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In a patient injured in a bicycle accident, radiological evaluation of the cervical spine revealed an oblique orientation of a dysplastic dens of the axis, which, to our knowledge, has not been reported in the literature. There were no other bony or soft tissue anomalies and no associated instability. This case should draw attention to congenital anomalies of the cranio-cervical junction in trauma patients.
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The craniovertebral junction is the most complex of the axial skeleton, residing between the skull and the upper cervical spine. Congenital, developmental, and acquired bony abnormalities result in compression and distortion of the neural structures, the vertebrobasilar vascular system, and the cerebrospinal fluid channels. The clinical significance of this has only been recently recognized, and mistaken diagnoses have led to a delayed treatment and at times adverse results. A review of the anatomy, the embryology, and the mechanics of this region is essential to the understanding of the pathophysiology encountered.
PAR-1 kinases are required to determine the anterior-posterior (A-P) axis in C. elegans and Drosophila, but little is known about their molecular function. We identified 14-3-3 proteins as Drosophila PAR-1 interactors and show that PAR-1 binds a domain of 14-3-3 distinct from the phosphoserine binding pocket. PAR-1 kinases phosphorylate proteins to generate 14-3-3 binding sites and may therefore directly deliver 14-3-3 to these targets. 14-3-3 mutants display identical phenotypes to par-1 mutants in oocyte determination and the polarization of the A-P axis. Together, these results indicate that PAR-1's function is mediated by the binding of 14-3-3 to its substrates. The C. elegans 14-3-3 protein, PAR-5, is also required for A-P polarization, suggesting that this is a conserved mechanism by which PAR-1 establishes cellular asymmetries.
This is a case of a 58-year-old woman who presented with progressive stridor due to immobile vocal cords. This was found to be due to cervical cord compression by an upwardly subluxed odontoid peg. Despite surgical intervention the outcome was fatal.
BACKGROUND: The optimal surgical treatment of atlanto-axial instability remains controversial despite the variety of modifications and supplemental techniques currently available. METHODS: We describe a modification of the Brooks posterior wiring technique supplemented with transarticular screws for C1-C2 instability. RESULTS: This method has been implemented in 30 patients in our institution with no radiological failures. CONCLUSIONS: The modification provides several technical advantages and potentially stronger fixation compared to methods currently in use.
Calcium pyrophosphate dihydrate (CPPD) deposits, answerable for chondrocalcinosis, are frequently observed in elderly people. Involvement of the spine is not rare. We present the case of a woman hospitalised for an acute arthritis of the right knee related to CPPD crystal deposition disease who suffered from acute neck pain. The computerised tomography showed calcified deposits in the transverse ligament of the atlas highly suggestive of CPPD deposits. This localisation seems to be very common for CPPD deposits. These CPPD crystal deposits may induce pseudo-meningitic attacks or chronic mechanical neck pain. CPPD crystal deposits in the upper cervical spine should be diagnosed when the disease is quiet, in order to avoid unnecessary investigations and therapies when an acute cervical flare occurs.
The oncogene bmi-1, which was originally found to be involved in B- and T-cell lymphoma formation encodes a protein with a domain of homology to the Drosophila protein Posterior sex combs (Psc) and its relative Suppressor 2 of Zeste (Su(z)2) (refs 4 and 5). Psc is a member of the Polycomb-group gene family, which is required to maintain the repression of homeotic genes that regulate the identities of Drosophila segments. The possibility that bmi-1 may play a similar role in vertebrates was suggested by our previous finding that mice lacking the bmi-1 gene show posterior transformations of the axial skeleton. Here we report that transgenic mice overexpressing Bmi-1 protein show the opposite phenotype, namely a dose-dependent anterior transformation of vertebral identity. The anterior expression boundary of the Hoxc-5 gene is shifted in the posterior direction, indicating that Bmi-1 is involved in the repression of Hox genes. We propose that Bmi-1 is a member of a vertebrate Polycomb complex that regulates segmental identity by repressing Hox genes throughout development.
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An 18-month-old child was rendered tetraplegic below C6 in a road traffic accident. There was an associated fracture-dislocation of the atlanto-axial joint. Early management, and the probable role of autonomic dysreflexia in increasing the neurological deficit are considered.
A retrospective study of 33 patients with fracture of the ring of the axis (hangman's fracture) admitted to the Spinal Unit of the Department of Rehabilitation Medicine in the Tan Tock Seng Hospital between 1975 and 1988 was carried out. The aims were to establish the causes, mechanism and outcome of injuries that lead to Hangman's fracture in Singapore. The majority were males (27) and their ages ranged from 16 to 82 with a mean age of 33.7 years. 63.6% (21 cases) were due to road traffic accidents of whom 33% (11 cases) were motorcyclists or pillion riders and 30.3% (10 cases) were drivers or passengers of four wheel vehicles such as cars and vans. Using Effendi et al's classification, we have 21 type I, 11 type II and one type III fractures. Thirteen type I, 6 type II and one type III cases had no neurological deficit on admission. The rest had deficits ranging from tetraparesis to pure bladder dysfunction. After rehabilitation, 28 (84.8%) of them were able to return to gainful employment within a year of their injuries.
We investigated the type of injury and neurological prognosis in 82 patients with an upper cervical spine injury with neurological deficits, from a total of 247 such patients that we treated, from which 11 patients who were dead on arrival had been excluded. The incidence of neurological deficits in upper cervical spine injury was 33%. They were classified into three signs; cord, upper cervical nerve root, and cranial nerve signs. The types of injury accompanied by neurological deficits were burst fracture of the atlas, type II dens fracture, body fracture of the axis, type II traumatic spondylolisthesis of the axis, atlanto-occipital dislocation, and atlanto-axial dislocation. Most were unstable vertebral injuries. The four patients who died after arrival at hospital had complete tetraplegia with respiratory distress. The neurological deficit was one of paresis in the 78 patients who survived; in many, the paresis was mild with a resulting good neurological prognosis.
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The purpose of this study was to investigate how far tooth impacts were propagated in the body and whether the propagation would be influenced by posture. The impacts were propagated to all recording sites on the head and neck of the 10 examinees tested. In the recordings on the limbs, even at the most distal site, the number of examinees detecting the vibration was seven out of nine examinees. These results showed that the impacts exerted on the tooth were propagated to distal sites of limbs through the bones and soft tissues and implied that the propagated vibration would influence the whole of the body. On the other hand, as the amplitude of propagated vibration was influenced by posture and recording site, the posture during jaw functioning appears to be important.
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