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Deng C, Zou X, Yang H, Fu S, Chen J, Ma R, Xia H, Ma X. Autologous rib grafts for craniocervical junction surgery in children: a clinical application. BMC Musculoskelet Disord 2024; 25:494. [PMID: 38926741 PMCID: PMC11201322 DOI: 10.1186/s12891-024-07607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children. METHODS The outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates. RESULTS All surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3-6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications. CONCLUSION Autologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.
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Affiliation(s)
- Chenfu Deng
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Xiaobao Zou
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Haozhi Yang
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Suochao Fu
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Junlin Chen
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
- Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China
| | - Rencai Ma
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Hong Xia
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China
| | - Xiangyang Ma
- Department of Spinal Surgery, General Hospital of Southern Theater Command, 111 Liuhua Rd, Guangzhou, China.
- Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China.
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Akinci G, Alyaarubi S, Patni N, Alhashmi N, Al-Shidhani A, Prodam F, Gagne N, Babalola F, Al Senani A, Muniraj K, Elsayed SM, Beghini M, Saydam BO, Allawati M, Vaishnav MS, Can E, Simsir IY, Sorkina E, Dursun F, Kamrath C, Cavdar U, Chakraborty PP, Dogan OA, Al Hosin A, Al Maimani A, Comunoglu N, Hamed A, Huseinbegovic T, Scherer T, Curtis J, Brown RJ, Topaloglu H, Simha V, Wabitsch M, Tuysuz B, Oral EA, Akinci B, Garg A. Metabolic and other morbid complications in congenital generalized lipodystrophy type 4. Am J Med Genet A 2024; 194:e63533. [PMID: 38234231 PMCID: PMC11060913 DOI: 10.1002/ajmg.a.63533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024]
Abstract
Morbidity and mortality rates in patients with autosomal recessive, congenital generalized lipodystrophy type 4 (CGL4), an ultra-rare disorder, remain unclear. We report on 30 females and 16 males from 10 countries with biallelic null variants in CAVIN1 gene (mean age, 12 years; range, 2 months to 41 years). Hypertriglyceridemia was seen in 79% (34/43), hepatic steatosis in 82% (27/33) but diabetes mellitus in only 21% (8/44). Myopathy with elevated serum creatine kinase levels (346-3325 IU/L) affected all of them (38/38). 39% had scoliosis (10/26) and 57% had atlantoaxial instability (8/14). Cardiac arrhythmias were detected in 57% (20/35) and 46% had ventricular tachycardia (16/35). Congenital pyloric stenosis was diagnosed in 39% (18/46), 9 had esophageal dysmotility and 19 had intestinal dysmotility. Four patients suffered from intestinal perforations. Seven patients died at mean age of 17 years (range: 2 months to 39 years). The cause of death in four patients was cardiac arrhythmia and sudden death, while others died of prematurity, gastrointestinal perforation, and infected foot ulcers leading to sepsis. Our study highlights high prevalence of myopathy, metabolic abnormalities, cardiac, and gastrointestinal problems in patients with CGL4. CGL4 patients are at high risk of early death mainly caused by cardiac arrhythmias.
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Affiliation(s)
- Gulcin Akinci
- Department of Pediatric Neurology, University of Health Sciences, Izmir Faculty of Medicine, Behcet Uz Children’s Hospital, Izmir, Turkey
| | | | - Nivedita Patni
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nadia Alhashmi
- Clinical and Biochemical Genetics Department, Child Health Department, Royal Hospital, Muscat, Oman
| | | | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Nancy Gagne
- Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Funmbi Babalola
- The Hospital for Sick Children, Department of Pediatrics, Toronto, ON, Canada
| | - Aisha Al Senani
- National Diabetes and Endocrine Center, Royal Hospital, Muscat, Oman
| | - Kavitha Muniraj
- Samatvam Diabetes Endocrinology and Medical Center, Bangalore, India
| | - Solaf M. Elsayed
- Medical Genetics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marianna Beghini
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | | | | | - Madhumati S Vaishnav
- Samatvam Diabetes Endocrinology and Medical Center, Bangalore, India
- Indian Institute of Science, Center for Nano Science and Engineering, Bangalore, India
| | - Ender Can
- Division of Pediatric Neurology, Gaziantep Children’s Hospital, Gaziantep, Turkey
| | | | - Ekaterina Sorkina
- Endocrinology Research Centre, Moscow, Russia
- Clinical Research Facility, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fatma Dursun
- Department of Pediatric Endocrinology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Clemens Kamrath
- Centre of Child and Adolescent Medicine, Department of General Pediatrics and Neonatology, Justus-Liebig-University Giessen, Germany
| | - Umit Cavdar
- Division of Endocrinology, Katip Celebi University, Izmir, Turkey
| | - Partha P. Chakraborty
- Department of Endocrinology and Metabolism, Medical College Hospital, Kolkata, India
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | | | | | - Nil Comunoglu
- Department of Pathology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ahmed Hamed
- Child Health Department, Royal Hospital, Muscat, Oman
| | - Tea Huseinbegovic
- Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Jacqueline Curtis
- The Hospital for Sick Children, Department of Pediatrics, Toronto, ON, Canada
| | - Rebecca J. Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Haluk Topaloglu
- Department of Pediatric Neurology, Yeditepe University, Istanbul, Turkey
| | - Vinaya Simha
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Center Ulm, Ulm, Germany
| | - Beyhan Tuysuz
- Department of Pediatric Genetics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Elif A. Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Baris Akinci
- DEPARK, Dokuz Eylul University, Izmir, Turkey
- Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
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Mahadewa TGB, Junus ES, Awyono S, Japardi D, Lauren C. Severe traumatic atlantoaxial dislocation and type III odontoid fracture treated with occipitocervical fixation: a case report. J Surg Case Rep 2024; 2024:rjae281. [PMID: 38706486 PMCID: PMC11066803 DOI: 10.1093/jscr/rjae281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
The combination of atlantoaxial joint dislocation accompanied by an odontoid process fracture is exceptionally rare, with only a few cases reported. The estimated frequency of these cases is < 2% of all upper cervical spine injuries. In this report, the authors describe an unusual case of traumatic atlantoaxial dislocation with a type III odontoid fracture in a 44-year-old male patient. Before the diagnosis, the patient had a history of seeking a masseur for a neck massage. Subsequently, the patient underwent occipitocervical stabilization to address the underlying condition. This procedure aims to treat the instability between the skull and cervical spine and should be considered in the treatment planning if the patient's anatomy suits it.
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Affiliation(s)
- Tjokorda Gde Bagus Mahadewa
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Eufrata Silvestris Junus
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Steven Awyono
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Denny Japardi
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Kapre JP, Harjpal P, Mandhane KS, Kunjarkar K. Physiotherapeutic Approach Towards Sensory and Motor Recovery in a Patient With Lateral Mass Fixation: A Report of a Rare Case. Cureus 2024; 16:e60913. [PMID: 38910634 PMCID: PMC11193674 DOI: 10.7759/cureus.60913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Atlantoaxial dislocations (AAD) are a diverse set of C1-C2 rotatory subluxations that include the inferior and superior axial facet articulations. C1-C2 segments are both covered by cranial-cervical ligaments, indicating that AAD would damage both joints. Whenever the posterior elements are missing or impaired, lateral mass screw fixation has replaced alternative posterior cervical fixation procedures as the preferred treatment for securing the sub-axial cervical spine. An increase in muscle tone, hyperreflexia, pathological reflexes, digit/hand clumsiness, and gait deviations caused by spinal cord compression at the cervical level are the most common clinical features. A 23-year-old female patient came with the chief complaint of weakness, tingling sensation, and numbness in both upper and lower limbs along with imbalance while walking. She had a history of falls which was managed conservatively. As the symptoms progressed, an MRI, a CT scan, and an X-ray of the neck were done to rule out the level of injury which revealed AAD, and the patient was operated on for C1-C2 lateral mass fixation. Post-operatively, the patient was referred to the physiotherapy department for further management. The patient's quality of life and daily functioning were positively affected after undergoing early intervention as measured by the Functional Independence Measure, Neck Disability Index, Berg Balance Scale, and Dynamic Gait Index.
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Affiliation(s)
- Jaee P Kapre
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Komal S Mandhane
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ketki Kunjarkar
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kang J, Kim BJ. Unexpected postoperative atlantoaxial rotatory subluxation after excision of melanocytic nevi of the head and neck in older children: two case reports and literature review. Arch Craniofac Surg 2024; 25:85-89. [PMID: 38742335 PMCID: PMC11098760 DOI: 10.7181/acfs.2023.00444] [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: 09/13/2023] [Revised: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.
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Affiliation(s)
- Jiwon Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Merckling M, Vazquez S, Nolan B, Subah G, Fortunato M, Stein A, Patel H, Asprinio D, Wainwright J, Kinon M, Gandhi C, Al-Mufti F. Atlantoaxial subluxation and Down syndrome: A cross-sectional analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:173-177. [PMID: 38957770 PMCID: PMC11216643 DOI: 10.4103/jcvjs.jcvjs_1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/08/2024] [Indexed: 07/04/2024] Open
Abstract
Background Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established. This study aims to establish a prevalence rate of DS in patients hospitalized for AAS and compare outcomes between AAS patients with and without DS. Methods This study utilized the National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project (HCUP). In accordance with HCUP 2023 Clinical Classifications Software Refined files, data were queried using the International Classification of Diseases 10th Edition codes for DS and AAS. Demographics, comorbidities, hospital course, and outcomes were examined and compared using binary and linear multivariate regression. IBM SPSS software was used for data analysis. Results Of the 213,095 patients in the NIS database admitted between 2016 and 2020 with AAS as their primary diagnosis, 7.2% were DS patients. DS patients were significantly younger (26.56 ± 20.81 vs. 49.39 ± 27.63, P < 0.01), less likely to be female (33.30% vs. 52.10%), and had fewer comorbidities (diabetes mellitus, hypertension, and hyperlipidemia) than non-DS patients. There was no significant difference in likelihood to undergo surgical fusion between DS patients and non-DS patients with AAS. Conclusion This large-scale study using NIS data determined that 7.2% of all patients admitted to hospitals for AAS are DS patients. The analysis of demographics, hospital course, and outcomes can influence the development of treatment protocols for AAS in the DS population.
