The Homologies and Comparative Anatomy of the Atlas and Axis.
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Journal Article↗
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Transoral approach to the cervical spine: report of four cases.
The transoral approach to the upper cervical spine is an established but little used route, offering excellent access with good wound healing, to lesions of the bodies of the atlas, axis and upper part of the third cervical vertebra. The authors report four cases which demonstrate the value of the procedure.
Adult↗
Autotomography: a means of improving visualization of the upper cervical spine.
Autotomography permits improved visualization of the atlas-axis and occipito-cervical articulations with virtually any x-ray equipment in less time than is required for anteroposterior and lateral tomograms. This technique is best applied in nontraumatic cases in which the dens is not seen clearly on the "open mouth view".
Axis, Cervical Vertebra↗
Microsurgical anatomy of the region of the foramen magnum.
The anatomy needed to plan microoperative approaches to the region of the foramen magnum was examined in 25 cadaveric heads. The structures examined included the lower cranial and upper spinal nerves, the caudal brain stem and rostral spinal cord, the vertebral artery and its branches, the veins and dural sinuses at the craniovertebral junction, and the ligaments and muscles uniting the atlas, axis, and occipital bone. The transoral, transpalatal, labiomandibular, glossolabiomandibular, transsphenoidal, transcranial-transbasal, transcervical, and suboccipital operative approaches to the region are also reviewed.
Atlanto-Occipital Joint↗
Modified neck muscular system of the giraffe (Giraffa camelopardalis).
The muscular and skeletal systems of the long neck were morphologically examined in order to clarify their modification and their functional significance in the giraffe (Giraffa camelopardalis). The longissimus, the thoracic and cervical, spinalis and semispinalis, the cranial and caudal head oblique, and the multifidus muscles, and the nuchal ligament were observed at their origin and insertion. The atlas, axis, and the third cervical vertebra were measured and examined. The modified spinous processes provided the large attachment surface for the strong nuchal ligament and for the muscles of the axis and other cervical vertebrae, while the muscle tendons had their origin in the ventrocaudally-enlarged transverse process. It is concluded that the modified muscles with their expanded belly and tendon have the functions of occupying the interspace among long vertebrae, and also of supporting the head and neck by means of their wide attachment to the altered vertebral processes.
Animals↗
Complex atlantoaxial fractures.
OBJECT: The authors conducted a retrospective study to evaluate the treatment of complex C1-2 fractures. METHODS: There were 10 cases of complex C1-2 fractures. Six patients were men (median age 58 years) and four patients were women (median age 55.5 years). Injuries resulted from seven falls, two motor vehicle accidents, and one diving incident. Three patients suffered from upper-extremity weakness. Neurological function in seven patients was intact preoperatively. Fracture combinations included six Jefferson/Type II odontoid, two anterior ring/Type II odontoid, one posterior ring/Type II odontoid, and one posterior ring/Type III odontoid/Type III hangman's fracture. All patients underwent surgery, five after halo immobilization for an average of 4 months failed to provide stability. Treatment included placement of six odontoid screws, one posterior C1-2 transarticular screw, one odontoid screw with anterior C1-2 transarticular screw fixation, one C1-2 transarticular screw with C1-2 Songer cable fusion, and one odontoid screw with bilateral C-2 pedicle screw fixation. Specific treatment was determined by the combination of fractures. Postoperatively, all patients were immobilized in a hard collar for 3 months. There were no intraoperative surgery-related complications. The mean follow-up period was 28.5 months. Neurological recovery was observed in one of three patients who presented with neurological deficits. Fusion occurred in all cases. CONCLUSIONS: The goals in treating these complex fractures are to achieve early maximum stability and minimum reduction in range of motion. These are often competing phenomena. Frequently in cases of atlas-axis fracture, odontoid screw fixation combined with hard collar immobilization is the best therapy, provided the transverse atlantal ligament is competent. If not, C1-2 stabilization with placement of transarticular screws is required for best results.
Adult↗
[Palmer-Sandberg-Gutmann chiropractic diagnosis of the atlanto-occipital joint from the conventional medical and radiologic viewpoints].
