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1.
Ochsner J ; 15(1): 92-6, 2015.
Article in English | MEDLINE | ID: mdl-25829888

ABSTRACT

BACKGROUND: Traumatic carotid-cavernous fistulas (CCFs) present the clinician with diagnostic and surgical challenges. Extension of a CCF into the sphenoid sinus presents additional management difficulties. Endovascular interventions using various thrombogenic materials such as balloons, coils, or liquids are effective treatment strategies. Ideally, these techniques are used to obliterate the fistula while maintaining the patency of the parent artery. CASE REPORT: We present a rare case of traumatic carotid-cavernous sphenoid sinus fistulas complicated by multiple tears in the internal carotid artery with direct communication to the cavernous and sphenoid sinus. As a result, the patient developed massive epistaxis requiring emergent endovascular intervention. A total of 87 detachable coils were placed into the cavernous and sphenoid sinuses via transarterial and transvenous routes in a staged procedure, resulting in complete obliteration of the patient's multiple fistulas. CONCLUSION: To our knowledge, this is the first reported case of multiple fistulous tears in the internal carotid artery with extension to the cavernous and sphenoid sinus. This report emphasizes the importance of early diagnosis and neurosurgical intervention.

2.
Surv Ophthalmol ; 55(1): 2-34, 2010.
Article in English | MEDLINE | ID: mdl-19833366

ABSTRACT

Ocular ischemic syndrome encompasses a spectrum of clinical findings that result from chronic ocular hypoperfusion. It is relatively uncommon, and the diagnosis may be difficult to make because of its variable presentations. The presence of an ocular ischemic syndrome always implies underlying severe carotid occlusive disease and may be its sole clinical manifestation. It may also result from other causes of reduced blood flow to the eye and the orbit such as systemic vasculitis. Besides visual loss and ocular/orbital pain, affected patients are also at risk for developing cerebral and myocardial infarction. Establishing the diagnosis is therefore essential with respect not only to visual prognosis but also to patient survival. Ophthalmologists have an important role in early diagnosis and in coordinating the systemic evaluation of patients. Referral to the neuroradiologist and the neurovascular specialist is warranted. We present the current knowledge on the ocular ischemic syndrome.


Subject(s)
Carotid Stenosis/complications , Eye/blood supply , Ischemia/etiology , Ophthalmic Artery/physiopathology , Carotid Stenosis/diagnosis , Carotid Stenosis/therapy , Diagnosis, Differential , Diagnostic Techniques, Ophthalmological , Humans , Ischemia/diagnosis , Ischemia/physiopathology , Ischemia/therapy , Syndrome , Vision Disorders/diagnosis , Vision Disorders/etiology , Vision Disorders/physiopathology , Vision Disorders/therapy
3.
J Neurosurg ; 109(3): 439-44, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18759574

ABSTRACT

OBJECT: The association of vitreous and/or subhyaloid hemorrhage with aneurysmal subarachnoid hemorrhage (SAH) has been frequently identified since the original description by Terson in 1900. In this prospective clinical study the authors examined the actual incidence of Terson hemorrhage in patients suffering aneurysmal SAH, they attempted to identify those parameters that could predispose its development, and they evaluated its prognostic significance in the overall patients' outcome. METHODS: A total of 174 patients suffering aneurysmal SAH were included in this study. The admitting Glasgow Coma Scale scores (GCS), World Federation of Neurological Societies (WFNS) scale scores, Hunt and Hess grades, and Fisher grades were recorded. A careful ophthalmological evaluation was performed in all participants. The exact anatomical locations and the largest diameter of the dome of the ruptured aneurysms were also recorded. Surgical clipping or endovascular coiling was used in 165 patients. Clinical outcome was evaluated at discharge from the hospital by using the Glasgow Outcome Scale and the modified Rankin Scale. Periodic ophthalmological evaluations were performed for 2 years. RESULTS: In this series, the observed incidence of Terson hemorrhage was 12.1%. Statistical analysis of our data demonstrated that patients with low GCS scores and high WFNS scores, Hunt and Hess grades, and Fisher grades had an increased incidence of Terson hemorrhage. The mortality rate for patients with Terson hemorrhage was 28.6%, whereas that for patients without Terson hemorrhage was 2.0%. Moreover, patients with Terson hemorrhage who survived had significantly worse outcomes than those in patients without Terson hemorrhage. CONCLUSIONS: Terson hemorrhage constitutes a common SAH-associated complication. Its incidence is increased in patients with low GCS and high WFNS scores, and high Hunt and Hess and Fisher grades. Its presence is associated with increased mortality and morbidity rates.


