de la unión craneocervical con el fin de proveer datos cuantitativos indispensables para su realización. Para este estudio se utilizaron un total de 576 vértebras C1 secas de población mexicana contemporánea. Se realizaron 11 mediciones respecto a la morfología de C1. Las mediciones se efectuaron bilateralmente utilizando un vernier digital milimétrico con una precisión de 0,01 milímetros y se aplicó un análisis estadístico. Un total de 576 vértebras atlas (C1), fueron medidas de manera bilateral, todas nuestras mediciones se reportaron en milímetros. El promedio del ancho de las masas lateral fue de 14,87 mm ± 1,38 mm. El promedio de la altura de las masas laterales fue de 4,05 mm ± 0,93 mm. El promedio del ancho del foramen transverso fue de 5,93 mm ± 0,98 mm. El promedio del largo del foramen transverso fue de 6,96 mm ± 0,98 mm. El promedio de la altura del foramen transverso fue de 5,76 mm ± 1,31 mm. El promedio del ancho del surco de la arteria vertebral fue de 18,87 mm ± 1,3 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 12,47 mm ± 3,14 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 18,75 mm ± 3,94 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 19,7 mm ± 2,52 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 29,52 mm ± 3,23. Nuestro estudio demuestra que las mediciones realizadas en nuestra población presentan diferencias significativas respecto a lo reportado actualmente en la literatura. Es necesario contar con un conocimiento de la morfología vertebral en nuestra población para disminuir la ventana de error al realizar procedimientos quirúrgicos que involucren este segmento.


SUMMARY: To evaluate in an integral way the morphometric parameters of the atlas (C1) vertebra in the Mexican population of relevance in performing surgical procedures of the craniocervical junction in order to provide quantitative and essential data for its realization. For this study, a total of 576 dry C1 vertebrae of contemporary Mexican population were used. Eleven measurements were carried out regarding the morphology of C1. The measurements were made bilaterally using a millimeter digital vernier with an accuracy of 0.01 millimeters and a statistical analysis was applied. A total of 576 atlas vertebrae (C1) were measured bilaterally, all our measurements were reported in millimeters. The average width of the lateral masses was 14.87 mm ± 1.38 mm. The average height of the lateral masses was 4.05 mm ± 0.93 mm. The average width of the transverse foramen was 5.93 mm ± 0.98 mm. The average length of the transverse foramen was 6.96 mm ± 0.98 mm. The average height of the transverse foramen was 5.76 mm ± 1.31 mm. The average width of the groove of the vertebral artery was 18.87 mm ± 1.3 mm. The average distance between the midline and the medial edge of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 12.47 mm ± 3.14 mm. The average distance between the midline and the medial border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its upper face was 18.75 mm ± 3.94 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 19.7 mm ± 2.52 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its superior surface was 29.52 mm ± 3.23. Our study shows that the measurements made in our population present differences with respect to what is currently reported in the literature. It is necessary to have knowledge of vertebral morphology in our population to reduce the error window when performing surgical procedures involving this segment.


Subject(s)
Humans , Cervical Atlas/anatomy & histology , Cross-Sectional Studies , Vertebral Body/anatomy & histology
13.
Int. j. morphol ; 35(1): 337-344, Mar. 2017. ilus
Article in English | LILACS | ID: biblio-840975

ABSTRACT

The ponticulus posticus (PP) is a bridge of bone sometimes found on the atlas vertebra surrounding the vertebral artery and the first cervical nerve root. Sella turcica bridging (STB) is the fusion of anterior and posterior clinoid processes. The objective of this study was to find out the association between STB and PP. For the study, 752 digital lateral cephalograms were retrieved from the archived records of Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. There was a significant relationship between the presence of STB and PP (p=0.000, p<0.001). This study indicates that there is a significant correlation between the presence of STB and PP.


