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At least 109 records · Page 6Linked to original sources
PubMed1996

Anterior extraoral surgery to the upper cervical spine.

STUDY DESIGN: A series of 10 patients surgically treated with prevascular or retrovascular extraoral retropharyngeal approach to the upper cervical spine is examined. OBJECTIVES: In orthopedic surgery, retropharyngeal approach may replace the transoral surgery, obviating the risks of infection and the uncomfortable postoperative course of cases in which median labiomandibular glossotomy was used to accomplish complex bone reconstruction. SUMMARY OF THE BACKGROUND DATA: The transoral approach is reported in literature as the classical anterior access to the upper cervical spine that provides direct exposure for anterior decompression of the spinal cord. The risks, the surgical limits, and the postoperative difficulties of transmucosal access suggest the use of an anterior extraoral retropharyngeal approach in orthopedic surgery. METHODS: The series includes four neoplastic lesions (osteoma, aneurismal bone cyst, giant cell tumor, solitary metastasis), three retropharyngeal ossifications resulting from diffuse idiopathic skeletal hyperostosis, and a single case of os odontoideum, craniocervical malformation, and postlaminectomy kyphosis. RESULTS: At follow-up evaluation, all patients achieved a satisfactory outcome, with good clinical and radiographic results; nasotracheal intubation obviated the need for tracheostomy. The wide surgical exposure allowed reconstruction with iliac strut bone grafts and internal fixation in six patients, avoiding the need of a halo device. The only complications were four instances of transient palsies of the marginal mandibular branch of the facial nerve. CONCLUSIONS: In the anterior surgery of the upper cervical spine, the prevascular approach allows a wide surgical exposure, with visualization similar to that obtained with median labiomandibular glossotomy. The retrovascular approach is indicated in selected cases, such as tumor adjacent to the vertebral artery and C1-C2 arthrodesis with bilateral transarticular screws according to Barbour.

Adolescent↗
PubMed1997

Traumatic vertical atlantoaxial instability in a case of atlanto-occipital coalition.

STUDY DESIGN: This is a report of a woman with an atlanto-occipital coalition who experienced a traumatic vertical atlantoaxial facet dislocation and severe associated neurologic injury. OBJECTIVE: To describe the radiographic and pathoanatomic characteristics of the injury process. SUMMARY OF BACKGROUND DATA: Severe injuries of the occipito-atlantoaxial complex are uncommon and only rarely are associated with patient survival. This is the first report of this particular injury. METHODS: Plain radiography and tomography demonstrated the facet dislocation and instability of the injury. Surgical exploration for repair of the torn dura mater and bony arthrodesis demonstrated the gross pathoanatomy. RESULTS: The patient's vertical atlantoaxial instability was stabilized, her dura mater reconstructed, and her necrologic status has improved to allow mobilization with a cane. CONCLUSION: Vertical atlantoaxial instability has not been described previously. From the somewhat subtle radiographic findings, one might underestimate the severity of the neurologic damage. Aggressive work-up and management of this injury is suggested to avoid potential further necrologic sequelae.

Accidents, Traffic↗
PubMed2003

An unusual case of CV junction tuberculosis presenting with quadriplegia.

STUDY DESIGN: Isolated tubercular involvement of craniovertebral junction in a human immunodeficiency virus-positive patient causing paraplegia and sudden death with radiologic features is presented. OBJECTIVES: Isolated involvement of craniovertebral junction by tuberculosis causing quadriparesis is a rare entity. The role of imaging features is presented in diagnosis of craniovertebral junction tuberculosis, which is a treatable disease. Early detection of this entity with prompt treatment can prevent a fatal outcome. SUMMARY OF BACKGROUND DATA: Tuberculosis of the cervical spine is a rare and potentially dangerous manifestation of extrapulmonary tuberculosis. The incidence is probably less than 1% of all cases of spinal tuberculosis. However, in the developing countries this constitutes an increasingly important cause of craniovertebral junction instability and cervicomedullary compression. Most of the patients present with pain in the neck and local tenderness. Neurologic deficits of varying degrees have been reported in 24-40% of cases of craniovertebral junction tuberculosis. Quadriplegia followed by sudden death is exceptional (as seen in our case). The incidence of craniovertebral junction tuberculosis in immunocompromised patients is not known. Dramatic recovery is possible if craniovertebral junction tuberculosis is detected early in its course. Prompt medical and surgical treatment may avert a potential catastrophic event in such cases. Imaging methods such as computed tomography and magnetic resonance imaging are diagnostic of this condition and aid in the detection and prompt treatment of the same. METHOD: Frontal radiograph of the cervical spine and chest, and lateral view of cervical spine followed by plain and contrast enhanced computed tomography scan of the cervical spine was performed to detect the lesion. RESULT: These radiographic features were correlated with the clinical findings. The computed tomography findings of bone destruction, prevertebral and extradural peripherally enhancing soft tissue and infiltrating opacities in the lung apexes were consistent with tuberculosis. CONCLUSIONS: The computed tomography findings described in this report are very specific for tuberculosis of the craniovertebral junction. Clinical and radiologic correlation could help in making the early diagnosis and prompt treatment possible.