There can be no lateral displacement of the atlas (massae laterales) in relation to the condyles, because this is impossible from an anatomical point of view, neither "angular" (atlas A rule) nor "non-angular" (atlas B rule) in the sense of the "hole-in-one (HIO)" diagnostic method evolved by the U.S. chiropractor Palmer. The course of the condyle baseline is not altered by a lateral displacement of the atlas in relation to the condyles, but by a tilting rotation of the condyles in respect of the atlas. Rotatory movements will result, among other phenomena, in a change of the course of the condyle and atlas baseline due to projection-produced changes in the region of the atlanto-occipital and atlas-axis joints. Last but not least, the course of the condyle and atlas baseline is also influenced by other functional parameters, another important parameter being an asymmetrically constructed joint.
Atlanto-Axial Joint↗
Posterolateral approach to the atlas and the axis.
We have developed a new surgical approach to the atlas and the axis including the odontoid process, in which the vertebral artery is transposed and an access to their lateral aspects without exposing the anterior structures of the neck is achieved. A case of successful excision of a bone tumor of the lateral mass of the atlas and a hypertrophic odontoid process by this approach is described.
Adolescent↗
Rotatory subluxation of the atlas on the axis.
The clinical findings of rotatory subluxation of the atlas are subtle and x-ray films involving the upper cervical segment are difficult to interpret. Nevertheless, patients with rotatory subluxation must be separated from those with "stiff necks," for they require hospital admission for cervical traction if complications are to be avoided. A case is reported and management and diagnosis are reviewed.
Accidents, Traffic↗
About the treatment of fractures of the odontoid process with dislocation in front of the atlas on the axis.
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Ascomycota↗
C1-2 block vertebra. Fusion of the anterior arch of the atlas with the axis. Follow-up of the fusion in a child.
A peculiar form of C1-2 block vertebra (anterior arch of the atlas with the axis) is described. The progressive ossification is followed up in a child from the age of 9 to 15. The author also reviews the data of his five previously reported cases.
Adolescent↗
[Post-traumatic instability between the atlas and the axis in children. Apropos of 5 cases].
The authors have observed 5 cases of atlanto-axial instability in children aged from 18 months to 8 years. All the cases were seen after severe trauma and presented with abnormal neurological signs. All patients were first treated conservatively and were operated on secondarily by atlanto-axial fusion using graft and wiring for persistent radiological instability between the atlas and axis. In two cases instability was due to an atlanto-axial subluxation with rupture of the transverse ligament; one of these was reduced by traction. In one case there was an anterior subluxation without fracture. In one case there was a fracture of the odontoid process in which instability persisted in spite of bony union of the fracture. In the last case, the odontoid process was intact shortly after the trauma but its central portion disappeared secondarily. The cause of this disappearance is discussed.
Atlanto-Axial Joint↗
[A case of Jefferson fracture treated with the Sof'wire cable system method of fixation].
Jefferson fracture is a very rare disease which occurs in only 2-13% of all cervical spinal fracture cases and in only 1.3% of total spinal fracture cases. A combination of an atlas-axis fracture occurs relatively frequently and with a higher incidence of neurological morbidity than isolated fractures. However, a Jefferson fracture, which is an isolated C-1 fracture, occurs very rarely. A 58-year-old woman was involved in a traffic accident and admitted to our hospital. She had a large scalp laceration in the parietal region and complained of nuchal pain. Neurological examination revealed nothing abnormal. A cervical x-p (lateral view) revealed no abnormal findings, but an open-mouth view revealed an 8 mm displacement (in total) in the lateral mass of the atlas. A cervical CT revealed a Jefferson fracture. Crutchfield traction was performed for 9 days followed by external immobilization with a halo-vest to allow the patient to be ambulatory quickly. A posterior occipitocervical fusion was performed with an iliac bone autograft using the Sof'wire Cable system for late cervical stability and reducing the period of rigid external immobilization. The postoperative state was uneventful. The halo-vest was removed 10 weeks after surgery. An x-p obtained 3 months postoperatively showed good stability of the cervical spine. The Sof'wire Cable system proved to be very useful.
Accidents, Traffic↗
[Atlanto-axial kyphosis].