Subject(s)
Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/complications , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/epidemiology , Adult , Aged , Causality , Female , Follow-Up Studies , Glasgow Outcome Scale , Humans , Incidence , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/therapy , Male , Middle Aged , Prognosis , Prospective Studies , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/therapy
4.
J Clin Neurosci ; 14(5): 484-8, 2007 May.
Article in English | MEDLINE | ID: mdl-17344045

ABSTRACT

Complications associated with anterior odontoid screw fixation, although not very common can be quite troublesome. We report a patient with early back-out of the implanted screw and its salvage with re-implantation of a longer screw.


Subject(s)
Bone Screws/adverse effects , Internal Fixators/adverse effects , Aged , Humans , Male , Odontoid Process , Spinal Fractures/surgery , Treatment Outcome
5.
Neurocrit Care ; 5(1): 55-60, 2006.
Article in English | MEDLINE | ID: mdl-16960298

ABSTRACT

Pupillometry has been widely employed in the evaluation of a large number of pathological conditions, including intracranial pathology. The recent introduction of a portable, user-friendly, infrared pupillometer (ForSite, NeurOptics Inc., Irvine, CA) has enabled the accurate and reproducible measurement of several pupillary parameters, such as maximum and minimum apertures, constriction and dilation velocities, and latency period. It should be noted that various clinical conditions, especially neurological and ocular diseases, as well as numerous medications, may interfere with the measurements. Furthermore, a number of physiological parameters, such as the intensity of retinal illumination, the level of patient's alertness, the intensity of ambient light, as well as the time of day that the examination is performed may alter the obtained values. The potential implications of pupillometry in the clinical assessment of neurosurgical patients, including its complex relationship to intracranial pressure changes, mandate the undertaking of prospective clinical studies validating the clinical significance of this noninvasive, diagnostic modality.


Subject(s)
Anisocoria/diagnosis , Brain Injuries/surgery , Infrared Rays , Intracranial Hypertension/surgery , Neurosurgical Procedures/methods , Brain Injuries/complications , Diagnosis, Differential , Humans , Intracranial Hypertension/etiology
6.
Childs Nerv Syst ; 22(11): 1487-91, 2006 Nov.
Article in English | MEDLINE | ID: mdl-16960734

ABSTRACT

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) constitutes a well-described clinical entity, classically entailing characteristic edematous lesions on imaging studies in a patient with altered mental status, visual disturbances, headache, and seizures. PRES is reversible in the vast majority of cases, although progression to ischemia and hemorrhage has been documented. METHODS: We report a case of a 16-year-old male with chronic renal failure who developed PRES during a hypertensive crisis. The hypertension was successfully managed and PRES-associated symptomatology showed complete regression. However, approximately 2 months later, the patient returned with a spontaneous posterior fossa hemorrhage. Two weeks before this second admission, treatment with low-molecular weight heparin had been initiated. The patient finally succumbed, despite surgical evacuation. The pertinent literature is reviewed. CONCLUSION: We suggest that the administration of low-molecular weight heparin in the setting of recent PRES might increase the risk for the development of intracranial hemorrhage.


Subject(s)
Heparin, Low-Molecular-Weight/adverse effects , Intracranial Hemorrhages/etiology , Adolescent , Humans , Hypertensive Encephalopathy/drug therapy , Hypertensive Encephalopathy/etiology , Intracranial Hemorrhages/pathology , Magnetic Resonance Imaging/methods , Male , Renal Insufficiency/complications , Tomography, X-Ray Computed/methods
7.
J Neurosurg ; 105(1): 153-6, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16871892

ABSTRACT

OBJECTIVE: Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. METHODS: Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65-120 minutes) and the mean operative blood loss was 23 ml (range 10-50 ml). No procedure-related complication was noted. CONCLUSIONS: Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.


Subject(s)
Cerebrospinal Fluid Shunts/methods , Echocardiography, Transesophageal , Hydrocephalus/surgery , Pseudotumor Cerebri/surgery , Surgery, Computer-Assisted , Adult , Female , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
8.
South Med J ; 99(6): 620-4, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16800420

ABSTRACT

Intraorbital hydatid disease (IHD) is quite rare and represents < 1% of the Echinococcus cases. In our current communication, we report two children with solitary, primary intraorbital hydatid cysts. Both children presented with nontender, nonpulsatile proptosis. Imaging workup, including CT and MRI scans of the head and the orbits, revealed a retro-bulbar cyst in both patients. Surgical resection was performed by employing a fronto-temporo-orbito-zygomatic (FTOZ) approach. Accidental intraoperative rupture occurred in one case with no further consequences. Albendazole was postoperatively employed for 12 weeks. Outcome was excellent in both cases with complete resolution of their symptoms and complete visual recovery. Pertinent literature was reviewed with this opportunity.