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Affiliation(s)
- Matthew Merckling
- Department of Neurosurgery, School of Medicine, New York Medical College, New York, NY, USA
| | - Sima Vazquez
- Department of Neurosurgery, School of Medicine, New York Medical College, New York, NY, USA
| | - Bridget Nolan
- Department of Neurosurgery, School of Medicine, New York Medical College, New York, NY, USA
| | - Galadu Subah
- Department of Neurosurgery, Westchester Medical Center, New York, NY, USA
| | - Michael Fortunato
- Department of Neurosurgery, School of Medicine, New York Medical College, New York, NY, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, New York, NY, USA
| | - Harsdadkumar Patel
- Department of Orthopedics, Westchester Medical Center, New York, NY, USA
| | - David Asprinio
- Department of Orthopedics, Westchester Medical Center, New York, NY, USA
| | - John Wainwright
- Department of Neurosurgery, Westchester Medical Center, New York, NY, USA
| | - Merritt Kinon
- Department of Neurosurgery, Westchester Medical Center, New York, NY, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, New York, NY, USA
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Dave AR, Deshmukh MA, Deshmukh SS. Comprehensive Physiotherapeutic Management of Atlas Occipitalization: A Case Report. Cureus 2024; 16:e55660. [PMID: 38586711 PMCID: PMC10997220 DOI: 10.7759/cureus.55660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
The atlas (C1) and occipital bone at the base of the skull fuse together in atlas occipitalization, an uncommon congenital abnormality. Because it can result in cervical spine instability, nerve impingement, and related symptoms including stiffness, pain, and neurological impairments, it poses a challenging therapeutic problem. We describe the case of a female patient, 27 years old, who had gradually deteriorating neck discomfort, stiffness, and limited cervical mobility for six years prior to presentation. Her symptoms worsened over time despite conservative treatment, so more testing was necessary. Atlas occipitalization, congenital fusion at the C7 and D1 vertebrae, and other related cervical spine pathologies were identified by imaging examinations. The intricacies of atlas occipitalization and related cervical spine pathologies are highlighted in this case study, along with the diagnostic difficulties and interdisciplinary therapeutic strategy needed to address them. To improve cervical range of motion (ROM), lessen discomfort, and improve functional results, the patient underwent a thorough musculoskeletal examination and was given a customized physiotherapeutic intervention.
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Affiliation(s)
- Anandi R Dave
- Department of Physiotherapy, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Mitushi A Deshmukh
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Siddhant S Deshmukh
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Vornetti G, Renzetti B, Vara G, Tonon C, Lodi R, Conti A, Serchi E, Donti A, Mariucci E, Spinardi L. Vertebral artery dissection caused by atlantoaxial dislocation in a patient with Marfan syndrome. Am J Med Genet A 2024; 194:e63467. [PMID: 37933544 DOI: 10.1002/ajmg.a.63467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023]
Abstract
A small number of case reports have documented a link between atlantoaxial dislocation (AAD) and vertebral artery dissection (VAD), but this association has never been described in patients with hereditary connective tissue disorders. We present a case of an 18-year-old female patient, diagnosed with Marfan syndrome since the age of one, who underwent brain MRA for intracranial aneurysm screening revealing tortuosity of the internal carotid and vertebral arteries as well as atlantoaxial dislocation. Since the patient was asymptomatic, a wait-and-see approach was chosen, but a follow-up MRA after 18 months showed the appearance of a dissecting pseudoaneurysm of the V3 segment of the left vertebral artery. Despite the patient being still asymptomatic, it was decided to proceed with C1-C2 stabilization to prevent further vascular complications. Follow-up imaging showed realignment of the atlantoaxial joint and reduction of the dissecting pseudoaneurysm of the left vertebral artery. In our patient, screening MRA has led to the discovery of asymptomatic arterial and skeletal abnormalities which, if left untreated, might have led to severe cerebrovascular complications. Therefore, AAD correction or close monitoring with MRA should be provided to MFS patients with this craniovertebral junction anomaly, even if asymptomatic.
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Affiliation(s)
- Gianfranco Vornetti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Benedetta Renzetti
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Giulio Vara
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Caterina Tonon
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Raffaele Lodi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Elena Serchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Andrea Donti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Luca Spinardi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Shim JH, Kim WS, Kim KG, Yee GT, Kim YJ, Jeong TS. Automated Segmentation and Diagnostic Measurement for the Evaluation of Cervical Spine Injuries Using X-Rays. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01006-z. [PMID: 38378962 DOI: 10.1007/s10278-024-01006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/22/2024]
Abstract
Accurate assessment of cervical spine X-ray images through diagnostic metrics plays a crucial role in determining appropriate treatment strategies for cervical injuries and evaluating surgical outcomes. Such assessment can be facilitated through the use of automatic methods such as machine learning and computer vision algorithms. A total of 852 cervical X-rays obtained from Gachon Medical Center were used for multiclass segmentation of the craniofacial bones (hard palate, basion, opisthion) and cervical spine (C1-C7), incorporating architectures such as EfficientNetB4, DenseNet201, and InceptionResNetV2. Diagnostic metrics automatically measured using computer vision algorithms were compared with manually measured metrics through Pearson's correlation coefficient and paired t-tests. The three models demonstrated high average dice coefficient values for the cervical spine (C1, 0.93; C2, 0.96; C3, 0.96; C4, 0.96; C5, 0.96; C6, 0.96; C7, 0.95) and lower values for the craniofacial bones (hard palate, 0.69; basion, 0.81; opisthion, 0.71). Comparison of manually measured metrics and automatically measured metrics showed high Pearson's correlation coefficients in McGregor's line (r = 0.89), space available cord (r = 0.94), cervical sagittal vertical axis (r = 0.99), cervical lordosis (r = 0.88), lower correlations in basion-dens interval (r = 0.65), basion-axial interval (r = 0.72), and Powers ratio (r = 0.62). No metric showed adjusted significant differences at P < 0.05 between manual and automatic metric measuring methods. These findings demonstrate the potential of multiclass segmentation in automating the measurement of diagnostic metrics for cervical spine injuries and showcase the clinical potential for diagnosing cervical spine injuries and evaluating cervical surgical outcomes.
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Affiliation(s)
- Jae Hyuk Shim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Seok Kim
- Department of Traumatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Gi Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Young Jae Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Seok Jeong
- Department of Traumatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Huang CW, Lin MS, Tzeng CY, Chen TY, Tsou HK. The need for precise and accurate imaging navigation in cervical spine surgery for rheumatoid arthritis. Int J Rheum Dis 2024; 27:e15084. [PMID: 38375747 DOI: 10.1111/1756-185x.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mao-Shih Lin
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Miaoli County, Taiwan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua County, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Tse-Yu Chen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Hsi-Kai Tsou
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Miaoli County, Taiwan
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
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11
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Lee EJ, Kim YJ, Song SO, Lee S, Ryu J, Choi N. Comparison of the diagnostic performance of the Swischuk line method and the anterior atlantodental interval method in atlantodental subluxation. BMC Med Imaging 2024; 24:8. [PMID: 38166926 PMCID: PMC10763429 DOI: 10.1186/s12880-023-01187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Atlantodental subluxation (ADS) is a serious condition that can result in sudden death. Measuring the anterior atlantodental interval (AADI method) is the gold standard for diagnosis but the complex anatomy of this region can make diagnosis difficult, especially for beginners. Therefore, we would like to use a simpler method, the Swischuk line method, to diagnose ADS. The purpose of our study was to evaluate the diagnostic performance of the Swischuk line method for ADS on lateral cervical spine radiographs compared to the AADI method. METHODS A retrospective study was conducted with patients who presented with ADS (ADS group, n = 32, mean age 57.78 years, age range 34-82 years, 10 men, 21 women) and an age- and sex-matched control group (n = 32). The diagnostic performance of the AADI method and the Swischuk line method for ADS was assessed using lateral cervical radiographs in both flexion and neutral postures by an experienced musculoskeletal radiologist (reader 1), a senior resident (reader 2), and a junior resident (reader 3) in the radiologic department. RESULTS In the flexion posture, the AADI method and the Swischuk line method showed excellent diagnostic performance with AUCs > 0.9 for readers 1 2 and reader 3. In a neutral posture, the diagnostic performance of the AADI and Swischuk line methods was decreased. With a 1 mm cut-off value using the Swischuk line method in flexion posture, the sensitivity was 75% or more, the specificity was 100%, and the accuracy was 87.50% or more 90.63% for all readers. With a 2 mm cut-off value, the sensitivity was low (37.50-46.88%) but the specificity was 100% for all three readers. In a neutral posture, the sensitivity for both methods decreased, though specificity remained high (> 80%). CONCLUSIONS The Swischuk line method was found to be reliable and showed high sensitivity and specificity with a cut-off value of 1 mm for the diagnosis of ADS in cervical lateral radiographs in flexion posture. It can be used as a complement to the AADI method.
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Affiliation(s)
- Eun Ji Lee
- Department of Radiology, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, 22332, Incheon, South Korea
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeo Ju Kim
- Department of Radiology, College of Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdong-gu, 04763, Seoul, South Korea.
| | - Sung Oh Song
- Department of Radiology, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, 22332, Incheon, South Korea
- Department of Radiology, Naeun Hospital 23, Wonjeok-ro23, Seo-gu , 22819, Incheon, South Korea
| | - Seunghun Lee
- Department of Radiology, College of Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdong-gu, 04763, Seoul, South Korea
| | - Jeongah Ryu
- Department of Radiology, College of Medicine, Hanyang University Guri Hospital, 11923, Guri, South Korea
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, 04763, Seoul, South Korea
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12
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Hong S, Kim GU. Traumatic posterior dislocation of atlanto-axial joint with anterior arch fracture in the patient of atlanto-occipital assimilation: A case report. Int J Surg Case Rep 2024; 114:109133. [PMID: 38100924 PMCID: PMC10762359 DOI: 10.1016/j.ijscr.2023.109133] [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: 10/16/2023] [Revised: 11/24/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Traumatic atlanto-axial dislocation (AAD) is relatively uncommon and can pose life-threatening risks. In this case, we describe a patient with a combination of AAD, an anterior arch fracture of the atlas, and a rare congenital anomaly known as atlanto-occipital assimilation (AOA). CASE PRESENTATION A 70-year-old man presented with posterior neck pain and right-sided torticollis following an accident that collision with a car while riding an electric scooter. Radiographic findings confirmed posterior AAD with anterior arch fracture of C1 in the inherent setting of AOA. The patient showed no neurologic deficit, so a closed reduction technique using Gardner-Wells tongs was attempted in an awakened state, and successful reduction could achieve without a neurologic deficit. After about three months of rigid brace application, head and neck motion was allowed, and no recurrence of dislocation or cervical pain occurred during the follow-up period of about one year. CLINICAL DISCUSSION Because the posterior AAD is usually accompanied by anterior arch fracture of atlas, the transverse atlantal ligament remained intact. So nonoperative management after manual reduction was possible. The presence of a C1 anterior arch fracture observed in our case can be regarded as an indicator predicting the success of closed reduction of AAD. CONCLUSION Our case highlighted the successful nonoperative management of traumatic posterior AAD with an accompanying anterior arch fracture of the atlas in a peculiar inherent combination of AOA through the closed reduction technique and rigid cervical brace application.
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Affiliation(s)
- Sungan Hong
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Gang-Un Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
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13
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Yau K, Chu ECP, Zhao JG, Lee LYK, Tao C. Multimodal Management of Coexisting Atlantoaxial Subluxation and Spinal Stenosis in an Older Adult: A Case Report and Literature Review. Cureus 2024; 16:e51442. [PMID: 38298323 PMCID: PMC10828745 DOI: 10.7759/cureus.51442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
This case report investigates the diagnostic and therapeutic challenges caused by the coexistence of atlantoaxial subluxation and spinal stenosis in a 70-year-old male patient with chronic progressive numbness in both hands. A detailed assessment showed that the patient's symptoms were primarily caused by spinal stenosis, not atlantoaxial subluxation. Considering the patient's age and preference for nonsurgical treatment, a conservative chiropractic care plan was implemented, significantly improving his symptoms and quality of life. This case highlights the potential benefit of conservative chiropractic care in managing such complex cases, emphasizes the need for meticulous diagnosis, and requires further research to validate these findings and develop comprehensive management guidelines.
