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Spontaneous Osseous Fusion after Remodeling Therapy for Chronic Atlantoaxial Rotatory Fixation and Recovery Mechanism of Rotatory Range of Motion of the Cervical Spine. J Clin Med 2022; 11:jcm11061504. [PMID: 35329830 PMCID: PMC8949716 DOI: 10.3390/jcm11061504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to investigate the risk factors of spontaneous osseous fusion (SOF) of the atlantoaxial joint after closed reduction under general anesthesia followed by halo fixation (remodeling therapy) for chronic atlantoaxial rotatory fixation, and to elucidate the recovery mechanism of the rotatory range of motion (ROM) after halo removal. Twelve patients who underwent remodeling therapy were retrospectively reviewed. Five patients with SOF were categorized as the fusion group and seven patients without SOF as the non-fusion group. Three dimensional CT was used to detect direct osseous contact (DOC) of facet joints before and during halo fixation, while dynamic CT at neutral and maximally rotated head positions was performed to measure rotatory ROM after halo removal. The duration from onset to initial visit was significantly longer (3.2 vs. 5.7 months, p = 0.04), incidence of DOC during halo fixation was higher (0/7 [0%] vs. 4/5 [80%], p = 0.004), and segmental rotatory ROM of Occiput/C1 (Oc/C1) at final follow-up was larger (9.8 vs. 20.1 degrees, p = 0.003) in the fusion group. Long duration from the onset to the initial visit might induce irreversible damage to the articular surface of the affected facet, which was confirmed as DOC during halo fixation and resulted in SOF. Long duration from the onset to the initial visit and DOC during halo fixation could be used to suggest the risk for SOF. Nonetheless, rotatory ROM of Oc/C1 increased to compensate for SOF.
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Koljonen PA, Cheung KM. Concomitant atlantoaxial and atlanto-occipital rotatory dislocation in children: Radiological features, diagnostic pitfalls, and long-term outcome. J Orthop Surg (Hong Kong) 2021; 29:23094990211015502. [PMID: 33998343 DOI: 10.1177/23094990211015502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial and atlanto-occipital joints, or OAARD - short for occipital-atlantoaxial rotatory dislocation - is a condition which has been poorly elucidated and probably underdiagnosed. We believe that the pathogenesis of combined atlantoaxial and atlanto-occipital dislocation is most likely a result of untreated atlantoaxial rotatory dislocation leading to chronic secondary compensation measures occurring at the occiput-C1 joints. Unique clinical and radiological features lead to difficulty in diagnosis, and conventional treatment algorithms may not apply. This paper describes a combination of clinical and radiological features which can help clinicians correctly diagnose and treat OAARD.
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Affiliation(s)
- Paul A Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong
| | - Kenneth Mc Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong
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Iwai C, Fushimi K, Nozawa S, Mitsuishi N, Ogawa H, Maeda M, Kuramitsu N, Akiyama H. Spontaneous morphological remodelling of the O-C1 joint after posterior fusion for occipitocervical dislocation. Int J Neurosci 2020; 132:397-402. [PMID: 32883147 DOI: 10.1080/00207454.2020.1818740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Traumatic occipitocervical dislocation (OCD) occurs due to fatal high-energy injury. Modern screw-based constructs enable successful reduction and stabilisation. In view of this, there are no previous reports on the spontaneous remodelling of the O-C1 joint after posterior fusion. We report the first case of postoperative spontaneous remodelling and stabilisation of the O-C1 joint after traumatic OCD.Case description: A 9-year-old girl suffered from traumatic OCD, accompanied by complete rupture of the O-C1-C2 ligamentous complex. Halo-vest fixation, and subsequently posterior fusion surgery from the occipital bone to C2, with autologous iliac crest bone graft and an allograft were performed. However, we could not achieve complete reduction of the O-C1 joint during surgery owing to extremely severe instability.Postoperative X-ray and computed tomography scan showed incomplete reduction of the O-C1 joint. Insufficient congruity of the O-C1 joint persisted. Afterwards, gradual spontaneous remodelling of the O-C1 joint occurred, both anteriorly and posteriorly 3 months postoperatively. Solid union was achieved 6 months postoperatively. Two years later, bilateral O-C1 joints in the patient were completely reformed and restabilised by incredible vigorous remodelling. Insufficient reduction and persisting poor joint congruence after surgery for OCD was probably restabilised by further spontaneous remodelling of articular morphology in such a young patient. CONCLUSIONS Postoperative spontaneous remodelling of the O-C1 joint after posterior reconstruction for OCD may occur in young patients. Incomplete reduction of the O-C1 joint during surgery may be acceptable due to the possibility of postoperative bone remodelling and restabilisation.
