CLOSER LOOK AT SPINAL LESIONS: OPEN BIOPSY OF VERTEBRAL LESIONS.
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Adenocarcinoma↗
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Osteophytosis of the cervical spine in South African blacks and whites.
Cervical vertebral columns (214) of adult human skeletons belonging to South African blacks and whites were examined for the presence of osteophytes. It was found that the cervical vertebrae of the black samples were significantly less affected by degenerative changes than in the whites. This finding has specific clinical implications in that the distribution of osteophytosis in the blacks also follows a different pattern than in the whites; osteophytes appear to affect either the vertebral body or apophysial joint facets in the cervical vertebrae of the blacks. In the whites, in sharp contrast, both sites are often affected on the same vertebra, which in life may result in a pincer-like entrapment of the spinal nerve root and/or vertebral artery. Consideration is given to the possible physiological and/or functional causes of the differences in distribution and pattern of development of osteophytes in the cervical spines of the two population groups.
Adult↗
[Long-term prognosis of the hangman's fracture].
23 patients with traumatic spondylolisthesis of CII (hangman's fracture), all treated conservatively by external immobilisation and/or bed rest, were followed for an average of 9.6 years, 10 of them for 10-20 years. Radiographically two groups could be distinguished: one with bone formation between the vertebrae of CII and CIII and another without bone formation. Irrespective of the amount of bone formation their long-term prognosis was good: no new symptoms, old symptoms diminished and no limitation of neck movements. Degenerative changes in the neighbouring motor segments were not observed.
Axis, Cervical Vertebra↗
Association between morphology of the first cervical vertebra, head posture, and craniofacial structures.
In order to test the assumption of an association between the anatomy of the first cervical vertebra, the atlas, and dentofacial build, roentgen-cephalograms of 78 young adults with either a markedly high or a low atlas dorsal arch were analysed with regard to head posture, and cervicovertebral and dentofacial anatomy. The high and low dorsal arch groups each comprised 22 women and 17 men. The head was more extended in the low arch groups and particularly so among the women, in whose low arch group there was a tendency for the cervical spine to be inclined more forward. Both the dorsal arch and the dens of the second vertebra were vertically smaller in the low arch groups, and more so among the men. Vertebral length was reduced more in the women, however. The clival plane was more parallel to the foraminal plane in the low arch groups and the gonial angle was more obtuse. Furthermore, the women with low arches showed a steepened mandibular plane, a backward-rotated condylar head, a decrease in the ratio of posterior to anterior face height, smaller vertical overbite and reduced proclination of the lower incisors. The prevalence of severe malocclusions was higher than in the corresponding high arch group.
Adult↗
An anatomical study of the C-2 pedicle.
OBJECT: The C-2 pedicle plays an important role regarding screw purchase for spinal fixation. The aim of this study was to measure the C-2 pedicle-related linear and angular parameters. METHODS: Seven parameters in 160 C-2 pedicles (80 dry vertebrae) were measured using a Vernier caliper (accurate to 0.1 mm) and goniometer. The Student t-test was used to determine statistical significance. The authors found that the C-2 isthmus (pars interarticularis) and the C-2 pedicle are distinct structures. The C-2 isthmus covers the pedicle. The isthmus is present between the superior and inferior articular processes, and the pedicle is the structure beneath the C-2 isthmus. It connects the lateral mass-inferior articular process to the body of the axis. The heights of the right and the left C-2 pediculoisthmic components (PICs) were 10.3 +/- 1.6 and 9.9 +/- 1.5 mm, respectively. The posterior part of the superior aspect of the PIC was wider than the anterior portion. The widths of the posterosuperior aspect of the PIC were 11.1 +/- 2 and 11 +/- 1.7 mm on the right and left sides, whereas the widths of the anterosuperior aspect of the PIC were 7.9 +/- 1.7 and 8.5 +/- 1.6 mm, respectively. The inferior widths of this component were 6.0 +/- 1.5 and 5.5 +/- 1.3 mm on the right and left side, respectively. The lengths of the component were 28.8 +/- 2.9 mm on the right and 28.8 +/- 3.4 mm on the left side. The PIC exhibits a lateral-to-medial and an inferior-to-superior angle. Its axial angles were 28.4 +/- 2.5 and 28.6 +/- 2.2 degrees on the right and left sides, respectively; its sagittal angles were 18.8 +/- 2.1 and 18.8 +/- 1.7 degrees, respectively. CONCLUSIONS: The C-2 pedicle can be seen in the inferior aspect of the vertebra, and it connects posterior vertebral elements (that is, the lateral mass and inferior articular process) to the axial body. The isthmus drapes the pedicle. The authors suggest that this be termed "the pediculoisthmic component."