Subject(s)
Echinococcosis/diagnosis , Orbital Diseases/parasitology , Adolescent , Albendazole/therapeutic use , Antiprotozoal Agents/therapeutic use , Echinococcosis/drug therapy , Echinococcosis/surgery , Exophthalmos/parasitology , Female , Humans , Magnetic Resonance Imaging , Male , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , Orbital Diseases/surgery , Tomography, X-Ray Computed
9.
South Med J ; 99(5): 457-60, 2006 May.
Article in English | MEDLINE | ID: mdl-16711306

ABSTRACT

INTRODUCTION: Kyphoplasty, a minimally invasive technique, has recently been developed to provide immediate pain relief, biomechanical stabilization, prevention of fracture progression, vertebral height restoration, and prevention or reversal of kyphosis to patients with osteoporotic vertebral compression fractures (VCF). MATERIALS AND METHODS: We retrospectively reviewed 24 patients treated with kyphoplasty. A total of 37 vertebral levels were augmented. Visual analog scale (VAS) scores were documented in the immediate pre- and postoperative period, as well as 4, 12, and 72 weeks after the procedure. Vertebral body height restoration was assessed on postoperative x-rays. RESULTS: Mean preoperative VAS score was 9.3 and improved to 5.4 in the immediate postoperative period. At 4, 12 and 72 weeks post-operatively, mean VAS scores were 5.1, 5.9, and 6.1 respectively. All patients returned to their daily activities within 24 hours. No significant restoration of vertebral body height was observed. CONCLUSION: In regards to pain relief and postoperative functional outcome, kyphoplasty is a safe and effective treatment modality for osteoporotic VCFs, even when no significant restoration of vertebral body height is achieved.


Subject(s)
Body Height , Fractures, Compression/etiology , Fractures, Compression/surgery , Osteoporosis/complications , Pain/surgery , Spinal Fractures/etiology , Spinal Fractures/surgery , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Orthopedic Procedures/methods , Pain/etiology , Retrospective Studies , Treatment Outcome
10.
Neurosurg Focus ; 20(5): E10, 2006 May 15.
Article in English | MEDLINE | ID: mdl-16711658

ABSTRACT

Herbert Olivecrona was one of the pioneers of modern neurosurgery. In one of his articles, published more than half a century ago, Olivecrona shared his thoughts on the development of neurosurgery in the first half of the twentieth century and his vision regarding the future of neurosurgery and neurosurgical training. In the present paper, the authors communicate their reflections and thoughts on Herbert Olivecrona's visionary article.


Subject(s)
Neurosurgery/history , History, 20th Century , Neurosurgery/trends , Sweden
11.
Childs Nerv Syst ; 22(10): 1282-7, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16598498

ABSTRACT

OBJECTIVES: Golf-related head injuries constitute an increasingly common mechanism of head trauma in children. We present our experience with 33 pediatric cases of golf-associated head injury, with special emphasis in the type of injury, management strategy, and outcome. MATERIALS AND METHODS: A thorough review of all children admitted to our hospital with golf-related head injury during a period of 10 years (1 January 1994 to 31 December 2003) was undertaken. The patients' charts, operative reports, imaging studies, and follow-up data were analyzed. A comparison of our findings with those described in the pertinent literature was subsequently performed. CONCLUSIONS: Pediatric golf-related head trauma is a significant cause of sport-associated head injury, sometimes harboring a very dismal prognosis. The significance of establishing a task force for the prevention of these injuries cannot be overemphasized.


Subject(s)
Craniocerebral Trauma , Golf , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Craniocerebral Trauma/etiology , Craniocerebral Trauma/pathology , Craniocerebral Trauma/surgery , Female , Humans , Male , Neurosurgical Procedures/methods , Retrospective Studies , Treatment Outcome
12.
South Med J ; 99(2): 178-83, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16509559

ABSTRACT

Spinal hydatid disease is a not uncommon cause of spinal cord compression in endemic countries; however, involvement of the epidural space with sparing of the vertebral column is rare. Early diagnosis and surgical decompression with total removal of the hydatid lesion, when possible, is generally considered the standard of care for this disease. The authors describe a case of massive epidural hydatid disease without involvement of the vertebral column in a 62-year-old male patient, treated with a 2-stage surgical operation and administration of systemic albendazole. The literature is reviewed regarding the clinical features, diagnosis, treatment and prognosis of spinal echinococcosis.


