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Results for “Axis, Cervical Vertebra”

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PubMedDate not supplied

Sequelae of atlantoaxial stabilization in two patients with Down's syndrome.

Two patients with Down's syndrome and associated atlantoaxial instability with a chronically narrow spinal canal at C1-2 underwent surgical procedures in which the lesion was manipulated and posterior wiring and fusion were done. Both patients developed quadriplegia from the surgery. The authors recommend preoperative traction to reduce the deformity, then surgery with the traction maintained as a method to avoid this complication. Further, if reduction does not occur with traction, onlay grafting is recommended, avoiding any sublaminar wiring.

Adult↗
PubMedDate not supplied

Spontaneous atlantoaxial subluxation as a presenting manifestation of juvenile ankylosing spondylitis. A case report.

Juvenile-onset ankylosing spondylitis is an unusual disorder which can present with either peripheral arthritis or with more classic hip girdle and back symptoms. Atlantoaxial instability has been recognized as a late complication in only one patient and has not been reported as an early manifestation. This paper presents a case in which atlantoaxial instability and neck pain without neurologic involvement was a presenting manifestation. The laboratory and clinical features of juvenile ankylosing spondylitis are discussed, along with the importance of qualitative sacroiliac joint scintigraphy in the diagnosis of early or confusing cases.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Avascular necrosis of the dens: a follow-up study.

In order to determine the long-term consequences of avascular necrosis of the dens following halo-pelvic traction, 83 patients who had had their halo-pelvic apparatus removed at least five years previously were studied. Avascular necrosis of the dens was found in 31 patients (37%) within one year of removal of the apparatus, but after a minimum of five years the early bony changes had resolved and there was no evidence of atlantoaxial instability. However, 19% of patients who had had avascular necrosis had moderate or severe neck symptoms.

Adolescent↗
PubMedDate not supplied

Locked facets with fracture of the neural arch of the axis.

This report describes a rare variant represented by the association of locked facets at C2-3 with a fracture of the neural arch of the axis. Fracture of the neural arch of the axis is a broad term including the Hangman fracture, traumatic spondylolisthesis of the axis, fractures of the arch of the axis, or the more recently described fractures of the ring of the axis.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Spondylolysis of the axis. Report of four cases.

Spondylolysis or spondylolisthesis of the cervical spine, especially of the upper cervical spine, is very rare. The authors report four cases of spondylolysis of the axis and outline its roentgenographic features for differential diagnosis. The clinical course of the cases and the unvarying roentgenographic findings throughout the course strongly suggest that the lesion is congenital in origin.

Adult↗
PubMed1984

The nonsurgical management of odontoid fractures in adults.

Twenty-five odontoid fractures that were treated nonsurgically at the University of Virginia Hospital in the last 5 years were reviewed. Motor vehicle accidents were the major cause of this injury in our series. Early recognition and firm external stabilization of Type I and Type III fractures of the odontoid resulted in union in 100% of our patients. There were 12 Type II fractures with a nonunion rate of 42%. Thus, an overall rate of union of 80% was obtained. It is suggested in the literature and by this series that early recognition, reduction, and rigid external immobilization of Types I and III fractures of the odontoid should promote bony union. Type II fractures may also be managed successfully by closed methods, although the outcome is less certain.

Adolescent↗
PubMed1984

Lumbosacral spinal fusion. A biomechanical study.

The effects of spinal fusion on fused segment and the adjacent, unfused segments play a significant role in the clinical effectiveness of spinal fusion for low-back pain with or without sciatica. Much of the information on this important subject is derived from clinical impressions. The purpose of this biomechanical study is to investigate the altered kinematics and biomechanics of the three different types of spinal fusion (posterior, bilateral-lateral, and anterior) on the adjacent, unfused segment as well as within the fused segment and to investigate their clinical implications. Sixteen fresh human cadaver lumbosacral spines were tested under a simulated physiologic loading condition. The test specimens included three motion segments, L3-4, L4-5, and L5-S1. To study the mechanics of the lumbar spine under combined compression and bending loads, a special apparatus was designed. These loads were applied by an MTS machine through two sets of pulley systems. The loads, as well as displacement data from both actuators, were recorded. A video camera system was utilized to record the kinematics of the spinal motion segment. The unfused specimen was tested first, and the fused specimen then was retested under the identical loading conditions. A total of 16 spine specimens were tested and evaluated--five posterior, four bilateral-lateral, and seven anterior fusions. All types of fusion resulted in increased bending and axial stiffnesses. Overall, anterior fusion provided the largest increase in stiffness, followed by bilateral-lateral fusion and posterior fusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Computed axial tomography in C1-C2 trauma.

