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Ferch RD, Zhang T, Bogduk N. Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:203-210. [PMID: 37982760 PMCID: PMC10906710 DOI: 10.1093/pm/pnad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered. OBJECTIVE To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability. DESIGN Practice audit. SETTING Private practice of senior author. SUBJECTS Prospective series of 23 consecutive patients. METHODS Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability. RESULTS Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both. CONCLUSIONS The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.
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Affiliation(s)
- Richard D Ferch
- Department of Neurosurgery, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Tyson Zhang
- Department of Neurosurgery, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Nikolai Bogduk
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
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2
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Redaelli A, Stephan SR, Riew KD. Is neck pain treatable with surgery? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1137-1147. [PMID: 38191741 DOI: 10.1007/s00586-023-08053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Neck pain is one of the most common complaints in clinical practice and can be caused by a wide variety of conditions. While cervical spine surgery is a well-accepted option for radicular pain and myelopathy, surgery for isolated neck pain is controversial. The identification of the source of pain is challenging and subtle, and misdiagnosis can lead to inappropriate treatment. MATERIALS AND METHODS AND RESULTS: We conducted a thorough literature review to discuss and compare different causes of neck pain. We then supplemented the literature with our senior author's expert analysis of treating cervical spine pathology. CONCLUSIONS This study provides an in-depth discussion of neck pain and its various presentations, as well as providing insight into treatment strategies and diagnostic pearls that may prevent mistreatment of cervical spine pathology.
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Affiliation(s)
- Andrea Redaelli
- GSpine4, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Stephen R Stephan
- Department of Orthopaedic Surgery, San Diego Spine Foundation, San Diego, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Weill-Cornell Medical Center, New York, USA
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, USA
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3
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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4
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Suga Y, Shigematsu H, Tanaka M, Okuda A, Kawasaki S, Yamamoto Y, Ikejiri M, Asai H, Fukushima H, Tanaka Y. Factors associated with the increased risk of atlantoaxial osteoarthritis: a retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3418-3425. [PMID: 36260133 DOI: 10.1007/s00586-022-07414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Purpose Atlantodens osteoarthritis and atlantoaxial osteoarthritis cause neck pain and suboccipital headaches. Currently, knowledge on the risk factors for atlantoaxial osteoarthritis is lacking. This study aimed to investigate the factors related to the increased risk of atlantoaxial osteoarthritis. Methods We analyzed computed tomography (CT) images of the upper cervical spine of 1266 adult trauma patients for whom upper cervical spine CT was performed at our hospital between 2014 and 2019. The degree of atlantoaxial osteoarthritis was quantified as none-to-mild (not having osteoarthritis) or moderate-to-severe (having osteoarthritis). Risk factors associated with atlantoaxial osteoarthritis were identified using univariate and multivariable logistic regression analyses. Results The study group included 69.4% men, and the overall average age of the study population was 54.9 ± 20.4 years. The following factors were independently and significantly associated with atlantoaxial osteoarthritis in the multivariable logistic regression analysis: age in the sixth decade or older (odds ratio [OR], 20.5; 95% confidence interval [CI], 6.2‒67.2, p < 0.001), having calcific synovitis (OR, 4.9; 95% CI, 2.4‒9.9, p < 0.001), women sex (OR, 3.3; 95% CI, 1.9‒5.7, p = 0.002), and not having atlantodens osteoarthritis (OR, 2.1; 95% CI, 1.2‒3.8, p = 0.014). Conclusion In the multivariable logistic regression analysis, age in the sixth decade or older, calcification of the transverse ligament, being women, and not having atlantodens osteoarthritis were found to be significantly associated with atlantoaxial osteoarthritis. Delayed diagnosis and treatment can be avoided by focusing on these risk factors.