Subject(s)
Echinococcosis , Lumbar Vertebrae , Spinal Diseases , Thoracic Vertebrae , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Diagnosis, Differential , Echinococcosis/complications , Echinococcosis/diagnosis , Echinococcosis/therapy , Echinococcus granulosus/isolation & purification , Follow-Up Studies , Humans , Laminectomy , Male , Middle Aged , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Spinal Cord Compression/surgery , Spinal Diseases/complications , Spinal Diseases/diagnosis , Spinal Diseases/therapy , Tomography, X-Ray Computed
13.
Neurosurgery ; 58(3): E590; author reply E590, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16528161
14.
Eur Spine J ; 15 Suppl 5: 585-9, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16429292

ABSTRACT

The authors report a rare case of complete C2-C3 dislocation with unexpectedly mild neurological symptoms in a 57 year old man involved in a motor vehicle accident, who had previously undergone posterior laminectomy from C3 through C7. A retrospective chart analysis and a thorough radiographic review were performed. X-rays and CT of the cervical spine demonstrated a complete dislocation at the C2-C3 level. Computed tomographic angiography revealed disruption of both vertebral arteries; however, blood flow was evident in the basilar artery. After radiologically guided placement in cervical traction with tongs that reduced the subluxation by approximately 50% the patient had spontaneous eye opening and was able to follow commands. A two-stage 360 degree stabilization and fusion was performed and the patient was finally discharged 24 days after admission with his neurological status essentially unchanged. In conclusion, our patient presented with surprisingly mild neurological symptoms. The previously performed laminectomy could have both predisposed to injury as well as protected his spinal cord from potentially fatal trauma.


Subject(s)
Cervical Vertebrae/injuries , Joint Dislocations/complications , Nervous System Diseases/etiology , Nervous System Diseases/physiopathology , Angiography , Basilar Artery/physiopathology , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/therapy , Laminectomy , Male , Medical Records , Middle Aged , Regional Blood Flow , Severity of Illness Index , Spinal Fusion , Tomography, X-Ray Computed , Traction , Vertebral Artery/diagnostic imaging
15.
Neurosurgery ; 57(6): 1303-5; discussion 1303-5, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16331180

ABSTRACT

HIPPOCRATIC WORKS LEND themselves still today to the modern physician for further analysis of his approach to the diagnosis and treatment of various pathological conditions. We present an attempt to systematize his methodology regarding the management of head trauma and present it in the format of a modern-era algorithm.


Subject(s)
Craniocerebral Trauma/history , Neurology/history , Reference Books, Medical , Algorithms , Craniocerebral Trauma/therapy , Famous Persons , Greece, Ancient , History, Ancient , Humans , Medicine in the Arts
16.
J Neurosurg ; 103(6 Suppl): 496-500, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16383247

ABSTRACT

OBJECT: The authors describe the prospective use of a new hand-held point-and-shoot pupillometer (NeurOptics) to assess pupil function quantitatively. METHODS: Repetitive measurements were made in 90 pediatric participants ranging in age from 1 to 18 years, providing a total of 100 measurements under ambient light conditions. The participants consisted of 45 patients without known intracranial or ophthalmological pathological conditions as well as 45 volunteers in the outpatient setting. Quantitative pupil measurements were reliably replicated in the study participants. The mean resting pupil aperture was 4.11 mm and the minimal diameter after stimulation was 2.65 mm, resulting in a 36% change in pupil size. The mean constriction velocity was 2.34 mm/second, with a mean dilation velocity of 2.2 mm/second. CONCLUSION: Pupil symmetry was impressive in the entire cohort.


Subject(s)
Diagnostic Techniques, Ophthalmological , Pupil/physiology , Adolescent , Child , Child, Preschool , Diagnostic Techniques, Ophthalmological/instrumentation , Diagnostic Techniques, Ophthalmological/standards , Equipment Design , Humans , Infant , Infant, Newborn , Prospective Studies , Reaction Time , Reference Values
17.
South Med J ; 98(9): 896-901, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16217982

ABSTRACT

OBJECTIVES: In the present study, the authors comment on their experience with anterior odontoid screw fixation in the management of odontoid fractures, in an attempt to further assess the safety and the efficacy of this procedure. MATERIALS AND METHODS: A retrospective analysis of 50 consecutive patients with reducible type II or rostral type III odontoid fractures, operated at our hospital with anterior odontoid screw fixation. Radiographic bony fusion, complications, and clinical outcome were evaluated. RESULTS: Solid bony fusion was evident in 38 (90.5%) of the patients. One mechanical instrumentation-related complication occurred, without clinical significance. No other major complications related to the procedure were noted. A satisfactory range of motion in the cervical spine was observed in all patients. CONCLUSIONS: Anterior odontoid screw fixation is a safe and effective procedure for the treatment of type II and rostral type III odontoid fractures. Compliance to the specific indications and contraindications of this operation is crucial for optimal outcome.


