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Takahata M, Hyakkan R, Oshima S, Oda I, Kanayama M, Hyakumachi T, Fujita R, Endo T, Kajino T, Iwasaki N. Cervical Myelopathy Caused by Non-Rheumatic Retro-Odontoid Pseudotumor: An Investigation of Underlying Mechanisms and Optimal Surgical Strategy. Global Spine J 2023; 13:2053-2062. [PMID: 35000408 PMCID: PMC10556925 DOI: 10.1177/21925682211069542] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE This study aimed to identify the underlying pathologies of non-rheumatic retro-odontoid pseudotumors (NRPs), which would help establish an appropriate surgical strategy for myelopathy caused by NRP. METHODS We identified 35 patients with myelopathy caused by NRP who underwent surgery between 2006 and 2017. An age- and sex-matched control group of 70 subjects was selected from patients with degenerative cervical myelopathy. Radiographic risk factors for NRP were compared between cases and controls. We also assessed surgical outcomes following occipital-cervical (O-C) fusion, atlantoaxial (C1-2) fusion, or C1 laminectomy. RESULTS Patients with NRP had significantly lower C1 sagittal inner diameter, C2-7 range of motion (ROM), C2-7 Cobb angle, and C7 tilt, as well as significantly higher C1-2 ROM, atlantodental interval (ADI), and C1-2 to O-C7 ROM ratio. Multivariate regression analysis revealed that ADI, C2-7 ROM, and C7 tilt were independent risk factors for NRP. Neurological recovery and pseudotumor size reduction were comparable among surgical procedures, whereas post-operative cervical spine function was significantly lower in the O-C fusion group than in the other groups. CONCLUSION Non-rheumatic retro-odontoid pseudotumor was associated with an increase in ADI, suggesting that spinal arthrodesis surgery is a reasonable strategy for NRP. C1-2 fusion is preferable over O-C fusion because of the high prevalence of ankylosis in the subaxial cervical spine. Given that 29% of patients with NRP have C1 hypoplasia, such cases can be treated by posterior decompression alone. Our study highlights the need to select appropriate surgical procedures based on the underlying pathology in each case.
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Affiliation(s)
- Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Hokkaido Spine Study Group, Sapporo, Japan
| | - Ryota Hyakkan
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Hokkaido Spine Study Group, Sapporo, Japan
| | - Shigeki Oshima
- The Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | - Itaru Oda
- Hokkaido Spine Study Group, Sapporo, Japan
- The Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | - Masahiro Kanayama
- Hokkaido Spine Study Group, Sapporo, Japan
- The Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | - Takahiko Hyakumachi
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryo Fujita
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Hokkaido Spine Study Group, Sapporo, Japan
| | - Tsutomu Endo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Hokkaido Spine Study Group, Sapporo, Japan
| | - Tomomichi Kajino
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Hokkaido Spine Study Group, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Seok SY, Lee DH, Lee HR, Cho JH, Hwang CJ, Lee CS, Yoon SM. Floating Laminoplasty for the Treatment of Compressive Myelopathy Accompanied by C1 Posterior Ring Hypoplasia: A Technical Note and Case Series. World Neurosurg 2023; 174:69-73. [PMID: 36787857 DOI: 10.1016/j.wneu.2023.01.075] [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: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023]
Abstract
Posterior ring hypoplasia of the atlas (C1) is not common and in most cases is found by chance without symptoms. This disorder is sometimes accompanied by a mild C1-C2 instability or the presence of a space-occupying lesion such as ossification of posterior longitudinal ligament, pannus, or retro-odontoid pseudo-tumor, which are indications for surgery if symptomatic cord compression is present. A C1 posterior arch resection has been the procedure of choice but is associated with several fatal complications. We here present a novel posterior arch decompression technique that is relatively safer and easier and that involves mobilization and posterior translation of the posterior arch as a whole, similar to a vertebral body sliding osteotomy.
