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Nonspecific and specific inflammatory disorders of the cervical vertebrae can be caused by diseases of the ear, nose and throat. In 16% of the patients with a dislocation of the atlanto-axial joint the aetiological factors pertain to the field of ENT. In 60% of these patients the disease is caused by an infection of the upper respiratory tract.
Fractures of the second cervical vertebrae (C2) can be difficult to diagnose in young children. A 17-month-old infant sustained bilateral C2 pedicle fractures after minor trauma. The initial lateral radiograph showed pedicle defects, but even with computed tomography and a bone scan with single photon emission computed tomography this could not be differentiated from a congenital abnormality. One week after injury, repeat radiographs showed spondylolisthesis confirming the defects were fractures. The fractures were treated by closed reduction and a halo vest and healed uneventfully. This child is among a small number of patients with bilateral C2 pedicle fractures that occur predominantly in young children. Diagnosis can be difficult even with a high index of suspicion.
BACKGROUND: Anteriorly located lesions at the craniocervical junction (CCJ) require careful surgical planning to avoid neuraxis retraction. Several different routes have been described in the search for the most appropriate yet least invasive approach. However, most of these far-lateral posterior approaches are specifically tailored for non-osseous intradural tumours or chordomas with cephalad extension. We introduce an approach that allows for better access to laterally extending osseous tumours originating from the second cervical vertebra. Using this approach, the lesion is manipulated from a strictly lateral direction parallel to a plane through the articular pillar of the CCJ and the odontoid process, and the C1- and C2-laminae are spared for posterior fixation. METHOD: The application of this approach is demonstrated in detail by an illustrative case of a chordoma originating from C2 that presented with intradural mass effect, considerable bone destruction, far-lateral extension to the right, and vertebral artery involvement. FINDINGS: The described approach gave ample access for total tumour resection. It allowed for safe control and displacement of the vertebral artery, spinal cord decompression, C2-corpectomy across the midline, and anterolateral bone reconstruction. No C1- or C2-hemilaminectomy was needed, and these bone elements could be used for posterior fixation (the patient presented in this study was referred to our institution after posterior fixation from the occiput to C3 had already been performed elsewhere). No intra-operative or postoperative complications occurred. At the 6-month follow-up, the patient was fully ambulatory with no neurological deficit. INTERPRETATION: The described lateral transfacetal route is the method of choice for operating on laterally extending osseous tumours originating from the second cervical vertebra.
Epigenetic variations and pathological alterations of cervical vertebrae in adult individuals inhumated in the Lepenski Vir and Vlasac protoneolithic settlements (c. 7000-5500 years B.C.) are described in the article. These findings were observed in 13 paleopathologic examined skeletons. Degenerative changes, growth alterations and congenital anomalies were noted by a detailed analysis of the vertebrae. Unilateral and bilateral epigenetic variations of foramen transversarium were found in 10 (or 76%) skeletons, and this variance frequency was of particular importance. Variations were classified as follows: (1)-Foramen transversarium duplex; (2)-Foramen transversarium accessorius; (3)-Tuberositas intra foraminis transversarium; (4)-Important diversity of diameters between the left and the right foramen, and (5)-Ribs of vertebra cervicalis VII. The frequent appearance of foramen transversarium epigenetic variations in examined skeletons the author attributes to the process of micro-evolution (gracilization and Mediterranean antropological race forming) already found in this protoneolithic population.
Image analysis techniques are introduced for evaluating disc space narrowing of cervical vertebrae interfaces from X-ray images. Four scale-invariant, distance transform-based features are presented for characterizing the spacing between adjacent vertebrae. K-means and self-organizing map clustering techniques are applied to estimate the degree of disc space narrowing using a four grade (0-3) scoring system, where 0 and 3 represent normal spacing and significant narrowing, respectively. For a data set of 294 vertebrae interfaces, experimental results yield average correct grade assignment of greater than 82.10% for each of the four grades using a one grade window around the correct grade.
The morphology and post natal ossification of the fifth, sixth and seventh cervical vertebrae of 51 crossbred puppies (aged from birth to 12 weeks) were examined grossly, histologically and radiographically. At birth there were two centres of ossification, one in the vertebral body and one in the base of each pedicle of the neural arch. By one month of age secondary centres of ossification were present in the cranial and caudal epiphyses of the vertebral body. By two months of age these epiphyseal centres began to show signs of closure. Endochondral ossification of the neural arch occurred from a single centre of ossification within each pedicle with bony fusion of the laminae occurring by one month of age. In addition the dimensions of the neural canal were measured. The difference between the caudal and cranial sagittal diameters of each vertebra was 1 mm or less. It was concluded that, after one month of age, the shape of the neural canal can be influenced only by changes within the physes between the vertebral body and the neural arch or by the remodelling of bone formed by intramembranous ossification.
The authors analyze caused and indications for prostheses of bodies of cervical vertebrae. As caused they mention bone tumours, metastases, benign bone tumours and injuries. For operation they indicate patients with neurological symptoms and instability of the spine. For prostheses they use bone grafts from the blade of the ilium. They insert the graft during traction, as described by Crutchfield and do not routine fix it. After operation they immobilize by "Minerva" for three weeks. The method is in case of metastases and bone tumours only palliative, but improves the patients' mobility and prevents the development of early neurological complications.