Subject(s)
Bone Screws , Fracture Fixation, Internal/methods , Odontoid Process/injuries , Odontoid Process/surgery , Spinal Fractures/surgery , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Female , Fracture Healing , Humans , Male , Middle Aged , Range of Motion, Articular , Retrospective Studies , Spinal Fractures/classification , Treatment Outcome
18.
Neurosurg Focus ; 19(2): E11, 2005 Aug 15.
Article in English | MEDLINE | ID: mdl-16122210

ABSTRACT

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.


Subject(s)
Diskectomy/adverse effects , Lumbar Vertebrae/diagnostic imaging , Microsurgery/adverse effects , Polyradiculopathy/diagnostic imaging , Postoperative Complications/diagnostic imaging , Adult , Diskectomy/methods , Humans , Lumbar Vertebrae/surgery , Male , Microsurgery/methods , Middle Aged , Polyradiculopathy/etiology , Radiography
19.
Neurosurg Focus ; 18(4): e9, 2005 Apr 15.
Article in English | MEDLINE | ID: mdl-15844872

ABSTRACT

The purpose of this article is to provide insight into the development of surgery for acoustic neurinomas throughout the years. The significant contribution of surgical authorities such as Cushing, Dandy, and House are discussed. The advances in surgical techniques from the very first operations for acoustic tumors at the end of the 19th century until today are described, with special emphasis on the technological and diagnostic milestones that preceded each step of this development.


Subject(s)
Neuroma, Acoustic/history , Neuroma, Acoustic/surgery , Neurosurgery/history , Neurosurgical Procedures/history , Vestibulocochlear Nerve/surgery , Cranial Fossa, Posterior/pathology , Cranial Fossa, Posterior/surgery , Facial Nerve Injuries/prevention & control , History, 19th Century , History, 20th Century , Humans , Intraoperative Complications/prevention & control , Microsurgery/history , Microsurgery/methods , Neuroma, Acoustic/diagnosis , Neurosurgery/methods , Neurosurgical Procedures/methods , Postoperative Complications/prevention & control , Radiosurgery/history , Radiosurgery/methods , Temporal Bone/pathology , Temporal Bone/surgery , Vestibulocochlear Nerve/pathology
20.
Spine (Phila Pa 1976) ; 30(6): 661-9, 2005 Mar 15.
Article in English | MEDLINE | ID: mdl-15770182

ABSTRACT

STUDY DESIGN: Retrospective analysis of the fusion rate of a group of 38 patients having undergone anterior screw fixation for type II and "shallow" type III odontoid fractures. OBJECTIVE.: To determine primarily the long-term fusion rate after anterior screw fixation and to study the clinical characteristics of patients that have a statistically significant or nonsignificant influence on successful outcome. SUMMARY OF BACKGROUND DATA: Long-term outcome of anterior screw fixation for odontoid fractures has been evaluated in very few studies. This information should be critical for further establishing this technique as a major therapeutic strategy for these cases. METHODS: Thirty-eight patients, 25 males and 13 females (with mean age 48.4 +/- 0.4 years), with type II and rostral type III odontoid fractures, underwent anterior cannulated screw fixation during a 62-month period. Radiologic examination of the cervical spine with plain radiographs was performed at 6 weeks, and 2, 6, 12, and 24 months, while computerized tomography of the upper cervical spine (C1-C3) was obtained at 6 months after surgery. Follow-up was available for 31 patients, and the follow-up time ranged from 39 to 87 months (mean 58.4). RESULTS: Radiographic evaluation of the follow-up group showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 27 (87.1%) patients. Pseudarthrosis developed in 4 (12.9%) patients; however, 3 (9.6%) of them without instability and 1 (3.2%) with instability. One (3.2%) patient had an instrumentation failure without instability. CONCLUSIONS: In our series, anterior odontoid screw fixation comprised a safe therapeutic modality with high stability and low mechanical failure rates during short-term and long-term follow-up.


Subject(s)
Bone Screws , Fracture Fixation, Internal/instrumentation , Odontoid Process/injuries , Odontoid Process/surgery , Spinal Fractures/surgery , Spinal Fusion/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Odontoid Process/diagnostic imaging , Retrospective Studies , Spinal Fractures/classification , Spinal Fractures/diagnostic imaging , Spinal Fusion/methods , Tomography, X-Ray Computed
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