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Atlanto-axial arthrodesis by the wedge compression method.

Fifteen patients with atlanto-axial instability (secondary to os odontoideum in three, nonunion of an odontoid fracture in seven, acute odontoid fracture in three, and rheumatoid arthirtis in two) were treated by wedge compression arthrodesis of the atlanto-axial joint. One patient died at home eight weeks after fusion with the cause of death never established. Of the two patients with rheumatoid arthritis (ankylosing spondylitis), one had a non-union and in the other the posterior arch of the atlas fractured and the fusion had to be extended up to the occiput and down to the third cervical vertebra. The procedure is rarely indicated in patients with long-standing rheumatoid arthritis or severe osteopenia.

Adult↗

Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis.

STUDY DESIGN: This study assessed numerous structural features of the second cervical vertebra (C2), describing the projection point of the pedicle on its posterior aspect. OBJECTIVES: Evaluation of the specimens included quantitative description of 18 linear and four angular parameters, which then were correlated between male and female specimens. The point of projection of the C2 pedicle axis was described with an emphasis on a perspective relevant to a posterior approach. SUMMARY OF BACKGROUND DATA: The literature regarding the anatomy of the axis focuses mainly on the dens. Very little research regarding the quantitative study of the C2 pedicle has been reported. METHODS: Fifty dry C2 cervical vertebrae (30 male, 20 female) were obtained for anatomic measurements. Anatomic evaluation focused on the pedicle, vertebral body, dens, superior facet, and vertebral canal. All measurements were made using calipers and a standard rule linear measurements and a goniometer for angular measures. Based on the measurement of 50 specimens, including 18 linear and four angular parameters, the mean, range, and standard deviation were calculated for all of the specimens and for male and female separately. RESULTS: A significant difference was found to exist for 11 of 18 linear measurements and one of four angular parameters. The projection point of the pedicle axis on the posterior aspect of the lateral mass was described with an emphasis on a perspective relevant to a posterior surgical approach. The location of the projection point of the pedicle axis was found to be 5.4 +/- 1.2 mm inferior to the horizontal line, and 7.2 +/- 1.3 mm lateral to the vertical line. The pedicle axis was found to lie at 33 degrees in the medial direction and 20 degrees in the superior direction form the point of pedicle axis projection. CONCLUSIONS: When the techniques described here are used, the findings may be helpful in cases involving C2 when surgical intervention and instrumentation are desired.

Adult↗

C2 over C3 spondyloptosis in a case with absent posterior elements. Report of an unusual case and analysis of treatment options.

We report an extremely rare anomaly in a 31-year-old male patient, where the posterior elements of the axis were almost completely absent and the anterior elements were dislocated anterior to the body of the C3 vertebra. The body of C3 caused severe compression of the high cervical cord. A radical transoral decompression and plate and screw fixation resulted in sustained clinical improvement. The relevant literature is briefly reviewed and the treatment options in such a case are analyzed.

Adult↗

Atlas fractures: treatment and long-term results.

Fractures of the first cervical vertebra (C1) represent approximately 7% of all acute cervical spine fractures. Frequently, the atlas will be fractured in combination with the axis (44% of cases). Treatment of isolated C1 fractures should be governed by the rules of Spence. The treatment of combination C1-C2 fractures is dictated by the type and severity of the C2 fracture. Experience with 57 cases of acute traumatic atlas fractures are reviewed. The long-term outcome from an atlas fracture is good (median follow-up, 40 months).

Adolescent↗

[Grisel's syndrome].

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Axis, Cervical Vertebra↗

An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth.

The present study aimed to provide a version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth based on the analysis of the second through fourth cervical vertebrae in a single cephalogram. The morphology of the bodies of the second (odontoid process, C2), third (C3), and fourth (C4) cervical vertebrae were analyzed in six consecutive cephalometric observations (T1 through T6) of 30 orthodontically untreated subjects. Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. The analysis consisted of both visual and cephalometric appraisals of morphological characteristics of the three cervical vertebrae. The construction of the new version of the CVM method was based on the results of both ANOVA for repeated measures with post-hoc Scheffé's test (P < .05) and discriminant analysis. The new CVM method presents with five maturational stages (Cervical Vertebral Maturation Stage [CVMS] I through CVMS V, instead of Cvs 1 through Cvs 6 in the former CVM method). The peak in mandibular growth occurs between CVMS II and CVMS III, and it has not been reached without the attainment of both CVMS I and CVMS II. CVMS V is recorded at least two years after the peak. The advantages of the new version of the CVM method are that mandibular skeletal maturity can be appraised on a single cephalogram and through the analysis of only the second, third, and fourth cervical vertebrae, which usually are visible even when a protective radiation collar is worn.

Adolescent↗