ABSTRACT
We reviewed seven children with torticollis due to refractory atlanto-axial rotatory fixation who were treated in a halo vest. Pre-operative three-dimensional CT and sagittal CT imaging showed deformity of the superior articular process of C2 in all patients. The mean duration of halo vest treatment was 67 days (46 to 91). The mean follow-up was 34 months (8 to 73); at the latest review six patients demonstrated remodelling of the deformed articular process. The other child, who had a more severe deformity, required C1-2 fusion. We suggest that patients with atlanto-axial rotatory fixation who do not respond to conservative treatment and who have deformity of the superior articular process of C2 should undergo manipulative reduction and halo-vest fixation for two to three months to induce remodelling of the deformed superior articular process before C1-2 fusion is considered.
Subject(s)
Atlanto-Axial Joint/injuries , Braces , Torticollis/therapy , Atlanto-Axial Joint/diagnostic imaging , Cervical Vertebrae/diagnostic imaging , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Imaging, Three-Dimensional/methods , Joint Dislocations/complications , Joint Dislocations/diagnostic imaging , Joint Dislocations/therapy , Male , Tomography, X-Ray Computed , Torticollis/diagnostic imaging , Torticollis/etiology , Treatment OutcomeABSTRACT
STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of pseudoaneurysm of the aortic arch presenting as hemoptysis following a cervical spondylodiscitis. The pseudoaneurysm was remote and any direct extension of the abscess was not observed from the cervical lesion. SETTING: Hamamatsu Medical Center. CASE REPORT: A 73-year-old male being treated with antibiotics for a cervical spodylodiscitis deteriorated tetraplegia. Following a posterior decompression of the cervical spine and subsequent neurological recovery, hemoptysis occurred and a pseudoaneurysm of the aortic arch was identified. Emergent vascular graftings combined with dèbridement of the pseudoaneurysm and the infected cervical intervertebral disc were performed. The patient recovered gradually and the cervical spondylodiscitis disappeared. CONCLUSIONS: The septicemia originating from the remote cervical spondylodiscitis was thought to contribute to this pseudoaneurysm. Attention should be paid to the systemic septicemia as well as the focal spinal infection. As for cervical spondylodiscitis, posterior decompression without drainage cannot be recommended as the initial treatment.