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Affiliation(s)
- Yuma Suga
- Department of Orthopedics and Surgery, Nara Medical University, KashiharaNara, 6348522, Japan
| | - Hideki Shigematsu
- Department of Orthopedics and Surgery, Nara Medical University, KashiharaNara, 6348522, Japan.
| | - Masato Tanaka
- Department of Orthopedic Surgery, Otemae Hospital, Osaka, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Center, Nara Medical University, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopedics and Surgery, Nara Medical University, KashiharaNara, 6348522, Japan
| | - Yusuke Yamamoto
- Department of Emergency and Critical Care Center, Nara Medical University, Nara, Japan
| | - Masaki Ikejiri
- Department of Orthopedics and Surgery, Nara Medical University, KashiharaNara, 6348522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Center, Nara Medical University, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Center, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedics and Surgery, Nara Medical University, KashiharaNara, 6348522, Japan
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5
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Yin M, Ding X, Liu S, Ma J, Mo W. Research Progress of Atlantoaxial Osteoarthritis: A Narrative Literature Review. World Neurosurg 2022; 160:e573-e578. [PMID: 35092813 DOI: 10.1016/j.wneu.2022.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this review was to consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve the systematic understanding of this clinical syndrome among spine surgeons. METHODS Articles reviewed were searched in PubMed, Ovid MEDLINE, and EMBASE using search terms: [("C1-C2" OR "C1-2" OR "atlantoaxial" OR "atlanto-axial" OR "C2" OR "C1" OR "atlas" OR "axis") AND ("osteoarthritis")]. All articles of any study design discussing on AAOA were considered for inclusion. Two independent authors read article titles, abstracts and the included appropriate articles. The relevant articles were studied in full text. RESULTS A total of 54 literatures were reviewed and consolidated in this narrative review. These articles are roughly divided into the following five subcategories: (1) epidemiology and etiology, (2) clinical presentation, (3) radiographic findings, (4) conservative treatment and (5) surgical indications and treatment options. CONCLUSION AAOA was a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. The most common cause of AAOA was joint degeneration, which was closely related to age and occupation. Initial treatment for AAOA was conservative. Atlantoaxial fusion was an option for patients with severe pain who unresponsive to conservative management.
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Affiliation(s)
- Mengchen Yin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Ding
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuang Liu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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6
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Tatter C, Fletcher-Sandersjöö A, Persson O, Burström G, Edström E, Elmi-Terander A. Fluoroscopy-Assisted C1-C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010114. [PMID: 35056423 PMCID: PMC8779556 DOI: 10.3390/medicina58010114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 04/21/2023]
Abstract
Background and Objectives: Posterior C1-C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1-C2 fixation, using TAS or CRS, between 2005-2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88% to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1-C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.
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Affiliation(s)
- Charles Tatter
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +46-8-517-74-126
| | - Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Oscar Persson
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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7
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Hurley RW, Adams MCB, Barad M, Bhaskar A, Bhatia A, Chadwick A, Deer TR, Hah J, Hooten WM, Kissoon NR, Lee DW, Mccormick Z, Moon JY, Narouze S, Provenzano DA, Schneider BJ, van Eerd M, Van Zundert J, Wallace MS, Wilson SM, Zhao Z, Cohen SP. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2443-2524. [PMID: 34788462 PMCID: PMC8633772 DOI: 10.1093/pm/pnab281] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. METHODS In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4-5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. RESULTS Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. CONCLUSIONS Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.
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Affiliation(s)
- Robert W Hurley
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Meredith C B Adams
- Anesthesiology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Meredith Barad
- Anesthesiology, Perioperative and Pain Medicine, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Arun Bhaskar
- Anesthesiology, Imperial College Healthcare NHS Trust Haemodialysis Clinic, Hayes Satellite Unit, Hayes, UK
| | - Anuj Bhatia
- Anesthesia and Pain Management, University of Toronto and University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Andrea Chadwick
- Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy R Deer
- Spine and Nerve Center of the Virginias, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
| | - Jennifer Hah
- Anesthesiology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - David Wonhee Lee
- Fullerton Orthopaedic Surgery Medical Group, Fullerton, California, USA
| | - Zachary Mccormick
- Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jee Youn Moon
- Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, South Korea
| | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
- Pain Diagnostics and Interventional Care, Edgeworth, Pennsylvania, USA
| | - Byron J Schneider
- Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee, USA
| | - Maarten van Eerd
- Anesthesiology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Mark S Wallace
- Anesthesiology, UCSD Medical Center - Thornton Hospital, San Diego, California, USA
| | | | - Zirong Zhao
- Neurology, VA Healthcare Center District of Columbia, Washington, District of Columbia, USA
| | - Steven P Cohen
- Anesthesia, WRNMMC, Bethesda, Maryland, USA
- Physical Medicine and Rehabilitation, WRNMMC, Bethesda, Maryland, USA
- Anesthesiology, Neurology, Physical Medicine and Rehabilitation and Psychiatry, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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8
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Hurley RW, Adams MCB, Barad M, Bhaskar A, Bhatia A, Chadwick A, Deer TR, Hah J, Hooten WM, Kissoon NR, Lee DW, Mccormick Z, Moon JY, Narouze S, Provenzano DA, Schneider BJ, van Eerd M, Van Zundert J, Wallace MS, Wilson SM, Zhao Z, Cohen SP. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Reg Anesth Pain Med 2021; 47:3-59. [PMID: 34764220 PMCID: PMC8639967 DOI: 10.1136/rapm-2021-103031] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023]
Abstract
Background The past two decades have witnessed a surge in the use of cervical spine joint
procedures including joint injections, nerve blocks and radiofrequency ablation to treat
chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the
American Academy of Pain Medicine approved and charged the Cervical Joint Working Group
to develop neck pain guidelines. Eighteen stakeholder societies were identified, and
formal request-for-participation and member nomination letters were sent to those
organizations. Participating entities selected panel members and an ad hoc steering
committee selected preliminary questions, which were then revised by the full committee.