Axis, Cervical Vertebra↗
Interactive magnetic resonance imaging-guided biopsy in the head and neck: initial patient experience.
Because of its excellent soft tissue resolution, magnetic resonance imaging (MRI) can optimize image guidance for interventional and surgical procedures. Notably, needle biopsy of head and neck lesions has been used for years, deeper lesions often requiring some form of image guidance. The closed space of diagnostic MRI scanners proves cumbersome for intervention. The authors report on the first head and neck image-guided biopsies performed in a new, investigational "open configuration" intraoperative MRI scanner. Vertical space between the scanner's upright coils gives access to the patient while imaging; image acquisition is as fast as 2 sec/image. Biopsies were performed on seven patients (parotid, parapharyngeal space, second cervical vertebra); five specimens were diagnostic. Both general anesthesia and intravenous sedation were used. The procedures were without complications. Imaging provided definition of anatomy to direct needle placement. Access to the patient allowed for both percutaneous and transoral approaches. The environment of the open magnet is well suited for biopsy of the head and neck, and near real-time intraoperative MRI has promise for guiding more complex head and neck procedures. Further study should optimize the quality of the images and the interactibility of localization and targeting and fully utilize MRI's three-dimensional imaging capabilities.
Adenoma, Pleomorphic↗
Vertebra plana and eosinophilic granuloma of the cervical spine in children.
Eosinophilic granuloma of the cervical spine in children is a rare lesion which presents both diagnostic and therapeutic problems. The report describes three additional cases. Open biopsy is recommended instead of attempted needle aspiration in children. Laminectomy is likely to result in spinal deformity, and is not advised unless a second stage fusion is planned. Radiotherapy is effective in controlling the lesion. The ultimate outcome is usually good.
Adolescent↗
Percutaneous vertebroplasty for metastatic involvement of the axis.
BACKGROUND AND PURPOSE: Percutaneous vertebroplasty in the upper cervical spine is a challenging procedure, and little is known about its therapeutic outcome. The purpose of this study was to assess the risks and benefits of percutaneous vertebroplasty for metastatic involvement of the axis. METHODS: From January 1994 to August 2004, 12 patients (mean age, 52.3 years) underwent percutaneous vertebroplasty via an anterolateral approach using fluoroscopic guidance for metastatic lesions involving the C2 vertebral body; pain intensity was scored on a scale ranging from 0.0 (no pain) to 10.0 (maximum pain intensity). Eight patients (66.7%) were followed up (mean, 6.9 months); 5 of them had percutaneous vertebroplasty indicated for pain control and spine stabilization and 3, for spine stabilization only. RESULTS: The mean volume of cement injected was 2.9 +/- 0.7 mL (range, 2.0-4.0 mL) with a mean vertebral filling of 60.7 +/- 14.6% (range, 25-80%). Cement leakage was detected in 7 treated vertebrae (58.3%). Pain improvement was achieved in 4/5 patients (80%). Spine stability was observed in 7 patients (87.5%), but 1 patient (12.5%) presented with a secondary spine deformity in association with partial vertebral filling. Two postprocedural clinical manifestations (16.7%) were observed: 1 patient (8.3%) had a transient occipital neuralgia and another (8.3%) had an ischemic stroke. Mortality and morbidity rates at mean follow-up were 0.0% and 12.5% (1 patient), respectively. CONCLUSION: Percutaneous vertebroplasty of C2 metastases by an antero-lateral approach is an effective option in the treatment strategy of patients with metastases to C2. Nevertheless, it is a challenging procedure and may carry regional and even intracranial risks due to the proximity to the vertebral artery.
Adult↗
Associations between atlantoaxial and craniomandibular anatomy.