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Affiliation(s)
- Kristy Yau
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Jason G Zhao
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, HKG
| | - Cliff Tao
- Department of Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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14
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Zhang Z, Zhao Y, Chou D, Zhang S, Zhou R, Ma Z, Wang L, Yu Z, Liu Y, Wang Y. Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold. J Orthop Surg Res 2023; 18:919. [PMID: 38042858 PMCID: PMC10693051 DOI: 10.1186/s13018-023-04410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
OBJECTIVES To propose a surface reconstruction algorithm based on a differential manifold (a space with local Euclidean space properties), which can be used for processing of clinical images and for modeling of the atlantoaxial joint. To describe the ideal anatomy of the lateral atlantoaxial articular surface by measuring the anatomical data. METHODS Computed tomography data of 80 healthy subjects who underwent cervical spine examinations at our institution were collected between October 2019 and June 2022, including 46 males and 34 females, aged 37.8 ± 5.1 years (28-59 years). A differential manifold surface reconstruction algorithm was used to generate the model based on DICOM data derived by Vision PACS system. The lateral mass articular surface was measured and compared in terms of its sagittal diameter, transverse diameter, articular surface area, articular curvature and joint space height. RESULTS There was no statistically significant difference between left and right sides of the measured data in normal adults (P > 0.05). The atlantoaxial articular surface sagittal diameter length was (15.83 ± 1.85) and (16.22 ± 1.57) mm on average, respectively. The transverse diameter length of the articular surface was (16.29 ± 2.16) and (16.49 ± 1.84) mm. The lateral articular surface area was (166.53 ± 7.69) and (174.48 ± 6.73) mm2 and the curvature was (164.03 ± 5.27) and (153.23 ± 9.03)°, respectively. The joint space height was 3.05 ± 0.11mm, respectively. There is an irregular articular space in the lateral mass of atlantoaxial, and both upper and lower surfaces of the articular space are concave. A sagittal plane view shows that the inferior articular surface of the atlas is mainly concave above; however, the superior articular surface of the axis is mainly convex above. In the coronal plane, the inferior articular surface of the atlas is mostly concave above, with most concave vertices located in the medial region, and the superior articular surface of the axis is mainly concave below, with most convex vertices located centrally and laterally. CONCLUSION A differential manifold algorithm can effectively process atlantoaxial imaging data, fit and control mesh topology, and reconstruct curved surfaces to meet clinical measurement applications with high accuracy and efficiency; the articular surface of the lateral mass of atlantoaxial mass in normal adults has relatively constant sagittal diameter, transverse diameter and area. The distance difference between joint spaces is small, but the shape difference of articular surfaces differs greatly.
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Affiliation(s)
- Zeyuan Zhang
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yao Zhao
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Dean Chou
- Department of the Neurosurgery, Columbia University, New York, USA
| | - Shuhao Zhang
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ruifang Zhou
- School of Mathematics and Information Sciences, Zhongyuan University of Technology, Zhengzhou, China
| | - Zeyu Ma
- School of Mathematics and Information Sciences, Zhongyuan University of Technology, Zhengzhou, China
| | - Limin Wang
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Zhong Yu
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yilin Liu
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China.
| | - Yuqiang Wang
- Department of the Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China.
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15
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Singh DK, Kumar R, Pathak V, Kaif M, Yadav K. C1-C2 coronal and sagittal joint angle based treatment algorithm for the need of transoral odointectomy in complex craniovertebral junction anomalies with Clinico-Radiological outcome analysis. Br J Neurosurg 2023; 37:1594-1603. [PMID: 36073850 DOI: 10.1080/02688697.2022.2118232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Craniovertebral junction (CVJ) pathology by virtue of its complexity is a surgical challenge in the realm of neurosurgery. We analyzed the need for transoral odointectomy in view of their C1-C2 joint coronal and sagittal angle of 58 patients with complex CVJ anomalies treated surgically. The clinical and radiological outcome of the patients was assessed and a treatment algorithm is proposed. METHODS A total of 58 cases were included in the Prospective study over the period of 2 years. Patients were evaluated clinically, investigated, and operated with reduction and rigid internal fixation with screws and rod. The clinical outcome was measured by Modified Japanese orthopedic association score(mJOA) and radiologically by conventional craniometrics indices. Paired 't' test used for statistical analysis. RESULTS Mean age of patients: 30 years, with mean, follow up: 20.5 months. 46(80%) patients were operated by posterior and 12(20%) by combined approach (anterior transoral with posterior). Occipitocervial fixation was done in 15(25.8%) cases and C1-C2 fixation in 43(74.2%) cases. As compared to patients with low coronal angle, the patient with coronal angle >65° needed anterior decompression (87.5%) and all (100%) had Occipitocervical fixation. Clinical outcome analysis showed significant improvement in mean mJOA score (preop 11.9 Vs postop 14.6) after surgery. All craniometrics indices were significantly improved after surgery. The overall complication rate was 10% with a mortality of 1.7%. 6 months follow up completed in all patients with a 100% fusion rate. CONCLUSION Occipitocervical fixation and anterior decompression is required in increased C1-C2 joint CA (>65°) for bony realignment and adequate decompression. Measurement of C1-C2 joint coronal and sagittal angle in complex CVJ anomalies will easily anticipate the surgeon regarding the need for anterior decompression inform of transoral odointectomy.
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Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kumar
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vipul Pathak
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Mohd Kaif
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Kuldeep Yadav
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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16
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Gehrz JA, Hudson AS, James WF, McGuire MM. STRANGULATION-INDUCED ATLANTOAXIAL ROTATORY SUBLUXATION TREATED WITH CLOSED REDUCTION. J Emerg Med 2023; 65:e444-e448. [PMID: 37813737 DOI: 10.1016/j.jemermed.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/19/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Cervical subluxation is a broad class of injuries in which there are degrees of misalignment of vertebral bodies in relationship to adjacent vertebra. Atlantoaxial rotatory subluxation (AARS) is a subtype of cervical subluxation resulting from exaggerated rotation of the C1-C2 complex. Inflammatory, infectious, post-surgical, and traumatic etiologies are recognized and well-described. AARS is predominantly seen in children and occurs rarely in adults. CASE REPORT We submit the case of an otherwise healthy adult male patient presenting to the emergency department with strangulation-induced C1-C2 subluxation with a rotational component that was treated at the bedside by neurosurgery with closed reduction. Why Should an Emergency Physician Be Aware of This? Clinicians must consider a broad range of serious pathologies in a patient presenting with torticollis, especially in the setting of strangulation. Although extremely rare in adults, AARS must be considered in the differential diagnosis, as early identification increases the likelihood of successful nonoperative treatment.
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Affiliation(s)
- Joseph A Gehrz
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
| | | | - William F James
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Morgan M McGuire
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
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17
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Hou X, Tian Y, Xu N, Li H, Yan M, Wang S, Li W. Overstrain on the longitudinal band of the cruciform ligament during flexion in the setting of sandwich deformity at the craniovertebral junction: a finite element analysis. Spine J 2023; 23:1721-1729. [PMID: 37385409 DOI: 10.1016/j.spinee.2023.06.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CONTEXT In the setting of "sandwich deformity" (concomitant C1 occipitalization and C2-3 nonsegmentation), the C1-2 joint becomes the only mobile joint in the craniovertebral junction. Atlantoaxial dislocation develops earlier with severer symptoms in sandwich deformity, which has been hypothesized to be due to the repetitive excessive tension in the ligaments between C1 and C2. PURPOSE To elucidate whether and how the major ligaments of the C1-2 joint are affected in sandwich deformity, and to find out the ligament most responsible for the earlier development and severer symptoms of atlantoaxial dislocation in sandwich deformity. STUDY DESIGN A finite element (FE) analysis study. METHODS A three-dimensional FE model from occiput to C5 was established using anatomical data from a thin-slice CT scan of a healthy volunteer. Sandwich deformity was simulated by eliminating any C0-1 and C2-3 segmental motion respectively. Flexion torque was applied, and the range of motion of each segment and the tension sustained by the major ligaments of C1-2 (including the transverse and longitudinal bands of the cruciform ligament, the alar ligaments, and the apical ligament) were analyzed. RESULTS Tension sustained by the longitudinal band of the cruciform ligament and the apical ligament during flexion is significantly larger in the FE model of sandwich deformity. In contrast, tension in the other ligaments is not significantly changed in the sandwich deformity model compared with the normal model. CONCLUSIONS Considering the importance of the longitudinal band of the cruciform ligament to the stability of the C1-2 joint, our findings implicate that the early onset, severe dislocation, and unique clinical manifestations of atlantoaxial dislocation in patients with sandwich deformity are mainly due to the enlarged force loaded on the longitudinal band of the cruciform ligament. CLINICAL SIGNIFICANCE The enlarged force loaded on the longitudinal band of the cruciform ligament can add to its laxity and thus reducing its ability to restrict the cranial migration of the odontoid process. This is in accordance with our clinical experience that dislocation of the atlantoaxial joint in patients with sandwich deformity is mainly craniocaudal, which means severer cranial neuropathy, Chiari deformity, and syringomyelia, and more difficult surgical treatment.