Each question was assigned to a module composed of 4–5 members, who worked with
the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent
to the full committee after revisions. We used a modified Delphi method whereby the
questions were sent to the committee en bloc and comments were returned in a non-blinded
fashion to the Chairs, who incorporated the comments and sent out revised versions until
consensus was reached. Before commencing, it was agreed that a recommendation would be
noted with >50% agreement among committee members, but a consensus
recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17
topics. Among participating organizations, 14 of 15 that voted approved or supported the
guidelines en bloc, with 14 questions being approved with no dissensions or abstentions.
Specific questions addressed included the value of clinical presentation and imaging in
selecting patients for procedures, whether conservative treatment should be used before
injections, whether imaging is necessary for blocks, diagnostic and prognostic value of
medial branch blocks and intra-articular joint injections, the effects of sedation and
injectate volume on validity, whether facet blocks have therapeutic value, what the
ideal cut-off value is for designating a block as positive, how many blocks should be
performed before radiofrequency ablation, the orientation of electrodes, whether larger
lesions translate into higher success rates, whether stimulation should be used before
radiofrequency ablation, how best to mitigate complication risks, if different standards
should be applied to clinical practice and trials, and the indications for repeating
radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected
individuals, with medial branch blocks being more predictive than intra-articular
injections. More stringent selection criteria are likely to improve denervation
outcomes, but at the expense of false-negatives (ie, lower overall success rate).
Clinical trials should be tailored based on objectives, and selection criteria for some
may be more stringent than what is ideal in clinical practice.
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Affiliation(s)
- Robert W Hurley
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Meredith C B Adams
- Anesthesiology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Meredith Barad
- Anesthesiology, Perioperative and Pain Medicine, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Arun Bhaskar
- Anesthesiology, Imperial College Healthcare NHS Trust Haemodialysis Clinic, Hayes Satellite Unit, Hayes, UK
| | - Anuj Bhatia
- Anesthesia and Pain Management, University of Toronto and University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Andrea Chadwick
- Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy R Deer
- Spine and Nerve Center of the Virginias, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
| | - Jennifer Hah
- Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - David Wonhee Lee
- Fullerton Orthopaedic Surgery Medical Group, Fullerton, California, USA
| | - Zachary Mccormick
- Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jee Youn Moon
- Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, South Korea
| | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA.,Pain Diagnostics and Interventional Care, Edgeworth, Pennsylvania, USA
| | - Byron J Schneider
- Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee, USA
| | - Maarten van Eerd
- Anesthesiology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Mark S Wallace
- Anesthesiology, UCSD Medical Center - Thornton Hospital, San Diego, California, USA
| | | | - Zirong Zhao
- Neurology, VA Healthcare Center District of Columbia, Washington, District of Columbia, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine and Rehabilitation and Psychiatry, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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9
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Texeira da Silva LEC, Khan AA, Campos de Barros AG, Krywinski FM, Cabral de Araujo Fagundes FA, de Souza E Silva FG. A novel classification and algorithmic-based management of craniovertebral junction osteoarthrosis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:321-330. [PMID: 33824563 PMCID: PMC8019119 DOI: 10.4103/jcvjs.jcvjs_172_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: The objective of this study is to propose a novel classification and algorithmic-based management plan for craniovertebral junction osteoarthrosis (CVJOA). Materials and Methods: A retrospective study was done based on prospective database of radiological studies and clinical history. Twenty symptomatic patients (12 females and 8 males) with a mean age of 54.8 years were identified with CVJOA. These patients underwent either nonsurgical treatment only or surgical intervention and had follow-up of at least 14 months. Classification of CVJOA is based on coronal deformity, rigidity, stability, and two modifiers. The main surgical procedures done in the surgical arm of these patients included C1–C2 fusion, C1–C2 facet distraction and fusion, and unilateral subaxial facet distraction, and posterior column osteotomy. Results: All the twenty patients included in this study complained of either sub-occipital or upper neck pain and had radiological evidence of CVJOA. Seven patients improved with nonsurgical management and 13 underwent surgical intervention. Surgical recommendations for each type of CVJOA have been described with case examples, and algorithm for the management of CVJOA has been developed based on this study. Interobserver agreement on CVJOA classification was measured using kappa value statistics which showed moderate strength of agreement (0.467). Conclusion: This study describes a novel classification and management of CVJOA based on algorithm and current surgical recommendations for each type of CVJOA.
