1
|
Grin A, Lvov I, Talypov A, Kordonskiy A, Godkov I, Khushnazarov U, Krylov V. Factors affecting the outcomes of traumatic atlanto-occipital dislocations in adults: a systematic review. World Neurosurg 2022; 162:e568-e579. [DOI: 10.1016/j.wneu.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
|
2
|
Liao S, Jung MK, Hörnig L, Grützner PA, Kreinest M. Injuries of the upper cervical spine—how can instability be identified? INTERNATIONAL ORTHOPAEDICS 2020; 44:1239-1253. [DOI: 10.1007/s00264-020-04593-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
|
3
|
Kow CY, Li C, Harley B, Tee J. Pearls for addressing traumatic cranio-cervical instability in a patient on extracorporeal membrane oxygenation (ECMO). NORTH AMERICAN SPINE SOCIETY JOURNAL 2020; 1:100004. [PMID: 35141577 PMCID: PMC8819859 DOI: 10.1016/j.xnsj.2020.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Concurrent craniocervical dissociation in a multi-trauma patient requiring venous-venous extracorporeal membranous oxygenation (ECMO) poses significant challenges in its management. PURPOSE This article describes the nuances of the surgical decision-making in a complex case of a polytrauma patient with craniocervical dissociation who required concurrent ECMO. STUDY DESIGN/ SETTING Case report and literature review. METHODS The authors describe a complex case of a patient with craniocervical dissociation requiring ECMO and who was managed surgically in a level 1 trauma centre in Victoria, Australia after sudden neurological deterioration whilst in a halo-vest. A literature search using appropriate medical subject headings and keywords was performed to identify published cases of craniocervical dissociation in patients requiring concurrent ECMO. RESULTS Literature search yielded twenty-seven articles, with only two relevant articles identified for full text review. Only one article was found to be relevant, which however did not provide detailed discussion on surgical aspect of the pathology. CONCLUSION To the authors' knowledge, this is the first report of management of craniocervical dissociation in a patient requiring ECMO due to polytrauma focused on the nuances of the complex surgical decision-making which is required for proper management of such critical condition.
Collapse
Affiliation(s)
- Chien Yew Kow
- National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, Victoria 3004, Australia
- Neurosurgery Department, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Charles Li
- Neurosurgery Department, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Benjamin Harley
- Neurosurgery Department, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Jin Tee
- National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, Victoria 3004, Australia
- Neurosurgery Department, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria 3800, Australia
| |
Collapse
|
4
|
Phuntsok R, Ellis BJ, Herron MR, Provost CW, Dailey AT, Brockmeyer DL. The occipitoatlantal capsular ligaments are the primary stabilizers of the occipitoatlantal joint in the craniocervical junction: a finite element analysis. J Neurosurg Spine 2019; 30:593-601. [PMID: 30771758 DOI: 10.3171/2018.10.spine181102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is contradictory evidence regarding the relative contribution of the key stabilizing ligaments of the occipitoatlantal (OA) joint. Cadaveric studies are limited by the nature and the number of injury scenarios that can be tested to identify OA stabilizing ligaments. Finite element (FE) analysis can overcome these limitations and provide valuable data in this area. The authors completed an FE analysis of 5 subject-specific craniocervical junction (CCJ) models to investigate the biomechanics of the OA joint and identify the ligamentous structures essential for stability. METHODS Isolated and combined injury scenarios were simulated under physiological loads for 5 validated CCJ FE models to assess the relative role of key ligamentous structures on OA joint stability. Each model was tested in flexion-extension, axial rotation, and lateral bending in various injury scenarios. Isolated ligamentous injury scenarios consisted of either decreasing the stiffness of the OA capsular ligaments (OACLs) or completely removing the transverse ligament (TL), tectorial membrane (TM), or alar ligaments (ALs). Combination scenarios were also evaluated. RESULTS An isolated OACL injury resulted in the largest percentage increase in all ranges of motion (ROMs) at the OA joint compared with the other isolated injuries. Flexion, extension, lateral bending, and axial rotation significantly increased by 12.4% ± 7.4%, 11.1% ± 10.3%, 83.6% ± 14.4%, and 81.9% ± 9.4%, respectively (p ≤ 0.05 for all). Among combination injuries, OACL+TM+TL injury resulted in the most consistent significant increases in ROM for both the OA joint and the CCJ during all loading scenarios. OACL+AL injury caused the most significant percentage increase for OA joint axial rotation. CONCLUSIONS These results demonstrate that the OACLs are the key stabilizing ligamentous structures of the OA joint. Injury of these primary stabilizing ligaments is necessary to cause OA instability. Isolated injuries of TL, TM, or AL are unlikely to result in appreciable instability at the OA joint.
