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At least 505 records · Page 28Linked to original sources
PubMed1981

Long-term corticosteroids and cervical subluxation in non-rheumatoid patients.

Forty-five non-rheumatoid patients with chronic chest disease were examined radiographically for evidence of cervical subluxation. Twenty-six patients had received continuous corticosteroids for periods of between two and 20 years. The remainder (19 patients) had never been treated with steroids and acted as controls. There was no difference in atlanto-axial distance between the steroid-treated and control groups and in no patient did this measurement exceed 3 mm. However, subaxial subluxation was significantly increased in the steroid-treated group, directly related to the duration of steroid therapy (P less than 0.025).

Adrenal Cortex Hormones↗
PubMed1982

Radionuclide imaging of the neck in rheumatoid arthritis.

Blind marking was used to assess radionuclide neck images obtained with technetium-99m methylene diphosphonate in 28 patients with rheumatoid arthritis and 12 with cervical degenerative joint disease (spondylosis). Eleven out of the 16 rheumatoid arthritis patients who had neck pain when imaged showed enhanced uptake in the region of the atlantoaxial and temporomandibular joints. In contrast, no patient with cervical spondylosis and only one rheumatoid arthritis patient without neck pain had high uptake in either joint. Changes in uptake in this region on repeat imaging correlated significantly (P less than 0.01) with changes in pain. Patients with rheumatoid arthritis, with or without neck pain, and with cervical spondylosis showed similar patterns of radiological abnormality in the cervical spine. No detailed correlation was detected between radionuclide and radiographic findings. Radionuclide abnormalities were seen in the middle and lower cervical spine in both rheumatoid arthritis and cervical spondylosis. An abnormal radionuclide image of the middle or lower neck is thus of little value except when no degenerative change is present on the radiograph. An abnormal radionuclide image of the upper neck may be a useful indication of inflammation.

Arthritis, Rheumatoid↗
PubMed1988

Bilateral hypoglossal nerve palsy due to vertical subluxation of the odontoid process in rheumatoid arthritis.

Two patients with rheumatoid arthritis involving the cervical spine developed a rapidly progressive dysarthria due to bilateral hypoglossal nerve palsies, in one patient as an isolated lesion, and in the other in conjunction with dysfunction of the vagus and glossopharyngeal nerves. Both patients showed upward movement of the axis, relative to the foramen magnum, which has been termed 'vertical subluxation of the odontoid' or 'cranial settling'. Mechanical injury to the nerves, secondary to this process, is the most likely mechanism.

Aged↗
PubMed2001

Traumatic subluxation of the axis after hyperflexion injury of the cervical spine in children.

Six cases of children (four boys and two girls, mean age 11 years) who had traumatic subluxation of the axis (C2) were reviewed retrospectively. Initial radiographs demonstrated no detectable vertebral fracture in any of the children. However, a slight anterior subluxation of C2 was observed in three of the patients. Radiographs, taken at 1 month after injury in all but one patient, revealed a progression of the subluxation and a local kyphosis in all of the patients. Four of the children were treated conservatively with a cervical brace, and an improvement of both the kyphosis and the anterior slippage of C2 was obtained accompanied by an anteroposterior growth of the C3 vertebral body. The kyphosis of two of the patients became severe and, ultimately, these patients underwent fusion surgery. At the follow-up, none of the patients presented with any significant symptom. For the correct diagnosis of traumatic subluxation of C2, sequential radiographs to confirm the progression of subluxation and local kyphosis are mandatory. Conservative treatment rather than early surgical treatment may be chosen for this injury, because mild and moderate kyphosis can be corrected spontaneously by remodeling of the cervical spine.

Adolescent↗
PubMedDate not supplied

Fracture of the axis arch. "Hangman's fracture" of the cervical spine.

Fifteen patients with fracture of the axis arch ("Hangman's Fracture" of the cervical spine) reviewed with regard to the clinical features, mechanism of injury and management, present a relatively high rate of cord involvement (11 patients) and injuries around the jaw (5 patients). All of the injuries occurred in civilian accidents. The jaw injuries suggest the inclusion of an extension-distraction force. Treatment was conservative in all patients, even in those with severe displacement. Union generally occurred in about 3 months. The only complaint in those patients with union in the displaced position, was limitation of lateral rotation of the head.

Adolescent↗
PubMed1975

Non-union of the odontoid process. An experimental investigation.

A clinical study of fractures of the odontoid process showed a 62 per cent failure on union. Of many features studied, only displacement and its direction had a definite bearing on non-union of the fracture. Blood supply was considered as a possible etiological factor. The blood supply of the human odontoid was elucidated by means of studying 19 human autopsies by means of microangiography. The dog was found to have a similar blood supply and hence, was used as the experimental model. Two osteotomies were performed; one below the accessory ligaments and one above the accessory ligaments. All osteotomies carried out below the accessory ligament united and all carried out above failed to unite. Microangiographic studies revealed however, that avascular necrosis was not the cause of non-union. Further anatomic studies revealed that different size gaps occurred depending on the level of the osteotomy, with a large gap occurring in the osteotomy of the odontoid which was performed above the accessory ligament. First the result of immobilization and the healing of the odontoid osteotomy was derived, by carrying out an instant occipito-cervical fusion by means of wire loops and methylmethacrylate. In distinction to the free floating apical segment of non-immobolized spines, with a high odontoid osteotomy, the occipito-cervical fusion resulted in a dense fibrous tissue stabilizing the apical fragment but at no time was bony union observed. A final attempt was to secure immobilization and reduce the gap, by carrying out only a partial osteotomy. The osteotomy was performed in such a way that the posterior cortex was left intact. Union occurred in all instances. The fracture gap and movement play a definite role in the pathogenesis of pseudarthrosis of the odontoid process. Where gap and movement were eliminated, union occurred. It is difficult to transpose this experimental situation to the clinical one, for the assessment of gap clinically, is only radiographic. This method is much too imprecise to be of value in this assessment. The fact however, that a high rate of non-union is associated with a high degree of displacement, supports the experimental thesis.