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Affiliation(s)
- Luis Eduardo Carelli Texeira da Silva
- Department of Spine Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil.,Department of Complex and Minimal Invasive Spine Surgery, Spine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, Brazil
| | - Ahsan Ali Khan
- Department of Spine Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil.,Department of Complex and Minimal Invasive Spine Surgery, Spine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, Brazil
| | | | - Fernando Miguel Krywinski
- Department of Spine Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil.,Department of Complex and Minimal Invasive Spine Surgery, Spine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, Brazil
| | | | - Felipe Gomes de Souza E Silva
- Department of Complex and Minimal Invasive Spine Surgery, Spine Institute of Rio de Janeiro (INCOL), Rio de Janeiro, Brazil
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Adogwa O, Buchowski JM, Sielatycki JA, Shlykov MA, Theologis AA, Lin J, CreveCoeur T, Peters C, Riew KD. Improvements in Neck Pain and Disability Following C1-C2 Posterior Cervical Instrumentation and Fusion for Atlanto-Axial Osteoarthritis. World Neurosurg 2020; 139:e496-e500. [PMID: 32311554 DOI: 10.1016/j.wneu.2020.04.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptomatic Atlanto-axial (C1-2) osteoarthritis (AAOA) is a common phenomenon in elderly patients; however, there is a paucity of data on the effectiveness of posterior atlanto-axial fusion (PAAF) for this condition. To this end, here we assess changes in patient-reported outcomes and neck-related disability in adult patients undergoing PAAF for symptomatic C1-2 AAOA. METHODS In this retrospective study, the clinical records of consecutive patients with symptomatic AAOA who underwent PAAF between 2004 and 2017 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative variables, and complication rates were collected. Neck Disability Index (NDI) scores were recorded at baseline and 6 weeks, 6 months, 1 year, and 2 years postoperatively. RESULTS Forty-two patients (average age, 72.04 ± 8.56 years; 26.19% males) met the study's inclusion criteria. In this cohort, 19.04% had previous subaxial cervical spine surgery, 35.71% had a history of smoking (all had stopped smoking before surgery), and 11.90% had type II diabetes. At baseline, the majority of patients had a normal neurologic exam. The average preoperative NDI score was 26.88 ± 24.85, which improved to 10.59 ± 14.88 at the 1-year follow-up and 13.20 ± 14.96 at the 2-year follow-up (P = 0.004). At baseline, 18% of the patients reported severe disability based on NDI score; this percentage decreased to 2% at 1 year and 0 at 2 years (P = 0.01). Importantly, a high percentage (11.90%) of patients had undergone previous subaxial cervical fusion for their pain due to a mistaken diagnosis for this condition, without symptom relief. CONCLUSIONS In appropriately selected patients, PAAF may decrease neck pain and improve functional disability in patients with AAOA. Future prospective longitudinal studies are needed to corroborate these findings.