Collapse
Affiliation(s)
- Rinchen Phuntsok
- 1Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah; and
| | - Benjamin J Ellis
- 1Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah; and
| | - Michael R Herron
- 1Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah; and
| | - Chase W Provost
- 1Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah; and
| | - Andrew T Dailey
- 2Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Douglas L Brockmeyer
- 2Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| |
Collapse
|
5
|
Wu X, Li Y, Tan M, Yi P, Yang F, Tang X, Hao Q. Long-Term Clinical and Radiologic Postoperative Outcomes After C1-C2 Pedicle Screw Techniques for Pediatric Atlantoaxial Rotatory Dislocation. World Neurosurg 2018; 115:e404-e421. [PMID: 29678707 DOI: 10.1016/j.wneu.2018.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although C1-C2 pedicle screw techniques have been extensively reported in pediatric series, reports on their use have examined only small series with short follow-up periods. The aim of this study was to report pediatric patients with atlantoaxial rotatory dislocation treated with these techniques with a minimum 5-year follow-up. METHODS Retrospective review was performed of 27 pediatric patients with atlantoaxial rotatory dislocation who underwent C1-C2 pedicle screw fixation between 2004 and 2012. Clinical and radiographic outcomes were collected and compared with a control group. RESULTS Follow-up period was 60-142 months (mean 84 months). Torticollis was completely corrected postoperatively in all but 1 patient. All patients experienced significant pain relief and improvement in range of motion, and 6 patients with neurologic deficits experienced significant improvement postoperatively. Both atlantodental interval and space available for the cord were significantly improved compared with preoperative values. At final follow-up, curvature was lordotic in 20 cases and straight in 7 cases. Compared with the control group, range of motion of the patient group was not significantly different in any direction except in flexion and rotation. Mean anteroposterior diameters of the spinal canal at C1 and C2 levels were not significantly different from the control group. CONCLUSIONS C1-C2 pedicle screw techniques are safe and effective for treatment of atlantoaxial rotatory dislocation and result in no obvious limitation on growth in older children.
Collapse
Affiliation(s)
- Xinjie Wu
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Yafeng Li
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Mingsheng Tan
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
| | - Ping Yi
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Feng Yang
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiangsheng Tang
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qingying Hao
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
6
|
Liao S, Schneider NRE, Hüttlin P, Grützner PA, Weilbacher F, Matschke S, Popp E, Kreinest M. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018; 13:e0195215. [PMID: 29624623 PMCID: PMC5889057 DOI: 10.1371/journal.pone.0195215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown. The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction. Methods and findings Ligamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system. In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure. Conclusion The current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.
Collapse
Affiliation(s)
- Shiyao Liao
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Niko R. E. Schneider
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Petra Hüttlin
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Frank Weilbacher
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Stefan Matschke
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Erik Popp
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
- * E-mail:
| |
Collapse
|
7
|
Clifton W, Feindt A, Skarupa D, McLauchlin L, Tavanaiepour D, Rahmathulla G. Paradoxical Distraction with Upright Position After Halo Fixation in 2 Patients with Atlanto-Occipital Dislocation. World Neurosurg 2017; 110:303-308. [PMID: 29174236 DOI: 10.1016/j.wneu.2017.11.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Atlanto-occipital dislocation (AOD) is the most uncommon form of traumatic cervical spine injury. The majority of patients die before reaching higher-level care, and only a small percentage of patients with AOD survive the initial injury after receiving tertiary care. As such, there is a paucity of evidence-based management guidelines for treating this condition. Halo vest fixation has been a proposed method for interim stability while these patients undergo medical optimization for surgical intervention. There have been several reports of worsening AOD after halo placement. Reverse Trendelenburg position after halo fixation has been previously described to aid in the reduction of AOD, as well as concomitant atlantoaxial dislocation by gravitational downward force. CASE DESCRIPTION In this series we present 2 cases of obese patients (body mass index >30) with AOD treated by halo fixation that had increased distraction after head of bed elevation. CONCLUSION Our theorized mechanism for this phenomenon is due to the downward pull of subaxial forces secondary to a large body habitus.
Collapse
Affiliation(s)
- William Clifton
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Austin Feindt
- Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - David Skarupa
- Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laura McLauchlin
- Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Daryoush Tavanaiepour
- Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gazanfar Rahmathulla
- Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA.
| |
Collapse
|
8
|
Menon KV, Al Habsi I, Al Ghafri K. Traumatic occipito-cervical dissociation in adults: a Middle Eastern cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:381-387. [PMID: 28986644 DOI: 10.1007/s00590-017-2053-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022]
Abstract
The objective of this study is to describe a series of cranio-cervical dissociation victims and evaluate their outcomes as well as discuss the clinical dilemmas we faced in the context of current literature evidence. This is a retrospective cohort study of traumatic occipito-cervical dissociation in five patients (three males and two females) encountered between 2010 and 2016 at a tertiary care facility in the Middle East region. All patients underwent occipito-cervical fusion using screws and rods system with mean postoperative follow-up period of 2.5 years. All patients survived, and four were independently mobile and one wheel chair bound. Most had some degree of neurological sequelae, often due to associated injuries and all complained of limited neck range of motion. Contemporary literature review shows that CT scan with MRI is often the best diagnostic modality. Surgery is usually indicated though rare cases treated conservatively have been reported. The commonest predictor of mortality is missed injury, associated head injury and wide separation between the skull base and C1 on imaging studies.
Collapse
Affiliation(s)
| | - Ismail Al Habsi
- Oman Medical Specialty Board, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman
| | | |
Collapse
|