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Since April, 1990, the authors have been reporting a surgical technique for anterior cervical fusion utilizing autogenous bone graft from the cervical vertebrae. This series included 53 patients (40 males and 13 females). The age ranged from 24 to 72 years with a mean of 49 years. There were 42 cases of cervical disc disease, and 11 cases of cervical disc disease with ossification of the posterior longitudinal ligament (OPLL). The patient was out of bed within two days and treated in a soft collar for 3 months. In all patients, the symptoms improved postoperatively. Postoperative X-ray showed slight anterior angulation deformity in 3 out of 53 cases (6%). The advantages of our surgical technique are as follows: 1) There are no problems related to the iliac donor site 2) The removal of posterior spur and localized OPLL is safely and easily performed.
The gross anatomical features of human cervical vertebrae during the fetal-neonatal period were investigated in order to develop morphological standards for the individual ossification centres for use in forensic and anthropological osteology. It was found that the morphology of the cervical vertebral arches and the centra cannot be used for the determination of fetal age although the dens of the axis displays some developmental differences which may be useful for the determination of fetal maturity.
Lateral flexion of the cervical spine may cause a sagittally oriented fracture of the lateral mass with shearing of all or part of the lateral mass away from the vertebral body. We report 22 patients with 24 sagittal fractures of the cervical lateral masses. Cross-table lateral roentgenograms suggested the presence of a sagittal lateral mass fracture in two thirds of the cases based upon malalignment or widening of the facet joints, displaced fracture fragments, subluxation of the spine, or rotation of the spine above the level of abnormality. However, the cross-table lateral roentgenogram was normal in one third of cases. Oblique roentgenograms were available in eight cases; these were positive in five, equivocal in one, and negative in two. Visible fracture lines, often associated with lateral displacement of part or all of the lateral mass, allowed all 24 fractures to be detected on the supine anteroposterior view films. Sagittal lateral mass fractures were unstable in 59% (13/22) of the cases; neurologic deficits, including quadriplegia, hemiplegia, and radiculopathy, were present in 45% (10/22). Computed tomography and complex-motion tomography were useful in confirming the sagittal lateral mass fracture and in detecting other associated fractures.
The cervical vertebral column of 103 horses of different age (42 weeks old fetus to 23 years) were examined with respect to age-related changes of the intervertebral disks. On gross examination the cervical intervertebral disks in the horse miss a pulpy nucleus but consist of a fibrocartilaginous tissue only, which is in contrast to literature. Age-related degenerative lesions as disintegration of connective tissue fibers leading to partial or complete loss of connection between the disks were found. In the more severe cases a yellow discoloration of the separated disks could be seen. Incidence and grade of the lesions increased with age and from the cranial to the caudal regions of the cervical vertebral column. Even in cases with a high degree degenerative separation clinical symptoms had not been reported.
Macerated cervical vertebrae of 139 adult and 39 juvenile dogs were assessed for morphological evidence of axial rotation, which is denoted by the shape and orientation of the articular facets. The potential effect of the presence of caudal costal foveae at C7 on facet geometry was also investigated. Four variations of caudal facet shape were evident, namely, plane, concave, convex and sigmoid. The earliest onset of change in shape from plane to curved was noticed in juvenile dogs who were older than 8 weeks. The incidence of curved facets denoting axial rotation ability was observed to increase on descending down the cervical spine. Concave caudal facets were more frequently present in males and in large dogs (P < 0.001), compared to Dachshunds and small breeds. The degree of concavity was not related to age but was associated with the transverse distance between the most medial aspects of the caudal and corresponding cranial facets (P < 0.05). In large breeds, the presence of concave caudal facets at C7 was inversely related to the presence of caudal costal foveae (P < 0.01). The effect of axial rotation is discussed in context with clinical literature suggesting that axial rotation might attribute to the development of the wobbler syndrome.
Traumatic lesions of the lower cervical spine give rise to two main problems - injury to the bones or ligaments leading to possible instability, and the presence or absence of damage to the spinal cord or nerve roots. After discussing the pathological anatomy and describing the clinical signs of the lesions, the authors explain their treatment programme which is based on seventeen years of practical experience. All unstable lesions involving the lower five cervical vertebrae are treated surgically, especially if there is partial or total tetraplegia. Instability can be rectified by reduction of the lesion and fixation by means of plates screwed into the articular masses, and this procedure has the additional advantage of improving the recovery of the neurological lesion. The nursing of the tetraplegic patient is also facilitated.
Acute traumatic lesions of the spine at the third and fourth cervical levels without associated fracture are not common. The eight lesions in this report occurred as a result of injuries sustained during tackle football. They included acute intervertebral disc herniation, anterior subluxation of the third cervical vertebra on the fourth, unilateral dislocation of the joint between the articular processes, and bilateral dislocation of the joints between the articular processes. The mechanism of injury was the use of the top or crown of the helmet as the primary point of contact in a high-impact collision when blocking, tackling, or head-butting. To avoid a seemingly inevitable increase in the incidence of these lesions occurring from tackle football, coaches and officials will have to modify the current techniques of blocking tackling, and head-butting.
A clinico-roentgenological examination of the transitional craniovertebral division has revealed a high incidence and a great diversity of isolated underdevelopment of the arches of the upper cervical vertebra--from their fissure-like splitting to complete absence. Usually these forms create no preconditions for disturbances of any functions, do not manifest clinically, and can be regarded as variants of normal structure of the craniovertebral division.
The articular surfaces and vertebral foramen of the first cervical vertebra can be used to estimate race from complete and fragmentary specimens. Eight measurements taken from 200 vertebrae from the Terry and Hamann-Todd collections (Smithsonian Institution and Cleveland Museum of Natural History, respectively) were used to construct 13 discriminant functions that predict race with 76-60% accuracy.