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Affiliation(s)
- Owoicho Adogwa
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri.
| | - J Alex Sielatycki
- Department of Orthopedic Surgery, New York Presbyterian Hospital/Columbia University School of Medicine, New York, New York, USA
| | - Maksim A Shlykov
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Alekos A Theologis
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - James Lin
- Department of Orthopedic Surgery, New York Presbyterian Hospital/Columbia University School of Medicine, New York, New York, USA
| | - Travis CreveCoeur
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Colleen Peters
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - K Daniel Riew
- Department of Orthopedic Surgery, New York Presbyterian Hospital/Columbia University School of Medicine, New York, New York, USA
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11
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Yang JS, Li J, Chen H, Liu P, Chen C, Liu TJ, Chu L, Hao DJ. Suboccipital neuralgia after C1 pedicle screw insertion: do we neglect atlantooccipital joint violation? - Case report and literature review. BMC Surg 2019; 19:96. [PMID: 31337382 PMCID: PMC6652010 DOI: 10.1186/s12893-019-0551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/30/2019] [Indexed: 11/11/2022] Open
Abstract
Background Occipital neuralgia is one of the postoperative complications of C1 lateral mass screw insertion, which was deemed to be related with the C2 nerve root dysfunction. Case presentation A 52-year-old female patient presented with gradually progressive numbness and weakness in her extremities for 6 months. X-ray and computed tomography (CT) scan revealed obvious anterior atlantoaxial dislocation (ADD), which was reducible on extensive view. Atlantoaxial pedicle screw fixation and bone graft was performed. Immediately after the operation, the neurological symptom significantly improved. The patient complained of restricted cervical rotation and suboccipital neuralgia which was exacerbated by rotation with an intensity of 7 on a visual analog scale (VAS) ranging from 0 to 10 at postoperative day 5. While a satisfactory reduction was detected in the postoperative CT, violation of the left atlantooccipital joint was observed in the left C1 screw. Nimesulide (daily dosage of 0.2 g) and bracing were recommended immediately. At the 2 month follow-up, both the neurological improvement and reduction were maintained. The VAS of suboccipital neuralgia is 3 and decreased to 1 at 6 months postoperative. Bony fusion of the left atlantooccipital joint was confirmed by CT scan at 6 months postoperative. The patient complained that the suboccipital neuralgia was tolerable without the assistance of braces or medications for pain. At the 18 month follow-up, only stiffness of head flexion and rotation was observed without suboccipital neuralgia. Conclusion Suboccipital neuralgia after atlantooccipital joint violation of C1 pedicle screw placement most likely results from C1 nerve root irritation. As the corresponding dermatome differs from the distributing region and aggravated factor of C2 nerve root dysfunction, neuralgia due to C1 irritation was only localized at suboccipital region and exacerbated by rotation.
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Affiliation(s)
- Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Jing Li
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Hao Chen
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Chu Chen
- Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Lei Chu
- Department of orthopaedics, the second affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Chongqing, 400010, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
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12
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Fung M, Frydenberg E, Barnsley L, Chaganti J, Steel T. Clinical and radiological outcomes of image guided posterior C1-C2 fixation for atlantoaxial osteoarthritis (AAOA). JOURNAL OF SPINE SURGERY 2019; 4:725-735. [PMID: 30714004 DOI: 10.21037/jss.2018.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Atlantoaxial (C1-C2) osteoarthritis (AAOA) causes severe suboccipital pain exacerbated by lateral rotation. The pain is usually progressive and resistant to conservative therapy. Posterior fusion surgery is performed to stabilise the C1-C2 segment. This is the first Australian study reporting the outcome of posterior atlantoaxial fixation including hybrid fixations performed for AAOA. Methods All patients who underwent posterior atlantoaxial fixation surgery for AAOA from 2005 to 2015 at our institutions were enrolled (N=23). Patient demographics and surgical technique were recorded. These techniques included transarticular screw (TAS) fixation using image guidance with iliac crest bone graft and supplemental posterior Sonntag wiring, or C1-C2 lateral mass fixation (Harms technique). Some patients required a combination of fixation due to anatomical variation. Primary outcome measures including patient satisfaction, pain, disability scores and range of motion were recorded for all patients pre- and post-operatively. Post-operative assessment was supplemented with CT and X-ray imaging. Results Twenty-three patients (19 women, 4 males, mean age 71.8±6.3 years) underwent surgical fixation. Eight underwent TAS fixation, 8 had Harms fixation, and 7 had a hybrid fixation. All patients reported statistically significant improvement in pain scores [Visual Analogue Scale (VAS) 9.4 pre-op compared to 2.9 post-op, P<0.005]. Disability scores [Neck Disability Index (NDI)] were statistically significantly reduced from 72.2±12.9 pre-operatively to 18.9±11.9 post-operatively, P<0.005. Mean follow-up was 55.3±36.1 months. Results did not vary according to the construct type. Ninety-five point five percent of patients showed radiographic evidence of fusion. Ninety-one percent of patients said they would undergo the surgery again. Conclusions Posterior atlantoaxial fixation with TAS and Harms constructs are highly effective for the surgical treatment of intractable neck pain secondary to atlantoaxial lateral mass osteoarthritis (AAOA). Surgery offers a high rate of symptom relief. If anatomical variability exists, both transarticular and pedicle screw fixation could be safely used in the same patient.