El Ponticulus Posticus (PP) es un puente de hueso que se encuentra, a veces, en el atlas y rodea la arteria vertebral y la primera raíz del nervio cervical. El puente de la silla turca (PST) es la fusión de los procesos clinoides anteriores y posteriores. El objetivo de este estudio fue conocer la asociación entre PST y PP. Para el estudio, fueron utilizados 752 cefalogramas digitales laterales, obtenidos de los registros archivados de la Facultad de Odontología de la Universidad Necmettin Erbakan, Konya, Turquía. Hubo una relación significativa entre la presencia de PST y PP (p = 0,000, p <0,001). Este estudio indica que existe una correlación significativa entre la presencia de PST y PP.


Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Cervical Atlas/anatomy & histology , Cervical Atlas/diagnostic imaging , Sella Turcica/anatomy & histology , Sella Turcica/diagnostic imaging , Cephalometry , Sex Factors
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.
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
16.
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
17.
Chinese Journal of Surgery ; (12): 211-214, 2015.
Article in Chinese | WPRIM | ID: wpr-308567

ABSTRACT

<p><b>OBJECTIVE</b>To study the biomechanical change of the craniovertebral junction in conditions of atlas assimilation.</p><p><b>METHODS</b>Mimics software was used to process CT data of the craniovertebral junction in a health adult to obtain the three-dimensional reconstruction and the cloudy points of C1, C2 and part of the occipital bone. Then the cloudy points were imported into the Abaqus 6. 8 software to establish the occipito-atlantoaxial finite element model in normal structure. According to the established model in normal structure, the model in conditions of atlas assimilation was set by changing the model parameters. Both models of normal structure and atlas assimilation were loaded with 1. 5 N . m static moment to simulate four motions of flexion, extension, lateral bending and axial rotation respectively. The movement characteristics,joint stress force and ligament deformation was analyzed.</p><p><b>RESULTS</b>Under 1. 5 N . m moment, in model of atlas assimilation the C1-C2 range of movement decreased from 13. 55° to 11.88° in flexion,increased from 13. 22° to 15. 24° in extension and from 4. 05° to 4. 23° in lateral bending and remained unchanged in axial rotation when compared with the normal model. In flexion movement, the contact force of the atlanto-dental joint increased from 1. 59 MPa to 3. 28 MPa and the deflection of apical ligament, tectorial membrane and alar ligament increased 129. 1%, 157. 6% and 75. 1% respectively when compared with the normal model.</p><p><b>CONCLUSIONS</b>The normal C1-C2 motion mode is destructed in conditions of atlas assimilation, leading to the changes of the range of movement,joint stress force and the ligament deformation at C1 C2 junction. The atlantoaxial instability will likely occur in flexion motion.</p>


Subject(s)
Atlanto-Axial Joint , Physiology , Biomechanical Phenomena , Cervical Atlas , Physiology , Cervical Vertebrae , Finite Element Analysis , Humans , Imaging, Three-Dimensional , Joint Instability , Ligaments, Articular , Occipital Bone , Range of Motion, Articular , Rotation
18.
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
19.
Int. j. morphol ; 32(1): 54-60, Mar. 2014. ilus, tab
Article in English | LILACS | ID: lil-708723

ABSTRACT

The Ponticulus posticus is an anomalous ossification of unknown origin that arches backward from the superior articular process to the posterior arch of the Atlas vertebra, it can be complete or partial and houses vascular and nervous elements; it is diagnosed by lateral cervical radiography, cephalometric radiography or CT scans. The purpose for the present study was to determine the frequency of partial and complete Ponticulus posticus in lateral cephalometric radiography of Peruvian patients and identify any possible genre or age group associations. The study consisted in reviewing 1056 lateral cephalometric radiography of patients between 3­56 years old in search of partial or complete Ponticulus posticus. The mean age of subjects studied was 14.05±7.43 years old. The Ponticulus posticus frequency was 19.79%, the partial Ponticulus posticus frequency was 11.08% and the complete Ponticulus posticus frequency was 8.71%; Cramer´s V and ETA statistics found not significant association between the PP and the genre or the age groups (p>0.05). The Ponticulus posticus is not an infrequent radiographic finding, our results are similar to those reported in the Americas and similar to different for other ethnic groups, we confirm that the Ponticulus posticus is not associated with genre or age and we reviewed the importance of the Ponticulus posticus in the prognosis of the Atlas-Axis surgical stabilization.