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Affiliation(s)
- Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Building 1, Yard 9, Chengwan Street, Haidian District, Beijing, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
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18
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Essa A, Khatib S, Beit Ner E, Smorgick Y, Mirovsky Y, Anekstein Y, Rabau O. Traumatic Posterior Atlantoaxial Dislocation With an Associated Fracture: A Systematic Review. Clin Spine Surg 2023; 36:323-329. [PMID: 36750437 DOI: 10.1097/bsd.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/01/2022] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To investigate the clinical presentation, mechanism of injury, patients' characteristics, diagnosis, treatment, and prognosis of traumatic posterior atlantoaxial dislocation with fracture (TPAD). BACKGROUND TPAD is an extremely rare entity, with a limited number of cases reported in the literature. Although rare, a thorough understanding of the pathogenesis and management of such cases is required due to the high risk of spinal cord compression and the severity of neurological deficits. We conducted a systematic review of all cases of TPAD with fractures reported in the literature. METHODS This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. Relevant literature was retrieved from the Pubmed database. All published English-written studies involving human subjects with relevant data regarding TPAD were included. RESULTS Two case series and 20 case reports published between 1924 and 2021 describing 28 patients with TPAD were included. The median age at presentation was 51.5 years, with male predominance (83%). The most common fracture pattern was Anderson and D'alonzo type II odontoid fracture (78%). Neurological exam at presentation was intact in 52% of patients. The primary diagnostic imaging was computed tomography employed in 96% of cases. The management consisted of 2 stages protocol, initially, a temporary axial traction was employed (54%), and later definitive surgical treatment was employed (93%). The posterior surgical approach was favored in 82% of cases. CONCLUSION TPAD with fracture occurred in the majority of cases with Anderson and D'alonzo type II odontoid fracture, predominantly in males. Diagnosis is usually established based on computed tomography imaging; further imaging may not be indicated as it does not seem to alternate the patient's management course. Surgical intervention was employed in almost all cases, with favored results through posterior C1-C2 fusion. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
- Ahmad Essa
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Salah Khatib
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Eran Beit Ner
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Yossi Smorgick
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Orthopedic Surgery, Spine Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Yigal Mirovsky
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Orthopedic Surgery, Spine Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Yoram Anekstein
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Orthopedic Surgery, Spine Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Oded Rabau
- Department of Orthopedics, Shamir (Assaf Harofeh) Medical Center
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Orthopedic Surgery, Spine Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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Lenga P, Issa M, Krull L, Kiening K, Unterberg AW, Schneider T, Oskouian RJ, Chapman JR, Ishak B. Radiological Features in Type II Odontoid Fractures in Older Adults After High- and Low-Energy Trauma. Global Spine J 2023; 13:2471-2478. [PMID: 35344677 PMCID: PMC10538308 DOI: 10.1177/21925682221088215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Although type II odontoid fractures mainly occur due to high-energy trauma (HET), the number of odontoid type II fractures after low-energy trauma (LET) in the elderly is on the rise. However, there is a paucity of conclusive evidence on the relationship between trauma mechanism and cervical spine alignment in the elderly population. Consequently, we examined cervical alignment and osteoporotic and osteoarthritic patterns in elderly individuals (aged ≥65 years) with type II odontoid fractures. METHODS We retrospectively assessed cervical spine alignment in 76 elderly individuals who experienced type II odontoid fractures after HET (n = 36) and LET (n = 40) between 2005 and 2020. Osteoporotic and osteoarthritic changes on computed tomography and cervical alignment parameters on sagittal plane radiographs were examined. RESULTS Moderate and severe osteoporosis of the dens-body junction and osteoarthritis of the atlanto-odontoid joint were more prevalent in the LET than the HET group (P<.005). The anterior atlantodental interval (ADI) was significantly smaller in the LET group than in the HET group (.7 [.7] millimeter vs 1.2 [.8] mm; P=.003). An ADI equal 0 mm indicative for anterior fusion of C1/C2 was present in 37.5% of patients of the LET group. The C0-C2 angle, C1-C2 lordosis, and C2-C7 sagittal vertical axis were significantly different (HET vs LET: 33.2 [7.2]° vs 41.6 [11.4]°, P=.005; 28.1 [7.0]° vs 34.0 [8.0]°, P=.002; and 16.1 [11.1] millimeter vs 27.1 [12.4] mm, P=.008; respectively). CONCLUSION Significantly higher rates of osteoporotic and degenerative changes were observed after LET. Furthermore, previous cervical malalignment represents a risk factor for type II odontoid fractures after LET.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lennart Krull
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Till Schneider
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rod J. Oskouian
- Division of Complex Spine Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jens R. Chapman
- Division of Complex Spine Swedish Neuroscience Institute, Seattle, WA, USA
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Lin MS, Huang CW, Tsou HK, Tzeng CY, Kao TH, Lin RH, Chen TY, Li CR, Lee CY. Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients. Int J Rheum Dis 2023; 26:1996-2006. [PMID: 37565304 DOI: 10.1111/1756-185x.14855] [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: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
AIM An estimated 88% of rheumatoid arthritis (RA) patients experience various degrees of cervical spine involvement. The excessive movement of the atlantoaxial joint, which connects the occiput to the upper cervical spine, results in atlantoaxial instability (AAI). AAI stabilization is usually achieved by C1 lateral mass-to-C2 pedicle screw-rod fixation (LC1-PC2 fixation), which is technically challenging in RA patients who often show destructive changes in anatomical structures. This study aimed to analyze the clinical results and operative experiences of C1-C2 surgery, with emphasis on the advancement of image-guided surgery and augmented reality (AR) assisted navigation. METHODS We presented our two decades of experience in the surgical management of AAI from April 2004 to November 2022. RESULTS We have performed surgery on 67 patients with AAI, including 21 traumatic odontoid fractures, 20 degenerative osteoarthritis, 11 inflammatory diseases of RA, 5 congenital anomalies of the os odontoideum, 2 unknown etiologies, 2 movement disorders, 2 previous implant failures, 2 osteomyelitis, 1 ankylosing spondylitis, and 1 tumor. Beginning in 2007, we performed LC1-PC2 fixation under C-arm fluoroscopy. As part of the progress in spinal surgery, since 2011 we used surgical navigation from presurgical planning to intraoperative navigation, using the preoperative computed tomography (CT) -based image-guided BrainLab navigation system. In 2021, we began using intraoperative CT scan and microscope-based AR navigation. CONCLUSION The technical complexities of C1-C2 surgery can be mitigated by CT-based image-guided surgery and microscope-based AR navigation, to improve accuracy in screw placement and overall clinical outcomes, particularly in RA patients with AAI.
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Affiliation(s)
- Mao-Shih Lin
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, ROC
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ting-Hsien Kao
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tse-Yu Chen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Cheng-Ying Lee
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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21
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Siu WHS, Wang CJ, Wu CT, Wu CY, Ou LS. C1-C2 subluxation in enthesitis-related arthritis: two case reports and literature review of ten cases. Pediatr Rheumatol Online J 2023; 21:77. [PMID: 37537687 PMCID: PMC10401742 DOI: 10.1186/s12969-023-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND C1-C2 subluxation is a rare complication of enthesitis-related arthritis (ERA). If left untreated, it may lead to functional impairment or cervical spinal cord compression. This study aims to highlight key points regarding the management of C1-C2 subluxation in ERA. CASE PRESENTATION We present two cases of C1-C2 subluxation: an 8-year-old boy with ERA and 16-year-old boy with ERA with bilateral sacroiliitis. Ten cases of ERA in the literature were reviewed. The diagnosis of C1-C2 subluxation is mostly based on radiographs and cervical spine computed tomography. All patients were treated with non-steroidal anti-inflammatory drugs. Six ERA patients were treated surgically for cervical fusion. Most ERA patients with sacroiliitis had cervical collar protection. Neurologic abnormalities after treatment were not reported. Despite the use of cervical collar, cervical fusion and persisting ankylosis were found in two ERA patients with sacroiliitis without surgical treatment. CONCLUSIONS Cervical spine protection and ruling out spinal cord compression should be prioritized, in addition to controlling the underlying inflammation in ERA. Cervical halter traction may be applied after severe cervical inflammation is excluded. To reduce the risk of complications, early recognition and appropriate treatments of C1-C2 subluxation in ERA are essential.
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Affiliation(s)
- Wing Hin Stanford Siu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Jan Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Yi Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan
| | - Liang-Shiou Ou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan.
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22
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Alfhmi S, Sejeeni N, Alharbi K, Alharbi R, Malayoo B. Atlantoaxial Subluxation in a 10-Year-Old Girl With Down Syndrome: A Case Report. Cureus 2023; 15:e43955. [PMID: 37746433 PMCID: PMC10514675 DOI: 10.7759/cureus.43955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Down syndrome is the most common inherited chromosomal disorder caused by trisomy 21. Atlantoaxial instability (AAI) is more common in children with Down syndrome, resulting from ligament laxity and odontoid dysplasia. We report the case of a 10-year-old girl with Down syndrome submental. She came to the ER with a history of abnormal gait for one week and was admitted with a case of ataxia for investigations. Moreover, we discovered that she had atlantoaxial subluxation, which was treated surgically.
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Affiliation(s)
- Sumaiah Alfhmi
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | - Nevein Sejeeni
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | | | - Rahaf Alharbi
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Baraah Malayoo
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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23
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Tu CQ, Chen ZD, Yao XT, Jiang YJ, Zhang BF, Lin B. Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation: A case report. World J Clin Cases 2023; 11:4944-4955. [PMID: 37583995 PMCID: PMC10424031 DOI: 10.12998/wjcc.v11.i20.4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Eosinophilic granuloma (EG) is a proliferative condition that affects the cells of bone tissue. There are no specific clinical signs or imaging manifestations in the early stages of the disease, making it simple to overlook and misdiagnose. Because of the disease's rarity, there is presently no standardized treatment principle. There are few accounts of such occurrences affecting the axis among children. We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone. CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation, a 6-year-old boy was brought to our hospital. Following a careful evaluation, the pathology indicated a strong likelihood of an axial EG. Ultimately, we decided to treat the boy with posterior pedicle screw fixation and local steroid injections. CONCLUSION EGs of the upper cervical spine are quite uncommon in children, and they are exceedingly easy to overlook or misdiagnose. Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.
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Affiliation(s)
- Cheng-Quan Tu
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Zhi-Da Chen
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Xiao-Tao Yao
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Yuan-Jie Jiang
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Bi-Fang Zhang
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Bin Lin
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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Zhou Y, Guglielmi G, Garg S, Hankinson TC. Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00070. [PMID: 37651573 DOI: 10.2106/jbjs.cc.23.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CASE A 3-year-old boy presented to the emergency department with torticollis after a fall. With normal cervical radiographs and neurologic exam, he was diagnosed with cervical strain and discharged. After 2-week progressive symptoms, he was referred to a pediatric spine surgeon. Magnetic resonance imaging (MRI) revealed a cervical epidural hematoma, which was then surgically evacuated. He recovered fully and remains symptom-free 2 years later. CONCLUSION Pediatric spinal epidural hematoma is a rare condition with potentially serious outcomes yet often nonspecific symptoms. Timely management based on a comprehensive evaluation of symptoms and imaging findings is crucial in improving patient outcomes.
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Affiliation(s)
- Yan Zhou
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal, Illinois
| | - Sumeet Garg
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
- Department of Orthopedics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Todd C Hankinson
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
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25
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Sugiyama T, Miyamoto K, Yamamoto T, Tokuyama T, Akiyama H, Shimizu K. Atlantoaxial Instability after Treatment of Atlantoaxial Rotatory Fixation: A Case Report. J Orthop Case Rep 2023; 13:105-109. [PMID: 37398533 PMCID: PMC10308970 DOI: 10.13107/jocr.2023.v13.i06.3714] [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: 03/06/2023] [Revised: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction We encountered a case of atlantoaxial subluxation (AAS) after treatment of atlantoaxial rotatory fixation (AARF). Reports of developing AAS after AARF are extremely rare. Case Report An 8-year-old male who feels neck pain was diagnosed with AARF type II according to the Fielding classification. Computed tomography (CT) showed that the atlas was rotated 32° to the right relative to the axis. Neck collar, Glisson traction, and reduction under anesthesia were performed. Five months after the onset of AARF, the patient was diagnosed with AAS due to dilatation of atlantodental interval (ADI) and underwent posterior cervical fusion. Conclusion AARF treatments, such as long-term Glisson traction and reduction under general anesthesia, which exert a stress on the cervical spine, may damage the alar ligaments, apical ligaments, lower longitudinal band, and Gruber's ligament. Transverse ligament damage can also occur during the treatment of AARF, especially if AARF is refractory or requires long-term treatment. In addition, knowledge of the pathophysiology of atlantoaxial instability after AARF treatment is important.
