Biomedical subjects

J Drabier

Publications and source records attributed to J Drabier.

3 recordsLinked to original sources

PubMed1994

Transverse atlantal ligament disruption associated with odontoid fractures.

OBJECTIVES: The authors evaluated transverse atlantal ligament integrity in patients with fractures of the odontoid process of the axis. SUMMARY OF BACKGROUND DATA: Injuries of the transverse atlantal ligament can result in atlantoaxial instability after fractures of the atlas or axis, even if osseous healing occurs. METHODS: The clinical histories and follow-up examinations and radiographic data of 30 patients with odontoid fractures were reviewed, using a combination of magnetic resonance (MR) imaging, thin-cut computed tomography (CT), and plain radiographs to evaluate osseous and ligamentous injuries. RESULTS AND CONCLUSIONS: Osteoperiosteal ligamentous avulsion injuries were identified on MR imaging in three patients and were associated with acute and delayed instability and nonunion. The combination of MR imaging, CT, and plain radiographs is useful in evaluating unstable odontoid fractures to facilitate rational treatment planning. Odontoid fractures with transverse ligament injuries should be considered for early surgical stabilization because this combination of injuries is unlikely to heal nonoperatively. Anterior odontoid screw fixation should be avoided when the ligament is injured.

Adolescent↗

PubMed1993

Traumatic occipitoatlantal dislocations.

Fourteen occipitoatlantal dislocations were treated during an 11-year period. All patients presented with neurological deficits and definite evidence of spinal instability. Plain radiographs provided the diagnosis conclusively in 11 patients. Three patients required computed tomography (CT) or magnetic resonance (MR) imaging for diagnosis. Rotational subluxations were radiographically occult and associated with less severe neurological injuries compared to distracted or translated subluxations. Ten patients died acutely. One patient, who had complete C1 level quadriplegia, died after 3 months. Three patients with incomplete spinal cord syndromes had long-term survival and functional neurological recoveries. Extensive ligamentous injury predisposed patients to recurrent subluxations. In several patients, traction or a cervical collar caused distraction and neurological injury. Halo immobilization and urgent fusion are necessary for patients with salvageable neurological function. Nonoperative measures are inadequate for immediate or long-term spinal stability.

Accidents, Traffic↗

PubMed1993

Posterior atlantoaxial facet screw fixation.

Eighteen patients with atlantoaxial instability were treated with posterior atlantoaxial facet screws to obtain immediate rigid fixation of C1-2. Of these 18 patients, instability occurred due to trauma in nine, rheumatoid arthritis in six, neoplasms in two, and os odontoideum in one. Four patients presented with nonunion after failed C1-2 wire and graft procedures. In all cases in this series the screw fixations were augmented with an interspinous C1-2 strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. In every case fixation was satisfactory, and C1-2 alignment and stability were restored without complications due to instrumentation. One patient died 3 months postoperatively from metastatic tumor; the spinal fixation was intact. All 17 surviving patients have developed osseous unions (mean follow-up period 12 months, range 6 to 16 months). Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1-2 that is mechanically superior to wiring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis, and is particularly useful for pseudoarthrosis.

Adult↗