El ponticulus posticus es una osificación anómala de origen desconocido en forma de arco que va desde el proceso articular hacia el arco posterior del atlas; puede ser completo o parcial y aloja elementos vasculares y nerviosos; su diagnóstico se realiza mediante la radiografía lateral cervical, radiografía cefalométrica o tomografía computarizada. El propósito del estudio fue determinar la frecuencia del ponticulus posticus parcial y completo en radiografías cefalométricas de pacientes peruanos y determinar las diferencias de acuerdo al sexo y edad. Se revisaron 1056 radiografías cefalométricas de pacientes entre los 3 a 56 años de edad en busca de ponticulus posticus parcial o completo. La edad promedio fue de 14,05±7,43 años. La frecuencia de ponticulus posticus en general fue 19,79%, con el tipo parcial en un 11,08% y de tipo completo en un 8,71%. Se observó una mayor frecuencia en los hombres (10,22%) que en mujeres (9,56%). No se encontraron diferencias significativas entre la presencia de ponticulus posticus parcial o completo con respecto al sexo y a la edad (p>0,05). El ponticulus posticus no es un hallazgo infrecuente, nuestros resultados fueron similares a los reportados para pacientes americanos y similares a distintos para otros grupos étnicos, se confirmo mediante estadística que el ponticulus posticus no se encuentra asociado a la edad y se discute la importancia de la presencia del ponticulus posticus en el pronóstico de la estabilización del complejo vertebral atlas-axis.


Subject(s)
Humans , Male , Adolescent , Adult , Cervical Vertebrae , Cervical Vertebrae/abnormalities , Peru , Cervical Atlas , Cervical Atlas/abnormalities , Sex Factors , Cephalometry , Cephalometry/methods , Age Factors , Ossification, Heterotopic
20.
Pesqui. vet. bras ; 34(1): 91-97, jan. 2014. ilus
Article in English | LILACS | ID: lil-707118

ABSTRACT

This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.


Este estudo caracterizou a anatomia musculoesquelética normal do segmento cervical da coluna vertebral de cães por meio da ultrassonografia modo B. O objetivo do trabalho foi estabelecer o papel da ultrassonografia modo B na avaliação anatômica do segmento cervical de cães, comparando os achados ultrassonográficos com imagens por tomografia computadorizada e ressonância magnética. O exame ultrassonográfico, em cortes transversais e sagitais mediano, permitiu a identificação de parte da musculatura epaxial do pescoço, superfície óssea das vértebras cervicais e medula espinhal em áreas restritas com janelas acústicas naturais, como entre a articulação atlantoccipital, áxis e atlas, e áxis e terceira vértebra cervical. As imagens, em planos transversais e sagitais, por ressonância magnética de baixo campo foram superiores na identificação anatômica das estruturas, devido ao maior contraste entre os diferentes tecidos nessa modalidade. A tomografia computadorizada se mostrou superior no detalhamento ósseo da região quando comparada ao exame ultrassonográfico. Já a ressonância magnética, além dos músculos e vértebras cervicais, permitiu a identificação do líquido cefalorraquidiano, e diferenciar núcleo pulposo e anel fibroso dos discos intervertebrais. Embora não seja objetivo direto deste estudo, com o conhecimento da anatomia ultrassonográfica dessa região, acredita-se que algumas lesões possam ser identificadas, contudo de maneira restrita, quando comparadas as informações obtidas, principalmente na imagem por ressonância magnética. O exame ultrassonográfico apresentou valor morfológico inferior.


Subject(s)
Animals , Dogs , Cervical Atlas/anatomy & histology , Dogs/anatomy & histology , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed/veterinary , Ultrasonography , Spine , Musculoskeletal Physiological Phenomena
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