Adult↗
PubMed1978

Radiological study of cervical spine and hand in patients with rheumatoid arthritis of 15 years' duration: an assessment of the effects of corticosteroid treatment.

Radiological abnormalities in the cervical spine were assessed in detail in a group of 62 patients with rheumatoid arthritis of approximately 15 years' duration, of whom 33 had been treated with corticosteroids and 29 had not. The 10 criteria of damage described by Bland (1974), which include subluxation, correlated as a whole with the severity of the disease in general but not with the duration of corticosteroid treatment. Subluxation alone, whether assessed in the cervical spine as a whole or in the atlanto-axial joint alone, was less closely related to disease activity, was on average greater in patients treated with corticosteroids, and tended to increase in relation to the duration of treatment. Corticosteroid treatment thus tends to produce, over the course of years, a degree of subluxation in addition to that caused by the disease itself. Radiological signs of damage to the metacarpophalangeal (MCP) joints and carpal bones correlated with both the degree of damage and the degree of subluxation in the cervical spine as well as with corticosteroid treatment. Mutilans deformity at the MCP joints was associated with subluxation in the neck and with corticosteroid treatment.

Adrenal Cortex Hormones↗
PubMed1978

Anatomical observations of the foramina transversaria.

Four hundred and eighty foramina transversaria in dry cervical vertebrae of 36 spines and in a number of dissections were studied and classified according to size, shape, and direction of their main diameter. A coefficient of roundness was then elaborated. The variations of foramina appear to follow a pattern at various vertebral levels. The possible factors (in addition to the embryological ones) involved in causing these variations-for example, mechanical stress, size, course, and number of vertebral vessels-were analysed. The importance of the correct interpretation of the variations in the foramina transversaria in radiographic or computerised axial tomography is discussed. The contribution of the present study to the understanding and diagnosis of pathological conditions related to the vertebral artery and its sympathetic plexus is stressed.

Adult↗
PubMed1995

Substantial head trauma: value of routine CT examination of the cervicocranium.

PURPOSE: To evaluate the usefulness of routine performance of computed tomography (CT) of the craniocervical junction in unconscious patients with substantial head injury. MATERIALS AND METHODS: In a prospective study, CT of the head and the cervicocranium was performed in 202 patients with substantial cranial trauma (Glasgow Coma Scale scores of 3-6). Plain radiography was performed in all patients. Radiographs and CT scans were then blindly interpreted. RESULTS: Twenty-eight patients (13.9%) had C-1 or C-2 fractures; plain radiographs did not demonstrate cervical fractures in 11 of these patients. Nine patients (4.4%) had fractures of the occipital condyles; plain radiographs did not demonstrate occipital condyle fractures in eight of these patients. CONCLUSION: Because 5.4% of all patients had fractures of either C-1 or C-2 and 4.0% had occipital condyle fractures not seen at plain radiography, routine additional performance of CT of the craniocervical junction is useful in patients with substantial cranial trauma.

Adolescent↗
PubMed2001

The cervicocranium: its radiographic assessment.

Acute injuries of the cervicocranium (from the occiput to the second cervical intervertebral disk) may be radiographically obscure due to minimal displacement of fracture fragments, minor alterations of normal anatomic relationships (occipitoatlantal subluxation), or superimposition of normal skeletal structures. With the nasooropharynx adequately distended with air, the normal cervicocranial prevertebral soft-tissue contour is congruent with the anterior cortical margin of the cervicocranium; namely, concave above, convex anterior to, and concave below the anterior tubercle of C1. Alterations of the normal cervicocranial prevertebral soft-tissue contour due to hemorrhage into the retropharyngeal fascial space from subtle fractures or ligamentous injuries should prompt further assessment of the cervicocranium by means of computed tomography (CT). Cervicocranial CT prompted by an abnormal cervicocranial prevertebral soft-tissue contour has yielded a 16% positive injury rate, approximately three times the rate of acute cervical spine injuries reported in the literature.

Adult↗
PubMed1977

Congenital anomaly of the odontoid in children. A report of four cases.

The embryologic origins of congenital abnormalities of the odontoid process are reviewed. Four cases of odontoid dysgenesis in childhood are presented. All of our cases were associated with a head injury, which subsequently led to the diagnosis. Pain was the most common presenting complaint in our patients. Decreased cervical mobility was the most consistent physcial finding. There was no major neurological defect implicating spinal cord compression in any of our patients. This is not true of adults with congenital abnormalities of the odontoid, particularly those with atlantoaxial instability. The diagnosis of odontoid dysgenesis is a radiographic one. Flexion-extension films, tomograms and cineradiograms are often required to make the diagnosis. C1-C2 subluxation, either anterior or posterior is often found. Prompt posterior cervical fusion is recommended as the treatment of choice.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Cervicomedullary compression by separate atlantal lateral mass.

Compression of the cervicomedullary junction can result from a variety of congenital craniovertebral anomalies. We report an unusual case of cervicomedullary compression by a free lateral atlantal mass associated with contralateral occipito-atlantal fusion.

Brain↗