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Affiliation(s)
- Takaaki Sugiyama
- Department of Orthopaedic Surgery, Central Japan International Medical Center, Minokamo, Japan
| | - Kei Miyamoto
- Department of Orthopaedic Surgery, Gifu Municipal Hospital, Gifu, Japan
| | | | - Tsuyoshi Tokuyama
- Department of Orthopaedic Surgery, Kibogaoka Medical and Support Center for Children, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Katsuji Shimizu
- Department of Orthopaedic Surgery, Gifu Municipal Hospital, Gifu, Japan
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Ismail R, Manganaro M, Schartz D, Worley L, Kessler A. A pictorial review of imaging findings associated with upper cervical trauma. Emerg Radiol 2023:10.1007/s10140-023-02141-w. [PMID: 37254028 DOI: 10.1007/s10140-023-02141-w] [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: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are often associated with high morbidity and mortality unless readily identified and treated appropriately. Both computed tomography (CT) and magnetic resonance imaging (MRI) often are crucial in the workup of spinal injury and play a key role in arriving at a diagnosis. Unfortunately, missed cervical spine injuries are not necessarily uncommon and often precede detrimental neurologic sequalae. With the increase in whole-body imaging ordered from the emergency department, it is critical for radiologists to be acutely aware of key imaging features associated with upper cervical trauma, possible mimics, and radiographic clues suggesting potential high-risk patient populations. This pictorial review will cover key imaging features from several different imaging modalities associated with upper cervical spine trauma, explore patient epidemiology, mechanism, and presentation, as well as identify confounding radiographic signs to aid in confident and accurate diagnoses.
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Affiliation(s)
- Rahim Ismail
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Mark Manganaro
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Derrek Schartz
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Logan Worley
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Alexander Kessler
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
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27
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Wu X, Hao C, Ling M, Jin Z, Sun Z, Chang Y, Liu S, Yi Z, Zhu Z. Prevalence and radiographic features of atlantoaxial dislocation in adult patients with Kashin-Beck disease. INTERNATIONAL ORTHOPAEDICS 2023; 47:781-791. [PMID: 36348088 DOI: 10.1007/s00264-022-05616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Kashin-Beck disease (KBD) is an endemic osteoarthropathy affecting the epiphyseal growth plate of multiple joints in young and adolescent patients. Previous studies have focused on the visible deformed extremities instead of the spinal radiological features, especially the atlantoaxial joint. The aim of this study was to determine the prevalence and radiographic features of atlantoaxial dislocation (AAD) in adult patients with KBD. METHODS This study was conducted on KBD patients in three typical endemic counties between October 2017 and November 2019. The patients were evaluated by collecting basic information, clinical signs and symptoms. They underwent dynamic cervical radiography, by which AAD was diagnosed. For those patients with confirmed or suspected AAD, computed tomography (CT) imaging was performed to observe the odontoid morphology and degenerative changes in the lateral atlantoaxial joints. Radiographic evaluations were reviewed to determine the prevalence and features of AAD. RESULTS A total of 39 (14.6%) of 267 KBD patients were diagnosed with AAD. Compared with the non-AAD patients, the detection rate of AAD was associated with a longer disease duration and stage and was not associated with age, sex or BMI. Thirty-two patients had symptoms at the neck or neurological manifestations, while seven had no symptoms. There were three types of morphologies of the odontoid process in AAD patients: separating in 19 cases, hypoplastic in 15 cases and intact in five cases. Anterior dislocation was noted in 29 cases, and posterior dislocation was noted in ten cases. Thirty-four cases were reducible, and five were irreducible. The lateral atlantoaxial joints had different severities of degenerative changes in 17 cases. CONCLUSIONS This study revealed that the prevalence of AAD was 14.6% in adult KBD patients. The radiographic features of AAD include manifestations of odontoid dysplasia and chronic degenerative changes in atlantoaxial joints. KBD patients with severe stages and longer disease duration were more vulnerable to the occurrence of AAD. We postulate that this atlantoaxial anomaly might originate from chondronecrosis of the epiphyseal growth plate of the odontoid process in young and adolescent individuals. This study may provide a clinical reference to help clinicians screen, prevent and treat AAD in adult patients with KBD.
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Affiliation(s)
- Xueyuan Wu
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Cuipei Hao
- Department of Gynaecology Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Ming Ling
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China.
| | - Zhankui Jin
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Zhengming Sun
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Yanhai Chang
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Shizhang Liu
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Zhi Yi
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
| | - Zhehui Zhu
- Department of Orthopaedic Surgery, Shaanxi Provincial People's Hospital, No. 256 You Yi Western Road, Xi'an, 710068, Shaanxi Province, China
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28
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Wang Y, Song C, Ji Y, Xia J, Chen C, Haque M, Zhuang J, Zhou C, Zu J, Li X, Yan J. Clinical and Radiographic Features of the Atlantoaxial Dislocation Associated With Kashin-Beck Disease. World Neurosurg 2023; 171:e1-e7. [PMID: 36049725 DOI: 10.1016/j.wneu.2022.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Keshin-Beck disease (KBD) is a particular type of osteoarthritis that affects many joints. However, the deformity of atlantoaxial joint has been rarely reported in KBD, and therefore its clinical and radiograph features have not been identified. METHODS We reviewed data in 14 patients who were diagnosed with atlantoaxial dislocation (AAD) in KBD at our institution. The demographic data, clinical history, imaging data, operative data, and Japanese Orthopaedic Association score were collected for evaluation. RESULTS The mean age at presentation was 50 ± 1.7 years old. The most common features of AAD in KBD were the osteoarthritis, characterized by hypertrophic dens and anterior arch of the atlas. The average inner anteroposterior diameter (IAPD) of C1 was 28 ± 3.5 mm and the average spinal canal diameter was 14 ± 3.3 mm, which were respectively lower than the control level. Five patients had severe C1 stenosis (IAPD < 26mm). Separated odontoid process, like os odontoideum, was seen 9 patients. The tip of dens fused to C1 was observed in 4 patients; 12 patients had high-riding vertebral artery; and 5 patients had severe C1 stenosis, and they underwent C1 laminectomy with C1-C2 interarticular fusion or occipital-cervical fusion. All the patients displayed neurologic improvement after surgery. CONCLUSIONS The atlantoaxial level could be affected by KBD, which may lead to typical abnormalities and cause AAD. A C1 laminectomy with an C1-C2 interarticular fusion or occipital-cervical fusion is recommended for the patient with severe stenosis.
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Affiliation(s)
- Yufu Wang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chengchao Song
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Ye Ji
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jingjun Xia
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chao Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Moinul Haque
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jinpeng Zhuang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Changlong Zhou
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jianing Zu
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Xuefeng Li
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jinglong Yan
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China.
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29
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Tobing SDAL, Makabori JCF. Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report. Int J Surg Case Rep 2023; 104:107920. [PMID: 36812826 PMCID: PMC9976299 DOI: 10.1016/j.ijscr.2023.107920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Atlantoaxial dislocation is a loss of joint stability between the C1 (atlas) and C2 (axis) spine and could be associated with type II odontoid fracture. In a few previous studies, atlantoaxial dislocation with odontoid fracture has been reported to be the complication of upper cervical spondylitis tuberculosis (TB). CASE PRESENTATION A 14-year-old girl came with sudden neck pain and difficulty moving her head that has worsened in the last 2 days. There was no motoric weakness in her limbs. However, tingling in both hands and feet was felt. X-ray examination showed atlantoaxial dislocation with odontoid fracture. Traction and immobilization using Garden-Well Tongs obtained the reduction of the atlantoaxial dislocation. Transarticular atlantoaxial fixation using cerclage wire and cannulated screw with an autologous graft from the iliac wing was performed through the posterior approach. A postoperative X-ray showed stable transarticular fixation with excellent screw placement. CLINICAL DISCUSSION The application of Garden-Well tongs as a treatment for cervical spine injury has been documented in the previous study with a low rate of complications such as pin loosening, the asymmetrical position of the pin, and superficial infection. The reduction attempt did not significantly improve Atlantoaxial dislocation (ADI). Thus surgical treatment of atlantoaxial fixation using cannulated screw and c-wire with the application of an autologous bone graft is performed. CONCLUSION Atlantoaxial dislocation with an odontoid fracture in cervical spondylitis TB is a rare spinal injury. The use of traction with surgical fixation is needed to reduce and immobilize atlantoaxial dislocation and odontoid fracture.
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Affiliation(s)
- Singkat Dohar Apul Lumban Tobing
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Januar Chrisant Fladimir Makabori
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia.
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Katz EA, Katz SB, Freeman MD. Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients. J Clin Med 2023; 12:jcm12051797. [PMID: 36902584 PMCID: PMC10002528 DOI: 10.3390/jcm12051797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Injury to the head and neck resulting from whiplash trauma can result in upper cervical instability (UCIS), in which excessive movement at C1 on C2 is observed radiologically. In some cases of UCIS there is also a loss of normal cervical lordosis. We postulate that improvement or restoration of the normal mid to lower cervical lordosis in patients with UCIS can improve the biomechanical function of the upper cervical spine, and thus potentially improve symptoms and radiographic findings associated with UCIS. Nine patients with both radiographically confirmed UCIS and loss of cervical lordosis underwent a chiropractic treatment regimen directed primarily at the restoration of the normal cervical lordotic curve. In all nine cases, significant improvements in radiographic indicators of both cervical lordosis and UCIS were observed, along with symptomatic and functional improvement. Statistical analysis of the radiographic data revealed a significant correlation (R2 = 0.46, p = 0.04) between improved cervical lordosis and reduction in measurable instability, determined by C1 lateral mass overhang on C2 with lateral flexion. These observations suggest that enhancing cervical lordosis can contribute to improvement in signs and symptoms of upper cervical instability secondary to traumatic injury.
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Affiliation(s)
| | | | - Michael D. Freeman
- Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence:
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Dayasiri K, Rao S. Fifteen-minute consultation: Evaluation of paediatric torticollis. Arch Dis Child Educ Pract Ed 2023; 108:17-21. [PMID: 34799417 DOI: 10.1136/archdischild-2020-319668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/28/2021] [Indexed: 02/05/2023]
Abstract
Torticollis refers to a state in which the neck is twisted due to excessive contraction or shortening of the muscles on one side. Congenital muscular torticollis, which is more common than acquired torticollis, has an incidence of 0.3%-1.9% among all live births. The clinical approach to torticollis depends on the age at presentation, duration of torticollis and presenting symptoms. The underlying aetiology for torticollis varies with the age of the child. Torticollis can be a presenting feature for life-threatening conditions and thus requires careful evaluation.
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Affiliation(s)
- Kavinda Dayasiri
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Paediatrics, Faculty of medicine, University of Kelaniya, Sri Lanka
| | - Sahana Rao
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Department of Paediatrics, University of Oxford, Oxford, UK
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Huang H, Sheng M, Zeng G, Sun C, Li R. Establish a new parameter "horizontal view-axial angle" and explore its role in the treatment of atlantoaxial instability diseases. Front Surg 2023; 9:947462. [PMID: 36684255 PMCID: PMC9852530 DOI: 10.3389/fsurg.2022.947462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/21/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The objective of the study is to establish a new parameter that can be clearly measured on x-ray images to complement the description of the sagittal alignment of the craniocervical junction. The authors anticipate that this new parameter will enhance surgeons' understanding of the sagittal alignment of the craniocervical junction and play a positive role in the guidance of intraoperative reduction and in the evaluation of postoperative outcomes of patients with atlantoaxial instability. Methods From November 2018 to June 2020, a total of 159 asymptomatic subjects who underwent frontal and lateral cervical x-ray examination in the Second Affiliated Hospital of Soochow University were included in the study. Age, gender, previous spinal trauma, and disease history of each subject were recorded. After screening, 127 effective samples were finally obtained. When taking lateral cervical radiographs, all subjects placed their neck in a neutral position and looked straight ahead with both eyes. On the obtained lateral x-ray images, a straight line was drawn from the radix to the anterior clinoid process; another line was made along the posterior edge of the C2 vertebral body; and the angle between the two lines was measured, which was defined as the "horizontal view-axial angle." The angle formed by the tangent of the posterior edge of the C2 vertebra and C7 vertebral body is the "C2-C7 angle," which was used to describe the curvature of the lower cervical vertebra. The normal range of horizontal view-axial angle and its relationship with C2-7 angle were evaluated. Results The average C2-C7 angle of male subjects was (14.0° ± 7.4°), while that of female subjects was (11.09° ± 7.36°). The average horizontal view-axial angle of male subjects was (92.79° ± 4.52°), and that of female subjects was (94.29° ± 4.50°). Pearson correlation test showed that there was a significant negative correlation between horizontal view-axis angle and C2-C7 angle. Conclusions For patients with atlantoaxial instability diseases, the horizontal view-axis angle is expected to be a sagittal parameter to guide the intraoperative reduction and evaluate postoperative outcomes.