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Affiliation(s)
- Mitchell Fung
- Department of Neurosurgery, St Vincents Hospital, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, NSW, Australia
| | - Ellen Frydenberg
- Department of Neurosurgery, St Vincents Hospital, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, NSW, Australia
| | - Leslie Barnsley
- Department of Rheumatology, Concord Repatriation General Hospital, NSW, Australia.,School of Medicine, The University of Sydney, NSW, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincents Hospital, Darlinghurst, NSW, Australia
| | - Timothy Steel
- Department of Neurosurgery, St Vincents Hospital, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, NSW, Australia
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Abstract
Lateral atlantoaxial osteoarthritis (AAOA), or C1-C2 lateral mass arthritis (LMA), is an unfamiliar degenerative cervical disease with a clinical presentation that markedly differs from subaxial spondylosis. The prevalence of LMA in the nonsurgical outpatient setting is 4%. Risk factors include age and occupation. The typical patient is between 50 and 90 years old, presents with upper cervical or occipital pain, has limited rotation, and has pain provocation during passive rotation to the affected side. Pain stems from degeneration of the lateral C1-C2 articulation and may be referred or radicular, through the greater occipital nerve. Although there is no consensus on diagnostic work-up, the disease is classically seen on the open-mouth odontoid radiograph. Computerized tomography, magnetic resonance imaging, bone scan, and diagnostic injections are also useful. Initial treatment is conservative, and upwards of two-thirds of LMA patients obtain lasting relief with noninvasive measures and injections. In patients with severe, recalcitrant pain, limited C1-C2 fusion offers satisfactory and reliable relief. The goals of this review article are to provide a synthesis of the literature on LMA, to offer a treatment approach to LMA, and to identify problems with the current state of knowledge on LMA.
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE We set out to evaluate the radiographic and patient-reported outcomes following C1-C2 arthrodesis for atlantoaxial osteoarthritis (AAOA) using modern instrumentation and techniques. SUMMARY OF BACKGROUND DATA Few studies have evaluated outcomes following C1-C2 arthrodesis for AAOA using modern surgical fixation techniques. METHODS Retrospective analysis of all patients following C1-C2 arthrodesis with recalcitrant AAOA from a single center, single surgeon from 2002 to 2012. Preoperative, immediate and final follow-up postoperative radiographic images were evaluated. Patient-reported outcomes scores were assessed preoperative, 1-year, and final postoperative follow-up. RESULTS We found a total of 14 patients (13 female, 1 male) with average follow-up of 2.96 ± 2.26 years and mean age at surgery of 71.8 ± 9.3 years old. The most common construct was posterior C1-C2 bilateral screw-rod construct (SRC) (n = 9), and there were 3 patients with transarticular screw (TAS) constructs, and 2 patients with hybrid fixation (unilateral SRC and contralateral TAS). Mean change from baseline to final follow-up for Numeric Pain Rating Scale (NRS) was -4.7 ± 2.1, and Neck Disability Index (NDI) was -21.0 ± 13.6, with 11 (78.6%) patients demonstrated a substantial clinical benefit (change in NDI ≥ 10). There were no differences from baseline to all follow-up time points for SF-12 Physical and Mental Component Scores. All patients had evidence of solid C1-C2 arthrodesis and stable fixation at final follow-up, with no significant change in subaxial sagittal alignment. There were no perioperative or postoperative complications. CONCLUSION We report one of the largest series evaluating patient-reported outcomes in patients following arthrodesis for AAOA using modern C1-C2 fixation techniques. Our study found C1-C2 arthrodesis for AAOA to be safe and effective, with a significant improvement in patient-reported pain and neck disability and most patients reporting substantial clinical benefit. LEVEL OF EVIDENCE 4.
