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At least 523 records · Page 29Linked to original sources
PubMed1987

Fractures of the dens in adult patients.

The series involves 42 consecutive acute fractures of the dens, of which 41 were treated nonoperatively. There were 26 Type II and 16 Type III fractures, as classified by Anderson and D'Alonzo. All Type III fractures and undisplaced or anteriorly displaced Type II fractures united. Posteriorly displaced Type II fractures had an overall nonunion rate of 50%, which increased to 75% if displacement was more than 5 mm. Eight patients died within 40 days after sustaining their fracture; seven had Type II fractures with an average of 10-mm posterior displacement. Seven patients with a Type II fracture had an associated atlas fracture; five of these patients died early. In Type II fractures, posterior displacement is an important prognostic factor for union and possibly for early mortality of elderly patients. In Type II fractures with an associated atlas fracture, the mortality rate is high. Nonoperative management, preferably halo-thoracic immobilization, is successful in all acute fractures of dens, except posteriorly displaced Type II fractures.

Axis, Cervical Vertebra↗
PubMed1988

Factors influencing the outcome of cervical spine injuries.

Factors such as cause of the trauma, concomitant injuries, and cervical sagittal spinal canal size were compared between survivors and nonsurvivors of cervical spine injuries. Traffic accidents were more commonly the cause of the trauma among nonsurvivors (76%) than among survivors (50%). Concomitant injuries were of a more serious degree among nonsurvivors than in survivors. Cervical sagittal spinal canal size was measured at the atlas level. Patients without any neurologic deficits had significantly (p less than 0.001) wider canals (24.1 mm) than fatalities (20.7 mm). The energy level at the moment of trauma and the cervical sagittal spinal canal size are of great importance for the survival prognosis and also probably for the genesis of various degrees of neurologic deficits.

Axis, Cervical Vertebra↗
PubMed1990

Myelopathy due to hypertrophic nonunion of the dens: case report.

Fractures which occur near the base of the dens have a low propensity to unite spontaneously. One of the major complications of nonunion is displacement of the fracture resulting in neuraxis compression and the development of myelopathy. Hypertrophic nonunion of the dens may cause spinal cord compression even if displacement does not occur. This situation has not to our knowledge previously been reported. A literature review and appraisal of the issues raised are discussed. Appropriate therapeutic options are outlined, including posterior surgery and the use of transoral decompression.

Axis, Cervical Vertebra↗
PubMed1990

Dynamic computerized tomography of the occiput-atlas-axis complex in trauma patients with odontoid lateral mass asymmetry.

Over a 23-month period, 25 patients aged 11 to 74 years presented to our Level I trauma center with odontoid lateral mass asymmetry of 2 to 5 mm on properly centered AP open-mouth X-rays: 32% of patients were asymptomatic, 68% had cervical pain, and 32% had limited range of motion. Patients with cervical spine fractures or dislocations and those with fixed deformity were excluded. The clinical significance of asymmetry was determined utilizing dynamic axial CT scanning of the occiput (C0), atlas (C1) and axis (C2) with the head neutral and with 15 degrees to 30 degrees active rotation. Nineteen patients demonstrated greater than 5 degrees of relative motion of C1 on C2 bilaterally. Three patients had less than 5 degrees of relative motion bilaterally and three patients had less than 5 degrees relative motion with left rotation only. No patient had formal treatment and all had nearly normal cervical range of motion on clinical examination at the time of hospital discharge. The finding of an asymmetric odontoid-lateral mass interspace on properly centered open-mouth AP X-rays in the presence of otherwise normal cervical spine X-rays, in conscious patients without fixed deformity, appears to be incidental and requires no further evaluation or treatment.

Adolescent↗
PubMed1989

Combination Jefferson fracture of C1 and type II odontoid fracture requiring surgery: report of two cases.

Two cases of simultaneous Jefferson fracture of C1 and Type II odontoid fracture requiring surgical stabilization are reported. One patient required early stabilization because alignment could not be maintained in a halo vest, and the second patient required late stabilization for nonunion after a 3-month period of immobilization in a two-poster cervical brace. Although this uncommon injury can often be managed conservatively, surgical fusion will need to be considered in the setting of early or late instability.

Aged↗
PubMed1991

Axis fracture in ankylosing spondylitis: case report.

Ankylosing spondylitis is a chronic inflammatory disease that results in the slow progressive transformation of the normal spine into a rigid and brittle tube containing the normal neural elements. This pathological condition predisposes the patient to fractures of this structure and a potential for neurological damage greater than that of the normal population. We present a spontaneous fracture of the C1-C2 complex through the base of the dens, with impending neurological deficits in such a patient. We have reviewed the pertinent literature and emphasized several points relative to the management of similar patients.