Animals↗
PubMed1975

Roentgenographic signs of cervical injury.

The injured cervical spine may be completely examined without patient movement by positioning the X-ray tube relative to the injured patient. The prevertebral soft tissue in the cervical area is extremely important in the evaluation of injury, and a thickness of 5 mm or more at the level of the anterior inferior border of the body of C3 is indirect evidence of osseous injury. In hyperextension rotation cervical spine injuries the pillar view should always be taken. Anterior displacement of one vertical body upon another may be normal or secondary to trauma. Straightening or reversal of the cervical ordotic curve may be normal for the individual.

Adolescent↗
PubMedDate not supplied

Clinical review of cervical spine injuries in children.

Clinical presentation is made of 18 cervical fractures occurring in children age 15 and under. Seven of 18 patients sustained neurological complications. The incidence of childhood cervical spine injury increases with age. Sixteen of 18 lesions were found in the C1 through C4 area in contrast to a greater involvement in adults in levels of C4 through C7. Although normal variations and anomalies are frequent in cervical spines in children, over treatment, at least initially, is recommended in all cases in which the diagnosis is in doubt.

Accidents↗
PubMed2004

Structural properties of the axis studied in cadaveric specimens.

Peripheral quantitative computed tomography scans of the axis in 20 fresh cadaveric specimens obtained at autopsy were studied to investigate the internal structural properties of the axis. In all specimens, serial scans were done in three planes. The area of the dens consisted of dense cortical and trabecular bone (Region 1, above the base of the dens) and showed statistically significantly greater peripheral quantitative computed tomography values when compared with the anterior part of the body of the axis (Region 2, below the base of the dens). An age-related progressive decrease of peripheral quantitative computed tomography values was observed, with specimens from subjects younger than 40 years showing statistically significantly greater peripheral quantitative computed tomography values when compared with those from subjects older than 40 years. A small area of trabecular bone with decreased density was found close to the anteroinferior edge of the body of the axis in the specimens from younger subjects. In contrast, a large area of trabecular bone with decreased density extending anteroinferiorly to superoposteriorly to the base of the dens was found in the specimens from older subjects. Based on these findings, we think that dens fracture classification systems and fixation techniques should be reconsidered.

Adult↗
PubMed1979

Computed tomography of spinal fractures.

Computed tomography (CT) has aided significantly in the diagnosis and management of spinal fractures. The examination is easy, relatively quick, and avoids potentially harmful manipulation. The diagnostic advantages of CT include precise anatomic delineation and indication of extent of fractures, assessment of spinal stenosis, and demonstration of associated peraspinal lesions.

Adult↗
PubMed1980

Benign extramedullary foramen magnum tumors: diagnosis by computed tomography.

This paper reports two cases of benign extramedullary tumors of the foramen magnum studied by computed tomography (CT). The first case was a neurinoma; the second was a meningioma. Several different CT findings allowed a correct preoperative diagnosis of the location and nature of the tumors. In view of the invasiveness of traditional diagnostic methods and of the encouraging, although limited, experience of the present cases, the role of CT in the diagnosis of these lesions is promising.

Adult↗
PubMedDate not supplied

Vertical fracture of the odontoid: CT diagnosis.

A patient with a vertically oriented fracture of the odontoid is described. We found no previous report of this type of fracture. In our patient CT was the best imaging modality for defining the anatomic extent of the fracture.

Adult↗
PubMed1989

False-positive diagnosis of an odontoid fracture by CT scan.

Although computed tomography (CT) is a valuable tool for evaluating spine trauma, it's usefulness is limited. Horizontally oriented fractures of the cervical spine, particularly type 2 fractures at the base of the odontoid process, may be difficult to detect with CT. Our case report illustrates a false-positive diagnosis of this fracture and suggests that conventional polytomography is superior to CT for demonstrating this particular lesion when minimal displacement is present.

Adolescent↗
PubMed1996

Classification and treatment of axis body fractures.

We have classified 31 cases of axis body fracture by the type of bony injury depicted in radiographic images into the following four types: avulsion, transverse, burst, and sagittal fractures. The results of treatment in these types were retrospectively analyzed. In all of nine cases of avulsion fracture and two cases of transverse fracture, bone union was obtained by nonoperative treatment. All three cases of burst fracture healed, one by nonoperative treatment, and the remaining two by C2/3 anterior interbody fusion. Bone union was also obtained in all of the 17 cases of sagittal fracture, which included nonoperative treatment in 15 cases, and transoral atlanto-axial fusion in the remaining two cases. because many axis body fractures are inherently stable injuries, the authors normally select nonoperative treatment as initial therapy. However, in sagittal fractures, eight patients had sequelae of nuchal pain caused by osteoarthrosis of the atlanto-axial joint. As a result of these findings, the authors deem it appropriate to utilize atlanto-axial fusion when severe malalignment of the atlanto-axial joint is recognized.

Adult↗