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PubMedDate not supplied

Traumatic fractures of the craniovertebral junction. Management of 23 cases.

Twenty-three consecutive cases of traumatic C1-C2 fractures treated at the Department of Neurosurgery, University of Milano, are reported. Of these there were 13 cases of odontoid fractures, 6 hangman fractures, 2 anterior inferior corner fractures, 2 atlas-axis combination fractures and 2 Jefferson fractures. Almost all the patients were young people involved in motor vehicle accidents. Nineteen patients were treated with external immobilization (halo vest, Minerva) for 3-6 months while 4 odontoid fractures underwent early surgical posterior stabilization. At follow-up, 20 patients had a good fusion while 3, aged over 75 years, died due to cardiopulmonary or septic complications. The appropriate management of this type of lesion is still a matter of discussion. In our opinion the Halo device allows good stabilization after correct fracture reduction.

Adolescent↗
PubMed1989

Computed tomography of bones and joints.

The monograph sums up the problem of CT diagnosis of bones and joints making use of predominantly the authors' own experience based on CT tests of more than 45,000 patients examined at the Department of Radiology, Charles University Medical Faculty of Hygiene teaching hospital in Prague in the years 1980-1988. Specific scans of the skeleton were made in 4,500 patients, mostly for suspicion or closer assessment of neoplasms (43.5%), the radicular lumbosacral syndrome (34.5%), and injuries (12%). The opening chapters sum up basic facts about the principle of computed tomography, the apparatus in use, the evaluation of CT images, CT radiation doses, and the patients' preparation for CT scanning. The use of contrast media is discussed with regard to the possible hazards involved and to the need to hear allergological opinion first. For spinal canal visualization non-ionogenic contrast media are used exclusively. The management of side reactions to contrast medium application is also reviewed. Indications for bone and joint computed tomography now comprise a whole series of traumatological, orthopaedic, oncological, rheumatological, neurological and rehabilitation conditions, each of which is discussed in detail in a separate chapter. CT anatomical studies offer the advantage of being applicable even in patients examined for other than bone or articular diseases. The option of simultaneous soft tissue assessment represents another advantage. The authors describe different anatomical structures in terms of CT images, some of them complete with dimensional and density values. The chapter on anomalies and developmental variants stresses the relevance of computed tomography for precise characteristics of clefts of the spinal column and facial bones and for the diagnosis of anomalies and dysplasias of the spinal column and the chest. A rare case of cephalothoracopagus is demonstrated. As for traumatology, computed tomography is found useful in diagnosing fractures of the orbit and facial bones in general, the atlas, axis and pelvis and in tracing vertebral fragments displaced into the spinal canal. Computed tomography occupies a monopoly position in the diagnosis of post-injury haematomas of intracranial but also thoracic, pelvic and abdominal localization. There is a wealth of illustrations to document a wide range of traumatic conditions. The chapter on degenerative diseases is focused mainly on computed tomography in the lumbosacral radicular syndrome, one of the most frequent and also most effective indications for CT. Protrusion and herniation of the intervertebral disk and sequestra in the spinal canal are all absolute indications for CT scanning where surgical treatment is contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthrography↗
PubMed1987

[Critical study of radiculomedullary and neuromuscular complications of ankylosing spondylitis].

Medullo-radicular and neuro-muscular involvements of ankylosing spondylarthritis, often reported in an analytic fashion in the literature, deserve to be the subject of a critical study. Various neurological manifestations secondary to exceptional atlo-occipital and sometimes axis-atlas subluxations and medullary lesions as well as syndromes of the cauda equina. The medullary lesions have an epidural origin (3 cases in the literature, 2 cases from the authors) or are secondary to a spondylodiscitis (4 cases in the literature) or secondary to both (1 case reported by the authors). As for syndromes of the cauda equina the authors report 3 cases to be added to the 55 published previously. It concerns always old spondylarthritis. The lesions combine posterior diverticula and lesions of the lamina. The treatment is usually ineffective. A special case is represented by forms with trophic disorders. More debatable are the radicular lesions, which, except for intercostal pain, should be linked to local pain. Electromyographic abnormalities are of no significance. Alterations of the paravertebral muscles viewed on the scanner X have, for now, an uncertain significance. Finally, various associations, without significance such as multiple sclerosis, diffuse muscular lesions and the classic spondylotic pseudo-tabes, should be rejected.

Adult↗
PubMed1980

[Articular chondrocalcinosis revealed by acute cervical symptoms simulating meningitis (author's transl)].

Four cases of acute cervical pain with high fever and important stiffness of the cervical spine, leading to study the cerebrospinal fluid in emergency, are reported. All cases had elevated erythrocyte sedimentation rate. Recovery was obtained in all cases in a few days without treatment. The cerebrospinal fluid was normal in the three cases studied. In three patients the roentgenograms demonstrated calcified cervical cartilages, mainly in the atlas-axis joint, and osteo arthritis-like arthropathies. This syndrome, simulating meningitis revealed the calcium pyrophosphatecrystal deposition disease in the four cases. Crystal-induced arthritis of the cervical spine is suggested but not demonstrated.

Acute Disease↗
PubMed1993

Mice homozygous for a targeted disruption of Hoxd-3 (Hox-4.1) exhibit anterior transformations of the first and second cervical vertebrae, the atlas and the axis.

Gene targeting in embryo-derived stem (ES) cells was used to generate mice with a disruption in the homeobox-containing gene Hoxd-3 (Hox-4.1). Mice homozygous for this mutation show a radically remodeled craniocervical joint. The anterior arch of the atlas is transformed to an extension of the basioccipital bone of the skull. The lateral masses of the atlas also assume a morphology more closely resembling the exoccipitals and, to a variable extent, fuse with the exoccipitals. Formation of the second cervical vertebra, the axis, is also affected. The dens and the superior facets are deleted, and the axis shows 'atlas-like' characteristics. An unexpected observation is that different parts of the same vertebra are differentially affected by the loss of Hoxd-3 function. Some parts are deleted, others are homeotically transformed to more anterior structures. These observations suggest that one role of Hox genes may be to differentially control the proliferation rates of the mesenchymal condensations that give rise to the vertebral cartilages. Within the mouse Hox complex, paralogous genes not only encode very similar proteins but also often exhibit very similar expression patterns. Therefore, it has been postulated that paralogous Hox genes would perform similar roles. Surprisingly, however, no tissues or structures are affected in common by mutations in the two paralogous genes, Hoxa-3 and Hoxd-3.

Animals↗
PubMed1987

Pyogenic osteomyelitis of the occiput, the atlas, and the axis. A report of five cases.

Pyogenic osteomyelitis rarely affects the first and second cervical vertebrae, and when it does it can progress to abscess formation, compressing the spinal cord. If the process is unrecognized, it can be fatal. The cases of five patients are reported. Two patients were treated by anterior débridement and posterior cervical-occipital arthrodesis; one, by transoral drainage; one, by posterior cervical-occipital arthrodesis; and the fifth, by posterior atlanto-axial arthrodesis. The causative organism was Staphylococcus aureus in four patients and Pasteurella multocida in one. In all patients, intravenous antibiotics were used, followed by prolonged administration of oral antibiotics. All five patients recovered.

Aged↗