Roentgen-cephalometric studies have shown that anatomical features of the craniocervical junction are associated with head posture, cranial base angulation, and mandibular shape and growth. The aim of the present work was to study relationships between atlantoaxial and craniofacial morphology based on macroscopical observations of skeletal material derived from 38 prehistoric Polynesian and 53 prehistoric Thai people. The two uppermost cervical vertebrae and the mandible of each individual were studied macroscopically and each skull base was analyzed on cephalometric X-rays in lateral projection. The height of the atlantal anterior and posterior arches displayed a significant negative correlation with the cranial base angulation, in that the higher the arches the steeper the flexure between the sphenoidal/clival and clival/foraminal planes. None of the axial variables were associated with the cranial base angulation. The height of the atlantal posterior arch was also associated with the mandibular length, ramal height and gonial angle. Thus, in general, a high arch was seen in conjunction with a long, high and square shaped mandible, whereas a low arch was usually found together with a short and low mandible characterized by an obtuse jaw angle. The anterior height of the axis (vertebral mass + dens) was significantly associated with mandibular length and ramal height. It is suggested that these results are evidence of the intimate ontogenetic development of the atlas and the cranial base, and a reflection of the functional relationship between atlas and cranium.
Anthropology↗
Anatomical observations of the foramina transversaria.
Four hundred and eighty foramina transversaria in dry cervical vertebrae of 36 spines and in a number of dissections were studied and classified according to size, shape, and direction of their main diameter. A coefficient of roundness was then elaborated. The variations of foramina appear to follow a pattern at various vertebral levels. The possible factors (in addition to the embryological ones) involved in causing these variations-for example, mechanical stress, size, course, and number of vertebral vessels-were analysed. The importance of the correct interpretation of the variations in the foramina transversaria in radiographic or computerised axial tomography is discussed. The contribution of the present study to the understanding and diagnosis of pathological conditions related to the vertebral artery and its sympathetic plexus is stressed.
Adult↗
Comparison of mandibular growth with other variables during puberty.
The purpose of this investigation was to compare growth characteristics of the mandible during puberty with growth characteristics of the hyoid bone, cervical vertebrae, hand bones and standing height. Data were compiled from serial lateral cephalometric roentgenograms, hand-wrist roentgenograms and body height records of 33 Japanese girls between 9 and 14 years old. Records were updated annually. The mandibular growth rate differed from the other growth rates. The timing of maximum growth velocity of the mandible varied more widely than the timing of maximum growth velocity of the other parameters measured, and the total amount of mandibular growth did not correlate to any other measurement. The timing and magnitude of circumpubertal growth acceleration of various components of the body vary within a certain range of difference. However, the amount and timing of mandibular growth seems to be more variable than the other areas studied.
Adolescent↗
The arterial blood supply of the cervical vertebrae of the ox (bos taurus l.).
The arterial supply to the cervical vertebrae of the ox was studied in 22 animals (Friesland, Jersey and Guernsey cross-breeds), ranging from near full-term foetuses to adults. Various techniques, including angiography and clearing of bone, were employed to expose the extra- and intraosseous distribution of the arteries and a description is given of a modified Spalteholtz clearing technique. The extraosseous nutrient arteries are described and illustrated. A uniform pattern emerged from the investigation and it is suggested that the main branches be named: (1) the artery of the vertebral arch; (b) the artery of the transverse process; (c) the basivertebral arteries. Frequent anastomoses between epi- and metaphysial vessels in young animals are reported, and stress is laid on the effective collateral supply maintained by the extra- and intraosseous nutrient vessels.
Animals↗
[Current views on "hangman's fracture"].
The international literature calls "Hangman's fracture" (HF) the injury of the upper cervical spine with characteristic lesions of the epistropheus. The typical bone lesion in this injury is the bilateral fracture of the penduncles of the epistropheus, the dislocation of the arch, the luxation between CII and CIII and the injury of the disk, by chanche other additional fractures of the vertebrae CII and CIII too. Two forms are known: that of hyperextension distraction mechanism, leading to the classical death by hanging with very severe neurological lesion, and that with hyperextension compression mechanism, seen in modern traffic injury without neurological lesion or with relatively mild neurological symptoms. The later injury, seen more and more frequently in our days, appears with a rather broad spectrum and can be divided in three types. The stable injuries can be treated conservatively, the unstable injuries with Halo traction or with anterior operative methods, according to modern requirements. The prognosis is good. Authors describe their experiences, first in the Hungarian literature, gained from a critical review of the world literature and from a 11 years material.
Accidents, Traffic↗
[Neurologic symptoms and their dynamics in contusions of the spinal cord of mild and moderate severity at the level of the 1st and 2d cervical vertebrae].