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15
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Russo VM, Duits A, Dhawan RT, Casey ATH. Joint arthropathy at the cranio-vertebral junction. Scintigraphic patterns on bone SPECT/CT. Br J Neurosurg 2016; 31:45-49. [PMID: 27848263 DOI: 10.1080/02688697.2016.1226254] [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] [Indexed: 10/20/2022]
Abstract
Osteoarthritic degeneration at the cranio-vertebral junction (CVJ) is an underrecognized source of suboccipital and neck pain, limited range of motion and cervicogenic headaches. Correlation of radiographic findings with clinical symptoms is often difficult. Limited evidence currently exists to support the use of bone single-photon emission computed tomography/computed tomography (SPECT/CT) in this subgroup of patients. The aim of this study was to describe the scintigraphic patterns of joint arthropathy at the CVJ on bone SPECT/CT in patients with suboccipital/neck pain and cervicogenic headache. Patients with more than 3 months of suboccipital/neck pain/cervicogenic headache and abnormal SPECT/CT findings at the CVJ were included. Patients with known/suspected malignancy, trauma, infectious processes and previous surgery at the CVJ were excluded. Neck disability index (NDI), visual analogue scale (VAS) and treatment were recorded for each patient. Patterns of osteoblastic activity at the CVJ on bone SPECT/CT were described and correlated with arthritic changes on conventional scans. Eighteen patients were included (10 females, mean age 68). Mean NDI score was 22. Mean VAS was 7.5. On bone SPECT/CT, it was found that 13 patients had high osteoblastic activity unilaterally at the atlanto-axial joint (AAJ); two patients at the atlanto-dental joint (ADJ), one at the occipito-atlantal joint (OAJ), one at both OAJ and ADJ and one at the level of C2 pars/pedicle unilaterally. Metabolic activity on SPECT/CT was associated with severe degenerative changes on CT scans. The ability of hybrid bone SPECT/CT to precisely localize osteoblastic activity at the CVJ may provide significant improvement in the diagnosis and treatment of patients with suboccipital/neck pain and joint arthropathy at the CVJ. Further clinical studies are needed to establish the real clinical impact of bone SPECT/CT in the treatment of patients with suboccipital neck pain.
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Affiliation(s)
- Vittorio M Russo
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
| | - Anneli Duits
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
| | - Ranju T Dhawan
- b Department of Hybrid Functional Imaging & Nuclear Medicine , The Wellington Hospital , London , UK
| | - Adrian T H Casey
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
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16
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Guha D, Mohanty C, Tator CH, Shamji MF. Occipital neuralgia secondary to unilateral atlantoaxial osteoarthritis: Case report and review of the literature. Surg Neurol Int 2016; 6:186. [PMID: 26759731 PMCID: PMC4697204 DOI: 10.4103/2152-7806.172531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/10/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Atlantoaxial osteoarthritis (AAOA), either in isolation or in the context of generalized peripheral or spinal arthritis, presents most commonly with neck pain and limitation of cervical rotational range of motion. Occipital neuralgia (ON) is only rarely attributed to AAOA, as fewer than 30 cases are described in the literature. Case Description: A 64-year-old female presented with progressive incapacitating cervicalgia and occipital headaches, refractory to medications, and local anesthetic blocks. Computed tomography and magnetic resonance imaging studies documented advanced unilateral atlantoaxial arthrosis with osteophytic compression that dorsally displaced the associated C2 nerve root. Surgical decompression and atlantoaxial fusion achieved rapid and complete relief of neuralgia. Ultimately, postoperative spinal imaging revealed osseous union. Conclusions: Atlantoaxial arthrosis must be considered in the differential diagnosis of ON. Surgical treatment is effective for managing refractory cases. Intraoperative neuronavigation is also a useful adjunct to guide instrumentation and the intraoperative extent of bony decompression.
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Affiliation(s)
- Daipayan Guha
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chandan Mohanty
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed F Shamji
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Goel A. Posterior atlantoaxial 'facetal' instability associated with cervical spondylotic disease. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:51-5. [PMID: 25972708 PMCID: PMC4426521 DOI: 10.4103/0974-8237.156039] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior) atlantoaxial ‘facetal’ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA) scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months), all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ‘frequently’ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
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