Atlantoaxial kyphosis (AAK) is a rare sagittal deformity of the occiptoatlantoaxial junction. It is defined as a subgroup of anterior translatory atlantoaxial instability. AAK is a symptom of several ligamentours or bony disorders of the craniocervical junction; however, rheumatoid arthritis and trauma are the most common causes for AAK. AAK can be diagnosed on lateral radiographic views of the upper cervical spine if the angle between McGregor's line and the atlas plane is less than-15 degrees or the atlas-axis angle is greater 105 degrees. Treatment modalities for AAK depend on the ability to reduce the deformity. If closed reduction is achieved, posterior atlantoaxial fusion by sublaminar wiring according to Brooks or transarticular screw fixation according to Magerl are possible choices. Irreducible AAK can be treated with a combined transoral decompression, anterior plating according to Harms, and posterior wiring according to Brooks. This staged therapy for AAK was successful in our rheumatoid patient population with AAK.
Atlanto-Axial Joint↗
Unusual massive neurinoma in the suboccipital region--case report.
An 8-year-old boy with no evidence of von Recklinghausen's disease presented with an unusual neurinoma manifesting as a gradually progressive swelling in the suboccipital region over 2 years. The lesion was massive and had widely eroded the posterior aspects of the atlas, axis, and suboccipital bone. The tumor had involved the dura of the sigmoid and transverse sinuses, was highly vascular, and had encased the ipsilateral vertebral artery. The tumor was almost completely resected although with considerable loss of blood through a large rent in the right sigmoid sinus. This unusual benign neurinoma most probably arose from the second cervical ganglion.
Child↗
The interspinous method of posterior atlantoaxial arthrodesis.
Thirty-six patients underwent C1-2 posterior wiring and fusion procedures over a 5-year period for unstable C-2 fractures (eight cases), unstable atlas-axis combination fractures (six cases), rheumatoid C1-2 instability (14 cases), os odontoideum (four cases), traumatic C1-2 ligamentous instability (three cases), or instability secondary to a C-2 tumor (one case). In each case, the atlantoaxial arthrodesis utilized sublaminar wire at C-1 and incorporated an iliac-crest strut-graft positioned between the posterior arches of C-1 and C-2, held in place by securing wire around the base of the spinous process of the axis. Follow-up examination was performed in all patients after a mean postoperative duration of 33.7 months. The technical aspects and clinical merits of this fusion procedure, which led to a 97% union rate (one nonunion) and minimal morbidity and mortality rates, are presented.
Adult↗
[Clinical diagnosis and treatment of multiple-level injuries of the cervical spine].
OBJECTIVE: To investigate the character, diagnosis and treatment of multiple-level fractures of the cervical spine. METHODS: Forty-three patients (38 male, 5 female) with multiple-level fractures of the cervical spine were retrospectively analysed in our hospital from 1988-2001. RESULTS: Among 36 patients with multiple contiguous fractures of the cervical spine, 32 cases were injured at low cervical spine; 7 patients were non-contiguous spinal fractures in which there were 5 cases injured at upper and lower cervical spine. The frequently injured sites were vertebral body (31 patients), laminae (25 patients), spinous process (9 patients), vertebral arch (4 patients), transverse process (5 patients), lateral mass (5 patients); level frequently affected were C(4), C(5), C(6) and C(7); 21 patients were treated with anterior vertebrectomy and fusion, 10 patients with posterior laminectomy and fixation, 2 patients with both anterior and posterior decompression and fixation. 60.5% were flexion-compression injury. 10 patients with conservative treatment. CONCLUSIONS: Contiguous type was more common than non-contiguous type in multiple level cervical spinal fractures; Injured sites always located at lower cervical spine in contiguous cervical fractures different from that fractures of atlas, axis and lower cervical spine in non-contiguous type; Unstable segments and level of spinal cord injury were at lower cervical spine; Operations must obtain both decompression and stability of spine.
Adolescent↗
The clinical characteristics and therapy of syndrome of craniocerebral-cervical vertebral injury.
OBJECTIVE: To explore the clinical characteristics and new treatment for syndrome of craniocerebral-cervical vertebral injury. METHODS: The clinical data of 52 patients with head injury accompanied by neck injury were analyzed retrospectively. RESULTS: Craniocerebral injury could result in damage to cervical vertebrae, muscles, vessels and nerves, and even cause vertebral artery injury, which may lead to insufficient blood-supply of vertebral-basal artery. All patients were treated with cervical vertebral traction and the results were good. CONCLUSIONS: Acute craniocerebral injury with symptom of insufficient blood-supply of vertebral-basal artery, evident neurosis and atlas-axis half-dislocation in X-ray should be treated by cervical vertebral traction, which will yield better outcome.
Adolescent↗