The results of the study of 154 patients with an acute trauma of the cervical portion of the vertebral column showed that fractures, dislocations and fractures/dislocations of the first-second cervical vertebrae accounted for 10.4% of all the studied cases. In mild contusion of the first-second segments the leading clinical symptoms in the acute period were pareses of the arms and paralyses of hands with retained reflexes and insignificant impairments of sensitivity in fingers, i.e., the level of clinical manifestations did not correspond with the conventional segmento-metameric innervation. In the acute period of contusions of moderate severity tetraplegia is formed, which, however, does not affect the reflexes. Timely elimination of the compression helps to restore motor activity and sensitivity first in the legs and the body and later in the arms. In the long term of the injury motor activity in the arms recovers and the leading clinical symptoms become manifestations of pyramidal deficiency with insignificant sensitivity disorders in the hands and feet, predominantly of a subjective-radicular nature.
Adult↗
Biomechanics of the cervical spine. I: Normal kinematics.
UNLABELLED: This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of cervical spine injury. It summarizes the cardinal anatomical features of the cervical spine that determine how the cervical vertebrae and their joints behave. The results are collated of multiple studies that have measured the range of motion of individual joints of the cervical spine. However, modern studies are highlighted that reveal that, even under normal conditions, range of motion is not consistent either in time or according to the direction of motion. As well, detailed studies are summarized that reveal the order of movement of individual vertebrae as the cervical spine flexes or extends. The review concludes with an account of the location of instantaneous centres of rotation and their biological basis. RELEVANCE: The fact and precepts covered in this review underlie many observations that are critical to comprehending how the cervical spine behaves under adverse conditions, and how it might be injured. Forthcoming reviews draw on this information to explain how injuries might occur in situations where hitherto it was believed that no injury was possible, or that no evidence of injury could be detected.
Atlanto-Axial Joint↗
Odontoid hypoplasia with vertebral cervical subluxation and ventriculomegaly in metatropic dysplasia.
Our experience with 12 patients with metatropic dysplasia has demonstrated two important and treatable complications: odontoid hypoplasia with subluxation of the first and second cervical vertebrae, and ventriculomegaly. Hypoplasia and lack of ossification of the odontoid process were noted in all cases. Subluxation of these two vertebrae was demonstrated in all six patients who had lateral flexion-extension radiographs; three had subluxation even in a neutral position, and sudden odontoid dislocation developed in another after a simple fall. Four individuals have had surgical fusion of the cervical vertebrae; one child died suddenly, 1 week before scheduled surgery. In the three patients in whom computed tomography scans of the head were obtained, enlarged ventricles were found; one had symptomatic increased intracranial pressure and required a shunt. We recommend that odontoid hypoplasia be evaluated in all patients with metatropic dysplasia. If subluxation is proved, atlantoaxial fusion should be performed before damage to the cervical part of the spinal cord results. Serial head circumference measurements and evaluation for hydrocephalus are also recommended.
Adolescent↗
Erosion of the foramen transversarium of the axis. Anatomical observations.
Six hundred foramina transversaria (FT) of the axis vertebrae of 4 population groups were examined for the presence of erosion of the lateral articular mass. Of these, 127 (21%) and 72 (12%) presented with moderate and marked erosion, respectively. Evidence is presented incriminating the tortuosity of the vertebral artery as well as congenital factors in the etiology of the erosion of the FT. Attention is drawn to the possible correlation between angulation of the transverse process of the axis and erosion of the FT.
Adult↗
Follow-up study of atlanto-axial instability in Down's syndrome without separate odontoid process.
Clinical and roentgenologic studies were performed in 69 children with Down's syndrome, without the separate odontoid process, that could be followed for more than 5 years. At the follow-up examination, the atlanto-odontoid process interval (AOI) in flexion, neutral, and extension of the cervical vertebrae significantly decreased when compared with the one at the initial examination. This was particularly obvious up to 5 years of age. Although 14 of 69 cases (20.3%) had atlanto-axial instability at the initial examination, this decreased to four cases (5.8%) at the follow-up examination. However, there were two cases of atlanto-axial instability who were over 10 years of age. There was no significant difference in the minimum sagittal diameter (MSD) at the atlantal level between each position at both the initial and follow-up examinations. Moreover, there was a tendency for the MSD of the cases of positive instability at the follow-up examination to be smaller than those of the cases of negative instability. The degree of ligament laxity improved with increasing age and there was statistically the negative correlation. Although there was a tendency for the AOI to decrease with improvement of the degree of ligament laxity, the correlation could not be confirmed.
Aging↗