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Affiliation(s)
- Hongxiang Huang
- Department of Neurosurgery, Hainan General Hospital, Haikou, China
| | - Minfeng Sheng
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guangliang Zeng
- Department of Neurosurgery, Changshu No. 2 Peoples’ Hospital, Changshu, China
| | - Chao Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rujun Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China,Correspondence: Rujun Li
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Qu Y, Du Y, Zhao Y, Li J, Luo H, Zhou J, Xi Y. The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation. Front Surg 2023; 9:1028721. [PMID: 36684329 PMCID: PMC9852502 DOI: 10.3389/fsurg.2022.1028721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Atlantoaxial dislocation patients with neurological defects require surgery. Sometimes, release surgery is necessary for irreducible atlantoaxial dislocation to further achieve reduction. Whether release surgery is essential relies on the surgeon's experience and lacks objective reference criteria. To evaluate the value of atlantoaxial joint inclination angle (AAJI) in sagittal and coronal planes and reduction index (RI) in the surgical approach selection for atlantoaxial dislocation. Methods Retrospectively analyzed 87 cases (42 males and 45 females, 9-89 years) of atlantoaxial dislocation from January 2011 to November 2020. In addition, 40 individuals without atlantoaxial dislocation were selected as the control group. Imaging parameters were compared between the two groups. According to surgical methods, the experiment group was divided into two groups including Group A(release surgery group) and Group B (conventional operation group). The parameters were measured based on CT and x-ray. The relevant imaging parameters and clinical scores, including the AAJI in sagittal and coronal planes, the atlas-dens interval (ADI) before and after traction, the RI, and JOA scores were measured and analyzed. Results The sagittal and coronal atlantoaxial joint inclination angles(SAAJI and CAAJI) in the control group were 7.91 ± 0.42(L), 7.99 ± 0.39°(R), 12.92 ± 0.41°(L), 12.97 ± 0.37°(R), in A were 28.94 ± 1.46°(L), 28.57 ± 1.55°(R), 27.41 ± 1.29°(L), 27.84 ± 1.55°(R), and in B were 16.16 ± 0.95°(L), 16.80 ± 1.00°(R), 24.60 ± 0.84°(L), 24.92 ± 0.93°(R) respectively. Statistical analysis showed that there was a statistical difference in the SAAJI between the control group and the experiment group (P < 0.01), as well as between groups A and B (P < 0.01). The RI in groups A and B was 27.78 ± 1.46% and 48.60 ± 1.22% respectively, and there was also a significant difference between the two groups (P < 0.01). There was negative correlation between SAAJI and RI. Conclusions The SAAJI and RI can be used as objective imaging indexes to evaluate the reducibility of atlantoaxial dislocation. And these parameters could further guide the selection of surgery methods. When the RI is smaller than 48.60% and SAAJI is bigger than 28.94°, anterior release may be required.
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Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:209-224. [PMID: 36331596 DOI: 10.1007/s00264-022-05604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach. METHOD From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1-C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy, remodeling, and releasing techs. RESULT The operation time was 144 [Formula: see text] 25 min with blood loss of 102 [Formula: see text] 35 ml. The average pre-operative ADI improved from 7.5 [Formula: see text] 3.2 mm pre-surgery to 2.5 [Formula: see text] 1.5 mm post-surgery (p < 0.05). The average VDI improved from 12.3 [Formula: see text] 4.8 mm pre-surgery to 3.3 [Formula: see text] 2.1 mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 [Formula: see text] 25° pre-surgery to 158 [Formula: see text] 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 [Formula: see text] 28° pre-surgery to 141 [Formula: see text] 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 [Formula: see text] 2.8 pre-operatively to 13.8 [Formula: see text] 2.5 in the sixth months of follow-up. CONCLUSION In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasing combined with plate fixating was effective in treating IAAD/BI with bony obstruction factors.
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Zisakis A, Sun R, Pepper J, Tsermoulas G. Chiari Malformation Type 1 in Adults. Adv Tech Stand Neurosurg 2023; 46:149-173. [PMID: 37318574 DOI: 10.1007/978-3-031-28202-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The term Chiari malformation refers to a heterogeneous group of anatomical abnormalities at the craniovertebral junction. Chiari malformation type 1 (CM1) refers to the abnormal protrusion of cerebellar tonsils through the foramen magnum and is by far the commonest type. Its prevalence is estimated approximately 1%; it is more common in women and is associated with syringomyelia in 25-70% of cases. The prevalent pathophysiological theory proposes a morphological mismatch between a small posterior cranial fossa and a normally developed hindbrain that results in ectopia of the tonsils.In most people, CM1 is asymptomatic and diagnosed incidentally. In symptomatic cases, headache is the cardinal symptom. The typical headache is induced by Valsalva-like maneuvers. Many of the other symptoms are nonspecific, and in the absence of syringomyelia, the natural history is benign. Syringomyelia manifests with spinal cord dysfunction of varying severity. The approach to patients with CM1 should be multidisciplinary, and the first step in the management is phenotyping the symptoms, because they may be due to other pathologies, like a primary headache syndrome. Magnetic resonance imaging, which shows cerebellar tonsillar decent 5 mm or more below the foramen magnum, is the gold standard investigative modality. The diagnostic workup may include dynamic imaging of the craniocervical junction and intracranial pressure monitoring.The management of CM1 is variable and sometimes controversial. Surgery is usually reserved for patients with disabling headaches or neurological deficits from the syrinx. Surgical decompression of the craniocervical junction is the most widely used procedure. Several surgical techniques have been proposed, but there is no consensus on the best treatment strategy, mainly due to lack of high-quality evidence. The management of the condition during pregnancy, restriction to lifestyle related to athletic activities, and the coexistence of hypermobility require special considerations.
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Affiliation(s)
- Athanasios Zisakis
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Rosa Sun
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Joshua Pepper
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
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Liang ZH, Zhang YH, Liu HT, Zhang QQ, Song J, Shao J. Comparison of structural occipital and iliac bone grafts for instrumented atlantoaxial fusions in pediatric patients: Radiologic research and clinical outcomes. Front Surg 2023; 10:1059544. [PMID: 37025272 PMCID: PMC10070866 DOI: 10.3389/fsurg.2023.1059544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Structural autografts harvested from the iliac bone have been used in atlantoaxial fusion; they have been the gold standard for years. However, emerging occipital bone grafts have the advantage of avoiding donor-site morbidity and complications. Thus, we compared the clinical outcomes of structural autografts from the occipital bone or iliac crest and discussed the clinical significance of occipital bone grafts in pediatric patients. Methods Pediatric patients who underwent posterior fusion using occipital bone grafts (OBG) or iliac bone grafts (IBG) between 2017 and 2021 were included in this study. Data on clinical outcomes, including operation time, estimated blood loss, length of hospitalization, complications, fusion rate, and fusion time, were collected and analyzed. Additionally, 300 pediatric patients who underwent cranial computed tomography scans were included in the bone thickness evaluation procedure. The central and edge thicknesses of the harvested areas were recorded and analyzed. Results Thirty-nine patients were included in this study. There were no significant differences in patient characteristics between the OBG and IBG groups. Patients in both groups achieved a 100% fusion rate; however, the fusion time in the OBG group was significantly longer than that in the IBG group. Estimated blood loss, operation time, and length of hospitalization were significantly lower in the OBG group than those in the IBG group. The surgery-related complication rate was lower, but not significantly, in the OBG group than that in the IBG group. For occipital bone thickness evaluation, a significant difference in the central part of the harvesting area was found between the young and old groups, with no significant sex differences. Conclusion The use of OBG for atlantoaxial fusion is acceptable for pediatric patients with atlantoaxial dislocation, avoiding donor-site morbidity and complications.
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Affiliation(s)
| | | | | | | | | | - Jiang Shao
- Correspondence: Yue-Hui Zhang Jiang Shao
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The morphological classification and clinical significance of atlas vertebral artery sulcus based on computed tomography three-dimensional reconstruction. Surg Radiol Anat 2023; 45:241-246. [PMID: 36715709 PMCID: PMC9981493 DOI: 10.1007/s00276-023-03079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to research the morphological classification and clinical significance of vertebral artery sulcus on atlas based on CT three-dimensional reconstruction. METHODS Three-dimensional reconstruction images of 300 adult atlases were collected. A total of 600 atlas vertebral artery sulci were selected in this study. The parameters required for placement of C1 pedicle screw, including depth of grinding drilling (ao), width (cd), length ab), height (H), lateral wall thickness (L1), inner wall thickness (L2), medial angle (∠α), and the cephalad angle to the transverse plane of atlas pedicle (∠β), were measured. RESULTS CT three-dimensional reconstruction images showed that there were five types of atlas vertebral artery sulci: no process type (n = 494 cases, 82.33%), upper process type (n = 29, 4.83%), lower process type (n = 25, 4.17%), double process type (n = 19, 3.17%), and posterior ring type (33, 5.50%). One-way ANOVA tests showed that the five groups differed significantly in the parameter of ao, L2, H, ∠α and ∠β. One-way ANOVA with the LSD post hoc tests showed that the parameter ao of the group of no process type was less than that of the group of upper or lower process type (P < 0.05), and ao of the group of lower process or posterior ring type was less than that of the group of the upper type (P < 0.05). The parameter of ao of the male group was larger than that of the female group. CONCLUSION No process type of the atlas vertebral artery sulcus was the most common, and the medial angle and cephalad angle of the atlas pedicle in this type were the smallest. When pedicle screws are inserted, the above two angles should not be too large. Male's ao was larger than that of female's. All these findings should be considered to avoid the deviation of the nail track.