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Affiliation(s)
- Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazunari Fushimi
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naofumi Mitsuishi
- Department of Orthopaedic Surgery, Takayama Red Cross Hospital, Gifu, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masato Maeda
- Department of Orthopaedic Surgery, Takayama Red Cross Hospital, Gifu, Japan
| | - Norishige Kuramitsu
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Proietti L, Perna A, Ricciardi L, Fumo C, Santagada DA, Giannelli I, Tamburrelli FC, Leone A. Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series. Radiol Med 2020; 126:250-257. [PMID: 32654029 DOI: 10.1007/s11547-020-01252-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/02/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION There is no consensus on how to evaluate segmental fusion after lateral lumbar interbody fusion (LLIF). Bone bridges (BB) between two contiguous vertebra are reported as pathognomonic criteria for anterior fusion. However, to the best of our knowledge, there are no radiological investigations on zygapophyseal joints (ZJ) status after LLIF. The aim of this radiological study was to investigate the different fusion patterns after LLIF. MATERIALS AND METHODS This is a retrospective single-centre radiological study. Patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis, on a single lumbar level, were considered for eligibility. Complete radiological data and a minimum follow-up of 1 year were the inclusion criteria. Intervertebral BB were investigated for evaluating anterior fusion and ZJ ankylotic degeneration was evaluated according Pathria et al., as a matter of proof of posterior fusion and segmental immobilization. RESULTS Seventy-four patients were finally included in the present study. Twelve months after surgery, intervertebral BB were recognized in 58 segments (78.3%), whereas ZJ Pathria grade was I in 8 (10.8%) patients, II in 15 (20.3%) and III in 51 (68.9%) that were considered posteriorly fused. The overlapping rate between anteriorly and posteriorly fused segments was 72.4% (42 segments), whereas 10 (13.5%) did not achieve any fusion, anterior or posterior, and 6 (8.1%) were posteriorly fused only. CONCLUSIONS Our results seem to suggest that anterior fusion is not sufficient to achieve segmental immobilization. Further properly designed investigations are needed to investigate eventual clinical-radiological correlations.
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Affiliation(s)
- Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Via Pio X, 4, 73039, Tricase, LE, Italy.
- UO di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Facoltà di Medicina e Psicologia, Sapienza, Rome, Italy.
| | - Caterina Fumo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Alessandro Santagada
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Giannelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Vaishya R, Singh AK, Agarwal AK, Vijay V. Bilateral Spontaneous Bony Ankylosis of the Elbow Following Burn: A Case Report and Review of the Literature. J Orthop Case Rep 2019; 8:43-46. [PMID: 30740374 PMCID: PMC6367284 DOI: 10.13107/jocr.2250-0685.1204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Ankylosis of a joint could be intra-articular or extra-articular. Intra-articular ankylosis may be fibrous or bony. Soft tissue contracture and heterotopic ossification area common finding in patients with a deep burn around the joints. Intra-articular bony ankylosis after burn is uncommon, but a possible complication and we present a rare case with bilateral elbow involvement. Case Report: A 35-year-old female presented to us with contracture of both the elbows. She had a history of severe accidental thermal burn involving mainly the front of both the upper limbs 6months back. She developed burn contracture of both elbows. X-rays of both elbows showed bony fusion. Conclusion: Spontaneous bony fusion occurs in various pathologies, some are well known, but some are rare and unusual. Development of soft tissue contracture in deep burn is quite typical, followed by extra-articular ankylosis, but true spontaneous bony fusion can also occur. The possibility of spontaneous bony fusion in deep burn injuries around the joint should be kept in mind by both plastic surgeons and orthopedic surgeons.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110076, India
| | - Amit Kumar Singh
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110076, India
| | - Amit Kumar Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110076, India
| | - Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110076, India
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Kashii M, Masuhara K, Kaito T, Iwasaki M. Rotatory Subluxation and Facet Deformity in the Atlanto-occipital Joint in Patients with Chronic Atlantoaxial Rotatory Fixation: Two Case Reports. J Orthop Case Rep 2018; 7:59-63. [PMID: 29600213 PMCID: PMC5868886 DOI: 10.13107/jocr.2250-0685.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The relationship between the morphometry of atlantoaxial joint and chronic atlantoaxial rotatory fixation (AARF) is well known, but disorders in the atlanto-occipital joint in chronic AARF are not fully elucidated. The authors report two rare cases of secondary deformities in the atlanto-occipital joint in chronic AARF. Case Reports: Two patients with chronic AARF were treated with closed manipulation, skull traction and halo-vest immobilization. Clinical outcomes and radiographs were reviewed retrospectively, focusing on pathological changes in the atlanto-occipital joint using multiplanar reconstruction computed tomography and three-dimensional computed tomography images. Case 1 (12-year-old girl) had rotatory subluxation with a superior facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. After a series of conservative treatments, both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced, and both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed. She was monitored without surgery because the disorder progressed to the spontaneous fusion of the occipital bone to the axis. Case 2 (13-year-old boy) had rotatory subluxation without facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. However, both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed over time, and both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced after a series of conservative treatments. He still had severe neck pain and severely restricted neck mobility and underwent spinal fusion. Conclusion: Atlanto-occipital rotatory subluxation and facet deformity in the atlanto-occipital joint may occur after prolonged AARF. It is necessary to pay attention to pathological changes not only in the atlantoaxial joint but also in the atlanto-occipital joint, when orthopedic surgeons treat patients with AARF.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, Japan.,Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kenta Masuhara
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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