Axis, Cervical Vertebra↗
PubMed2000

Tuberculosis of the axis in a patient with systemic sarcoidosis: technique of posterior open biopsy of the dens: case report.

OBJECTIVE AND IMPORTANCE: This case report illustrates the importance of obtaining tissue from a destructive lesion of the dens in a patient with systemic sarcoidosis. Although sarcoidosis can involve the axial skeleton, tissue obtained at the time of C1-C2 fusion demonstrated unsuspected pathological features, which dramatically altered the subsequent medical treatment. The technique of open posterior biopsy of the dens is illustrated, and the advantages of the approach are discussed. CLINICAL PRESENTATION: A 40-year-old woman with systemic sarcoidosis developed neck pain and atlantoaxial instability. Imaging revealed multiple thoracic and cervical vertebral abnormalities, including a destructive enhancing lesion involving the base of the dens. INTERVENTION: At the time of posterior C1-C2 fusion, we elected to perform an open biopsy of the base of the dens. A 16-gauge biopsy needle was introduced along the medial portion of the left C2 pars, aiming medially toward the base of the odontoid process. This procedure was performed under direct observation, with fluoroscopic guidance. The biopsy specimen contained caseating granulomas, and cultures were positive for Mycobacterium tuberculosis. CONCLUSION: The unusual presentation, the technique, and the importance of obtaining tissue to confirm the diagnosis of tuberculous involvement of the dens are emphasized. The relationship between sarcoidosis and tuberculosis reported in the literature is reviewed. In the current case, cell wall-positive tuberculous bacteria were cultured, confirming the presence of two separate diseases in the same patient.

Adult↗
PubMed2002

Management of combination fractures of the atlas and axis in adults.

STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Treatment of atlas-axis combination fractures based primarily on the specific characteristics of the axis fracture is recommended. External immobilization of most C1--C2 combination fractures is recommended. C1--Type II odontoid combination fractures with an atlantodens interval of 5 mm or more and C1--hangman's combination fractures with C2--C3 angulation of 11 degrees or more should be considered for surgical stabilization and fusion. In some cases, the surgical technique must be modified as a result of loss of the integrity of the ring of the atlas.

Adult↗
PubMed1990

Hangman's fracture resulting from improper seat belt use.

Diagonal seat belt application without accompanying lap belt closure may produce severe cervical spine injuries, including hangman's fracture and decapitation. Seat belts are effective in reducing injury, but they must be worn properly to do so. Passive restraint systems involving a diagonal seat belt may be hazardous if the motorist does not use the accompanying lap belt. We have presented a case in which the driver in a motor vehicle accident sustained a hangman's fracture (bilateral fracture of the pedicles of C-2) caused by use of a diagonal seat belt without accompanying lap belt closure. The mechanism of injury, as classically described in judicial hanging, is hyperextension and distraction, which occurred when the victim "submarined" under the diagonal seat belt and was caught at the neck.

Accidents, Traffic↗
PubMed1978

Odontoid fracture complicating ankylosing hyperostosis of the spine.

Ankylosing hyperostosis of the spine (Forestier's disease) is a distinct clinical entity which must be differentiated from ankylosing spondylitis (Marie-Strumpell's disease) and hypertrophic spondylosis. In the case presented, the distinction was made by clinical, roentgenographic, and postmortem pathologic findings. This case had the unique and previously unreported feature of complication by a fracture of the odontoid. The patient's particular circumstances led to the decision to treat the fracture by posterior arthrodesis, though this is not necessarily recommended for all spinal fractures occuring in this disease.

Aged↗
PubMedDate not supplied

Congenital atlantoaxial fusion. A case report.

An adult patient, after a minor fall, had a painful neck, and roentgenograms of the affected area showed a separate odontoid with the remnant fused to the anterior ring of the atlas. The multiple nature of the anomalies, coupled with the lack of significant trauma, indicated that the finding was that of congenital atlantoaxial fusion.

Abnormalities, Multiple↗
PubMedDate not supplied

Halo-thoracic brace management of odontoid fractures.

Thirteen patients with fracture of the odontoid were treated with halo-thoracic brace. Major trauma was responsible for the fracture in only 5. Neither the degree nor the direction of displacement prevented union, which occurred in all 13. All patients were treated for least 60 days; 11 were treated longer. No complications occurred. The method is recommended based on the results.

Adult↗
PubMedDate not supplied

Traumatic atlantoaxial dislocation causing os odontoideum in infants.

The pathogenesis of os odontoideum is still a subject of debate. The authors encountered two infants who had traumatic atlantoaxial dislocation and in whom os odontoideum later developed. One of the infants died of tardive cervical myelopathy secondary to cord compression. The authors present their concept that postnatal development of this abnormality results from fracture of the odontoid.

Axis, Cervical Vertebra↗