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Zhou X, Yang YB, Meng Y, Lin T, Zhou X, Wang C. Comparison of surgical outcomes of C1-2 fusion surgery between O-arm-assisted operation and C-arm assisted operation in children with atlantoaxial rotatory fixation. Front Pediatr 2023; 11:1059844. [PMID: 36891232 PMCID: PMC9986453 DOI: 10.3389/fped.2023.1059844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Objective Placement of the pedicle screw is technically challenging during C1-2 fusion surgery in children and different intraoperative image-guided systems have been developed to reduce the risk of screw malposition. The purpose of the present study was to compare surgical outcomes between C-arm fluoroscopy and O-arm navigated pedicle screw placement in the treatment of atlantoaxial rotatory fixation in children. Methods We retrospectively evaluated charts of all consecutive children with atlantoaxial rotatory fixation who underwent C-arm fluoroscopy or O-arm navigated pedicle screw placement from April 2014 to December 2020. Outcomes including operative time, estimated blood loss (EBL), accuracy of screw placement (Neo's classification) and completed fusion time were evaluated. Results A total of 340 screws were placed in 85 patients. The accuracy of screw placement of the O-arm group was 97.4%, which was significantly higher than that of the C-arm group (91.8%). Both groups had satisfied bony fusion (100%). Statistical significance (230.0 ± 34.6 ml for the C-arm group and 150.6 ± 47.3 ml for the O-arm group, p < 0.05) was observed with respect to the median blood loss. There were no statistically significant difference (122.0 ± 16.5 min for the C-arm group and 110.0 ± 14.4 min for the O-arm group, p = 0.604) with respect to the median operative time. Conclusion O-arm-assisted navigation allowed more accurate screw placement and less intraoperative blood loss. Both groups had satisfied bony fusion. O-arm navigation did not prolong the operative time despite the time required for setting and scanning.
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Affiliation(s)
- Xin Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yue Benny Yang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yichen Meng
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China.,Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Lin
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xuhui Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ce Wang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Evaluation of U-Net models in automated cervical spine and cranial bone segmentation using X-ray images for traumatic atlanto-occipital dislocation diagnosis. Sci Rep 2022; 12:21438. [PMID: 36509842 PMCID: PMC9744882 DOI: 10.1038/s41598-022-23863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022] Open
Abstract
Segmentation of the cervical spine in tandem with three cranial bones, hard palate, basion, and opisthion using X-ray images is crucial for measuring metrics used to diagnose traumatic atlanto-occipital dislocation (TAOD). Previous studies utilizing automated segmentation methods have been limited to segmenting parts of the cervical spine (C3 ~ C7), due to difficulties in defining the boundaries of C1 and C2 bones. Additionally, there has yet to be a study that includes cranial bone segmentations necessary for determining TAOD diagnosing metrics, which are usually defined by measuring the distance between certain cervical (C1 ~ C7) and cranial (hard palate, basion, opisthion) bones. For this study, we trained a U-Net model on 513 sagittal X-ray images with segmentations of both cervical and cranial bones for an automated solution to segmenting important features for diagnosing TAOD. Additionally, we tested U-Net derivatives, recurrent residual U-Net, attention U-Net, and attention recurrent residual U-Net to observe any notable differences in segmentation behavior. The accuracy of U-Net models ranged from 99.07 to 99.12%, and dice coefficient values ranged from 88.55 to 89.41%. Results showed that all 4 tested U-Net models were capable of segmenting bones used in measuring TAOD metrics with high accuracy.
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Erbulut DU, Mumtaz M, Zafarparandeh I, Özer AF. Biomechanical Study on Three Screw-Based Atlantoaxial Fixation Techniques: A Finite Element Study. Asian Spine J 2022; 16:831-838. [PMID: 35378577 PMCID: PMC9827200 DOI: 10.31616/asj.2021.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/19/2021] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN This is a finite element study. PURPOSE This study is aimed to compare the biomechanical behaviors of three screw-based atlantoaxial fixation techniques. OVERVIEW OF LITERATURE Screw-based constructs that are widely used to stabilize the atlantoaxial joint come with their own challenges in surgery. Clinical and in vitro studies have compared the effectiveness of screw-based constructs in joint fixation. Nevertheless, there is limited information regarding the biomechanical behavior of these constructs, such as the stresses and strains they experience. METHODS A finite element model of the upper cervical spine was developed. A type II dens fracture was induced in the intact model to produce the injured model. The following three constructs were simulated on the intact and injured models: transarticular screw (C1- C2TA), lateral mass screw in C1 and pedicle screw in C2 (C1LM1-C2PD), and lateral mass screw in C1 and translaminar screw in C2 (C1LM1-C2TL). RESULTS In the intact model, flexion-extension range of motion (ROM) was reduced by up to 99% with C11-C2TA and 98% with C1LM1-C2PD and C1LM1-C2TL. The lateral bending ROM in the intact model was reduced by 100%, 95%, and 75% with C11-C2TA, C1LM1-C2PD, and C1LM1-C2TL, respectively. The axial rotation ROM in the intact model was reduced by 99%, 98%, and 99% with C11-C2TA, C1LM1-C2PD, and C1LM1-C2TL, respectively. The largest maximum von Mises stress was predicted for C1LM1-C2TL (332 MPa) followed by C1LM1-C2PD (307 MPa) and C11-C2TA (133 MPa). Maximum stress was predicted to be at the lateral mass screw head of the C1LM1-C2TL construct. CONCLUSIONS Our model indicates that the biomechanical stability of the atlantoaxial joint in lateral bending with translaminar screws is not as reliable as that with transarticular and pedicle screws. Translaminar screws experience large stresses that may lead to failure of the construct before the required bony fusion occurs.
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Affiliation(s)
- Deniz Ufuk Erbulut
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD,
Australia
| | - Muzammil Mumtaz
- Engineering Center for Orthopaedic Research Excellence (ECORE), University of Toledo, Toledo, OH,
USA
| | - Iman Zafarparandeh
- Department of Biomedical Engineering, Istanbul Medipol University, Istanbul,
Turkey
| | - Ali Fahir Özer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul,
Turkey
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Changes in retro-odontoid mass after upper cervical spine surgery. Sci Rep 2022; 12:20035. [PMID: 36414738 PMCID: PMC9681733 DOI: 10.1038/s41598-022-24436-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
A non-neoplastic mass posterior to the dens is termed a retro-odontoid mass (R-OM). This retrospective study evaluated radiographic and clinical outcomes and R-OM changes after upper cervical spine surgery. This study included 69 patients who underwent upper cervical spine surgery, including atlantoaxial fusion, occipitocervical fusion, or decompression. All patients underwent preoperative magnetic resonance imaging (MRI). Six-month follow-up MRI examinations were performed in 30 patients who had preoperative R-OMs. Radiographic outcomes of the anterior and posterior atlantodental intervals were measured using X-rays and computed tomography. The R-OM and space available for the cord (SAC) were measured using MRI. Clinical outcomes were evaluated using neck and arm pain visual analog scales, the Japanese Orthopedic Association score, the neck disability index, and the patient-reported subjective improvement rate. The anterior atlantodental interval decreased, while the posterior atlantodental interval and SAC increased postoperatively. Among the clinical outcomes, the neck and arm pain and the neck disability index decreased postoperatively, while the Japanese Orthopedic Association score increased. All clinical and radiographic outcomes improved postoperatively. The R-OM either decreased in size or disappeared after fusion surgery in all cases, except in one patient who underwent decompression surgery. In conclusion, stabilization through fusion surgery is essential for treating R-OM.
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Martins RS, Pereira CS, Lemos C, Rodrigues-Pinto R. Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada. Rev Bras Ortop 2022; 58:48-57. [PMID: 36969775 PMCID: PMC10038719 DOI: 10.1055/s-0042-1744502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/20/2022] [Indexed: 10/17/2022] Open
Abstract
Resumo
Objetivo O presente estudo tem como objetivo avaliar o comprimento e os ângulos de trajetória do parafuso para fixação atlantoaxial posterior em uma população portuguesa por meio do estudo de tomografia computadorizada (TC) cervical.
Métodos Tomografias computadorizadas cervicais de 50 adultos foram analisadas quanto às trajetórias pré-definidas dos parafusos transarticulares C1-C2 (C1C2TA), na massa lateral de C1 (C1LM), no pedículo de C2 (C2P) e na pars de C2 e C2 laminar (C2L). O comprimento e os ângulos dos parafusos em cada uma destas trajetórias foram medidos e comparados entre homens e mulheres.
Resultados O comprimento médio e ângulos medial e cranial da trajetória do parafuso C1C2TA foram de 34,12 ± 3,19 mm, 6,24° ± 3,06 e 59,25° ± 5,68, respectivamente; as medidas da trajetória do parafuso C1LM foram 27,12 ± 2,15 mm, 15,82° ± 5,07 e 13,53° ± 4,80. O comprimento médio e os ângulos medial e cranial da trajetória do parafuso C2P foram de 23,44 ± 2,49 mm, 27,40° ± 4,88 e 30,41° ± 7,27, respectivamente; as medidas da trajetória do parafuso da pars de C2 foram 16,84 ± 2,08 mm, 20,09° ± 6,83 e 47,53° ± 6,97. O comprimento médio e ângulos lateral e cranial da trajetória do parafuso C2L foram de 29,10 ± 2,48 mm, 49,80° ± 4,71 e 21,56° ± 7,76, respectivamente. Não houve diferenças entre os gêneros, à exceção do comprimento dos parafusos C1C2TA (p = 0,020) e C2L (p = 0,001), que foi maior no sexo masculino do que no feminino.
Conclusão O presente estudo fornece referências anatômicas para a fixação atlantoaxial posterior em uma população portuguesa. Estes dados detalhados são essenciais para ajudar os cirurgiões de coluna a colocar os parafusos de maneira segura e eficaz.
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Affiliation(s)
- Rita Santos Martins
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Carolina Lemos
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Unidade Vertebro-Medular, Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Janjua MB, Passias PG, Ray WZ. Critical appraisal of bibliometric study on most influential publications of upper cervical spine instability. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:190-192. [PMID: 35875620 PMCID: PMC9263730 DOI: 10.21037/jss-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M. Burhan Janjua
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Anterior Transarticular Crossing Screw Placement for Atlantoaxial Instability in Children: Computed Tomography-Based Study. World Neurosurg 2022; 161:e192-e198. [PMID: 35183796 DOI: 10.1016/j.wneu.2022.01.096] [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: 12/23/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The feasibility of anterior transarticular crossing screw (ATCS) fixation for atlantoaxial instability was confirmed in adults. However, atlantoaxial instability is more common in children. Therefore this study was aimed to ascertain the pediatric morphometric characteristics of ATCS in C1-2. METHODS Morphometric analysis was conducted on computed tomography scan in 87 pediatric patients who were divided into groups based on ages (1-6 years, 7-10 years, and 11-16 years). Measurements were taken in sagittal and axial planes of computed tomography imaging to determine the range of screw lateral angles, incline angles, and screw lengths. RESULTS The overall screw lengths were relatively longer in males than females. For those aged 1-6 years, the screw lengths were 25.5-32.8 mm in males and 24.2-31.3 mm in females, respectively. The screw lengths showed no difference in the 7- to 10-year group between sexes, while the incline angle was larger in females than males. And the screw lengths were 33.5-43.2 mm in males and 31.2-40.4 mm in females in the 11- to 16-year group. The screw lengths were increased with age, yet the lateral angles were decreased. We also found that the epiphyseal closure of odontoid reached 93.6% when the age was older than 7 years old. Therefore ATCS was recommended for children older than 7 years. CONCLUSIONS The overall screw lengths and lateral angles of ATCS were larger in male children than those in females, but the incline angles were larger in females. ATCS is feasible in children, particularly those aged 7 years or older.