Twenty patients with C1-C2 vertebral trauma underwent computed tomographic (CT) scans to evaluate prospectively its efficiency for diagnosis and treatment. It is suggested that if standard roentgenograms are inconclusive, CT scan is recommended for further evaluation of C1 fractures and C1-C2 rotatory subluxation in preference to tomography and cineradiography. CT scans do not assess dynamic stability and may miss minimally displaced odontoid fractures. It was also concluded that they add little in the treatment of hangman's fractures, although scanning did show that the pathology was often more complex than anticipated. The clinician must be aware of the capabilities and the limitations of the specific scanner in use and work closely with the radiologist to maximize the yield of information. The CT scan is very helpful as an adjunct to standard x-ray studies, but is not recommended as a screening procedure.

Adolescent↗
PubMed1985

A transverse fracture through the body of the axis. A case report.

Fractures of the axis most often involve the neural arches (Hangman's fractures) or the odontoid. Few articles describe fractures involving the body of the axis. No article nor standard fracture text was found that illustrates a transverse fracture through the body.

Adult↗
PubMed1987

Odontoid fractures treated with halo-vest.

In a consecutive series of 75 patients with unstable cervical spine injuries treated with halo-vest, 1976-1984, a total of 14 patients (comprising 18.7%) had odontoid fractures. Of the patients with odontoid fractures, 1 patient had an incomplete tetraparesis. All patients except 1 were treated within the first day after the trauma. A total of 50% were injured in motor vehicle accidents. The odontoid fracture was reduced by skull traction and then stabilized with a halo-vest for 12 weeks. One patient died within the first 2 weeks after the injury. There were no other serious complications during the treatment. The initial dislocation and reduction was studied. Ten patients were followed-up after 2 years. Another 2 patients died of other causes during that time. One had an Anderson-d'Alonzo Type II fracture that failed to unite. Different prognostic factors were analyzed. Fracture gap and fracture type may have contributed to nonunion. Only 1 patient was totally free from symptoms after 2 years. The halo-vest was well tolerated in all patients and assured a high percentage of healing.

Adult↗
PubMed1987

CT-functional diagnostics of the rotatory instability of upper cervical spine. 1. An experimental study on cadavers.

Twelve specimens of the upper cervical spine were functionally examined by using radiography, cineradiography and computerized tomographic (CT) scan. The range of rotation was measured from CT images after maximal rotations to both sides. The left alar ligament was then cut and the examination repeated. The alar and transverse ligaments could be differentiated on CT images in axial, sagittal, and coronal views. Rotation at occiput-atlas was 4.35 degrees to the right and 5.9 degrees to the left and at atlas-axis it was 31.4 degrees to the right and 33 degrees to the left. After one-sided lesion of the alar ligament, there was an overall increase of 10.8 degrees or 30% of original rotation to the opposite side, divided about equally between the occiput-atlas and the atlas-axis. It is concluded that a lesion (irreversible overstretching or rupture of alar ligaments) can result in rotatory hypermobility or instability of the upper cervical spine.

Axis, Cervical Vertebra↗
PubMed1987

Upper cervical involvement in rheumatoid arthritis.

Atlanto-axial dislocation and upward migration of the odontoid were studied in patients with rheumatoid arthritis treated conservatively and those treated by atlanto-axial posterior fusion. Upward migration of the odontoid was evaluated by Ranawat's and Redlund-Johnell's methods after determining the normal range in healthy Japanese adults. Of the 100 patients treated conservatively, atlanto-axial dislocation was found in 49% and upward migration of the odontoid in 26% by the former method, and in 8% by the latter method. The detection rate of these lesions increased with the increase in the duration of the disease and progression of rheumatoid lesions. Abnormal Ranawat values are associated with lesions in the C1-C2 segment and abnormal Redlund-Johnell values with 0-C2 lesions. The latter suggests severe conditions and seems to be a useful indicator for the diagnosis of upward migration of the odontoid in our study. Though rheumatoid lesions in the upper cervical spine mainly involved the C1-C2 level, marked deterioration of the atlanto-occipital joints was also occasionally observed. Therefore, in surgical treatment, attention should be paid also to this region. Patients with abnormal Redlund-Johnell values require spinal fixation including the occipital bone.

Adult↗
PubMed1987

Management of the fractured odontoid with halo-thoracic bracing.

This study of 65 cases of fractured odontoid indicates that halo-thoracic bracing is an effective method for treatment of the Types II and III fractures. There were 28 Type II, and 19 Type III fractures treated with halo-thoracic braces. Of these 47 patients, only 4 went on to nonunion after an average of 8 weeks in the brace, a rate of bony union of 91.5%. Seven of the remaining 18 patients underwent primary fusion at C1-2, two were treated in Guilford braces, and six received no treatment. Surgery was performed if the fracture was unstable, if the patient could not be relied upon to leave the halo in place, or if the patient chose it as primary treatment. All seven of these patients went on to bony fusion. All of the six patients who refused treatment went on to nonunion of the fracture. Three patients were lost to follow-up.

Adolescent↗