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Aoyama R, Yamane J, Ninomiya K, Takahashi Y, Kitamura K, Nori S, Suzuki S, Matsumoto S, Kato M, Ueda S, Anazawa U, Shiraishi T. Atlantoaxial stenosis after muscle-preserving selective laminectomy. J Clin Neurosci 2022; 100:124-130. [PMID: 35453100 DOI: 10.1016/j.jocn.2022.04.013] [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: 03/11/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
There are few reports of degenerative atlantoaxial stenosis and new stenosis after cervical decompression. We experienced four cases of atlantoaxial stenosis after muscle-preserving selective laminectomy. We compared these four cases with no stenosis cases after long-term follow-up of selective laminectomy, as well as healthy subjects. A total of 1205 patients who underwent muscle-preserving selective laminectomy due to cervical disorders were included in this study. Postoperative atlantoaxial stenosis, which needed decompression, appeared in 4 cases, and 30 patients did not have radiological stenosis for more than 10 years after surgery. Twenty healthy volunteers were also used as controls. The radiographic parameters measured were C2-C7 angle, C2-C7 sagittal vertical axis (SVA), C2 slope, C7 slope, C2-C5 angle, C5-C7 angle, C1-C2 angle, and atlantodental interval (ADI). We measured the anterior-posterior (AP) diameters of the spinal cord (SC) and dural tube (Dura) at C1/C2 with sagittal MRI. In the cases of atlantoaxial stenosis, the AP of SC and Dura at C1/C2 were smaller preoperatively, and the residual space for SC (SAC) was also smaller. The preoperative ADI was significantly higher in patients with atlantoaxial stenosis, suggesting preoperative instability at C1/C2. Analysis of the ROC curve showed that patients with a preoperative SAC of less than 3.6 mm and an ADI of more than 1.35 mm were more likely to develop postoperative atlantoaxial stenosis. When we perform a muscle-preserving selective laminectomy, decompression of C1/C2 is suggested when the SAC at C1/C2 is less than 3.6 mm and the ADI is more than 1.35 mm.
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Affiliation(s)
- Ryoma Aoyama
- Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan.
| | - Junichi Yamane
- Department of Orthopedics, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama City, Tokyo 208-0011, Japan
| | - Ken Ninomiya
- Department of Orthopedics, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu Ward, Shizuoka 424-8636, Japan
| | - Yuichiro Takahashi
- Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan
| | - Kazuya Kitamura
- Department of Orthopedics, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama 359-8513, Japan
| | - Satoshi Nori
- Department of Orthopedics, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Satoshi Suzuki
- Department of Orthopedics, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shogo Matsumoto
- Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan
| | - Masahiro Kato
- Department of Orthopedics, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi 321-0974, Japan
| | - Seiji Ueda
- Department of Orthopedics, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki Ward, Kawasaki, Kanagawa 210-0013, Japan
| | - Ukei Anazawa
- Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan
| | - Tateru Shiraishi
- Department of Orthopedics, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba 272-8513, Japan
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Rezvani M, Sabouri M, Aminmansour B, Tabesh H, Shafiei M, Mahmoodkhani M, Rahmani P, Falahpour S, Sourani A, Mahdavi SB. Atlantoaxial instability and cervical noninfectious spondylodiscitis in a patient with Wegener’s granulomatosis: A case report. Clin Case Rep 2022; 10:e05675. [PMID: 35387290 PMCID: PMC8978785 DOI: 10.1002/ccr3.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
A 61‐year‐old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.
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Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Masih Sabouri
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Bahram Aminmansour
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Homayoun Tabesh
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Shafiei
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Mahmoodkhani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Peiman Rahmani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Soheil Falahpour
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Arman Sourani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation School of Medicine Student Research Committee Child Growth and Development Research Center Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
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Planchamp B, Forterre F, Vidondo B, Hernandez-Guerra AM, Plessas IN, Schmidt MJ, Waschk MA, Precht C. Determination of cutoff values on computed tomography and magnetic resonance images for the diagnosis of atlantoaxial instability in small-breed dogs. Vet Surg 2022; 51:620-630. [PMID: 35292990 PMCID: PMC9311214 DOI: 10.1111/vsu.13799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine cutoff values for the diagnosis of atlantoaxial instability (AAI) based on cross-sectional imaging in small-breed dogs. STUDY DESIGN Retrospective multicenter study. SAMPLE POPULATION Client-owned dogs (n = 123) and 28 cadavers. METHODS Dogs were assigned to three groups: a control group, a "potentially unstable" group, and an AAI-affected group, according to imaging findings and clinical signs. The ventral compression index (VCI), cranial translation ratio (CTR), C1-C2 overlap, C1-C2 angle, atlantoaxial distance, basion-dens interval, dens-to-axis length ratio (DALR), power ratio, and clivus canal angles were measured on CT or T2-weighted magnetic resonance (MR) images. Receiver operating characteristic (ROC) analysis was performed to define cutoff values in flexed (≥25°) and extended (<25°) head positions. RESULTS Cutoff values for the VCI of ≥0.16 in extended and ≥0.2 in flexed head positions were diagnostic for AAI (sensitivity of 100% and 100%, specificity of 94.54% and 96.67%, respectively). Cutoff values for the other measurements were defined with a lower sensitivity (75%-96%) and specificity (70%-97%). A combination of the measurements did not increase the sensitivity and specificity compared with the VCI as single measurement. CONCLUSION Cutoff values for several imaging measurements were established with good sensitivity and specificity. The VCI, defined as the ratio between the ventral and dorsal atlantodental interval, had the highest sensitivity and specificity in both head positions. CLINICAL SIGNIFICANCE The use of defined cutoff values allows an objective diagnosis of AAI in small-breed dogs. The decision for surgical intervention, however, should remain based on a combination of clinical and imaging findings.
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Affiliation(s)
- Bastien Planchamp
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Franck Forterre
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Beatriz Vidondo
- Veterinary Public Health Institute, Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Liebefeld, Switzerland
| | - Angel M Hernandez-Guerra
- Department of Veterinary Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Martin J Schmidt
- Clinic for Small Animals, Department of Veterinary Clinical Sciences, Justus-Liebig- University Giessen, Giessen, Germany
| | - Maja A Waschk
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Christina Precht
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Cai G, Zhu D, Chen J, Lin X, Chen R. Effects of traction therapy on atlantoaxial joint dislocation-induced cervical vertigo. Braz J Med Biol Res 2022; 55:e11777. [PMID: 35239778 PMCID: PMC8905676 DOI: 10.1590/1414-431x2022e11777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P<0.001), but the traction therapy group had a greater reduction of LAD compared with the traditional group (P<0.01). Traction therapy consistently led to significantly greater relief of cervical vertigo symptoms, including dizziness, neck and shoulder pain, headache, inconvenience in daily living and work activities, impaired psychosocial adaptation, while improving quality of life. The efficacy of traction therapy for cervical vertigo surpasses that of traditional therapy, suggesting that traction therapy is potentially more clinically useful in treating these patients.
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Affiliation(s)
- Genghui Cai
- Department of Rehabilitation, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Dabin Zhu
- Department of Rehabilitation, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Jieyun Chen
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Xiuyao Lin
- Department of Rehabilitation, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Ri Chen
- Department of Rehabilitation, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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Abstract
BACKGROUND Atlantoaxial rotatory fixation (AARF) comprises a spectrum of abnormal rotational relationships between C1 (atlas) and C2 (axis). We aimed to evaluate the efficacy and long-term clinical outcomes of halter traction in treating patients diagnosed with primary AARF. METHODS We included patients <18 years of age who presented with new-onset painful torticollis, neck pain, and sternocleidomastoid muscle spasm, had an AARF diagnosis confirmed by use of 3-dimensional dynamic computed tomography, received in-hospital cervical halter traction under our treatment protocol, and were followed for ≥12 months. Radiographic and long-term clinical outcomes were analyzed. RESULTS A total of 43 patients (31 male and 12 female; average age of 7.9 years) satisfied the inclusion criteria. There were 5 acute, 6 subacute, and 32 chronic cases. The mean duration of initial symptoms prior to treatment was 12.1 weeks. Thirty-seven (86.0%) of the patients experienced previous minor trauma, and 6 (14.0%) had a recent history of upper-respiratory infection (Grisel syndrome). The mean duration of in-hospital traction was 17.6 days. The mean follow-up period was 8.5 years. Forty-two (97.7%) of the patients achieved normal cervical alignment after treatment. One patient (2.3%) had recurrence and received a second course of halter traction, with cervical alignment restored without any surgical intervention. No neurological deficits were noted during or after the treatment. No major complications were observed. CONCLUSIONS Normal anatomy and restoration of cervical alignment can be achieved by cervical halter traction in most cases of AARF. LEVELS OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chi-Yung Yeung
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Kuang Feng
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
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50
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Byun CW, Lee DH, Park S, Lee CS, Hwang CJ, Cho JH. The association between atlantoaxial instability and anomalies of vertebral artery and axis. Spine J 2022; 22:249-255. [PMID: 34500076 DOI: 10.1016/j.spinee.2021.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A screw-rod system is the most widely used technique for atlantoaxial instability (AAI). However, neglecting anomalies of the vertebral artery and axis could lead to fatal complications. Whether or not the presence of AAI is associated with a more complicated anatomy for instrumentation is unclear. PURPOSE To analyze the association between AAI and anomalies of the vertebral artery and axis in patients with and without AAI. STUDY DESIGN A retrospective comparative study. PATIENT SAMPLE One hundred and twenty patients who underwent preoperative 3-dimensional computed tomography with vertebral angiography of the cervical spine at our institution from 2012 to 2020. OUTCOME MEASURES The C2 isthmus height, internal height of the C2 lateral mass, and C2 pedicle width were radiologically assessed. METHODS A case control study with matched cohort analysis was conducted. One hundred and twenty patients were divided into 2 groups according to presence of AAI, and the presence of high-riding vertebral artery (HRVA) and a narrow pedicle for insertion of the C2 pedicle screw was assessed, as was the prevalence of extraosseous vertebral artery anomaly. RESULTS The C2 isthmus height, C2 internal height, and C2 pedicle width were significantly narrower in the AAI group (p<.01, <.01, and <.01, respectively). A significantly greater proportion of patients with AAI had HRVA and a narrow pedicle than those without (p<.01 and < 0.01, respectively). Among patients with AAI, the C2 internal height was significantly narrower in patients with rheumatoid arthritis (p<.01). Five patients (8.3%) with AAI had vertebral artery anomaly (3 fenestration, 2 persistent first intersegmental artery), while there were no vertebral artery anomalies in patients without AAI (p<.01). CONCLUSIONS Vertebral artery anomalies are more common in patients with AAI. Furthermore, posterior instrumentation in patients with AAI has a narrower safe zone compared to that in patients without AAI, which may be caused by a long-lasting deformity rather than a congenital deformity. Therefore, more thorough preoperative evaluation of the anatomy should be performed in these patients.
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Affiliation(s)
- Chan Woong Byun
- Department of Orthopedic Surgery, Seoul Segyero Hospital, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, PungNap-2-dong, SongPa-gu, Seoul, Republic of Korea.
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, PungNap-2-dong, SongPa-gu, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, PungNap-2-dong, SongPa-gu, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, PungNap-2-dong, SongPa-gu, Seoul, Republic of Korea
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