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Affiliation(s)
- Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggido, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Meen Yoon
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju University School of Medicine, Jejudo, Korea
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Chen L, Zhu X, He B, Chen Q, Li F. Effect of C 1 Single-door Laminoplasty on Symptomatic Atlas Canal Stenosis. Orthop Surg 2022; 14:2757-2765. [PMID: 36028926 PMCID: PMC9531081 DOI: 10.1111/os.13352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To verify the effect of single-door laminoplasty combined with atlantoaxial fusion in the treatment of symptomatic atlas canal stenosis. METHODS This is a single-center retrospective analysis. From February 2014 to January 2019, 16 patients (five were females) with an average age of 63.4 years (56-71 years) were enrolled in this study. Patients with compressive cervical myelopathy with CT scan showed an inner sagittal diameter (ISD) of C1 less than 29 mm or C1 canal space available for cord (SAC) of <12 mm were included, while isolated C1 stenosis without myelopathy or isolated C1 stenosis without atlantoaxial subluxation were excluded in this study. All patients underwent continuous heavy-weight skull traction, atlas single-door laminoplasty and atlantoaxial fusion. The differences in the pre- and post-operative inner sagittal diameter, space available for cord, atlas-dens interval (ADI) and compression of the spinal cord were analyzed by using CT and MRI. Functional evaluation was performed by using the Japanese Orthopaedic Association scoring system and the Neck Disability Index scoring system. RESULTS Single-door laminoplasty provided a full decompression for the spinal cord while retaining the whole posterior arch. No complications were encountered except a superficial wound infection in one patient. At final follow-up, The ADI was significantly reduced from 5.2 ± 1.8 mm to 1.7 ± 0.6 mm after surgery on average (P < 0.05). Average inner sagittal diameter of C1 was increased from 26.3 ± 2.6 mm to 34.9 ± 2.9 mm and the space available for cord was increased from 6 ± 1.7 mm to 17.8 ± 3.6 mm (P < 0.05). Meanwhile, the Japanese Orthopaedic Association (JOA) score of the 16 cases was improved from 11.4 ± 1.8 to 14.1 ± 1.4 on average (P < 0.05). The postoperative neck pain VAS score decreased significantly, from 2.6 ± 1.0 preoperatively to 1.3 ± 0.9 postoperatively (P < 0.05). The influence of neck pain on patient's life was improved from 17.8 ± 3.9 to 13.9 ± 3.3 after surgery (P < 0.05). At the last follow-up, the healing of the hinge fracture and the fusion between atlas and axis were observed in all patients. CONCLUSIONS Single-door laminoplasty combined with atlantoaxial fusion not only provides enough space for decompression but also offers intact arch for bone grafting, suggesting that it might provide a more feasible method for the correction of symptomatic atlas canal stenosis.
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Affiliation(s)
- Linwei Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xiuliang Zhu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Bin He
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Qixin Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fangcai Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Lin Y, Rao S, Liu B, Sun Y, Zhao S, Su G, Chen S, Li Y, Chen B. Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:720. [PMID: 35845524 PMCID: PMC9279768 DOI: 10.21037/atm-22-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses. Case Description The patient in Case 1 presented with neck pain and numbness and weakness in the limbs. The patient in Case 2 presented with numbness in the extremities and the patient in Case 3 presented with bilateral hand numbness and left lower limb weakness. They were all diagnosed with DASM and underwent PFEC1L treatment to maintain the enlargement and decompression of the atlantal canal, which achieved favorable outcomes without complications during the postoperative follow-up visit. Conclusions DASM is rare but potentially dangerous. Its diagnosis is made based on clinical manifestations combined with radiological imaging examinations, especially computed tomography (CT) scan and magnetic resonance imaging (MRI). While C1L is the most common surgical method, PFEC1L is a new feasible and safe therapeutic option with comparable good outcomes and the advantage of being minimally-invasive. To our knowledge this is the first report that PFEC1L was applied for DASM treatment.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Rao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingxin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai Zhao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyi Su
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shudong Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongjin Li
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
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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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CT morphometric analysis of the cervical spinal canal with special reference to the correlation with the vertebral level. J Orthop Sci 2021; 26:354-357. [PMID: 32418799 DOI: 10.1016/j.jos.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/23/2020] [Accepted: 04/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Narrowness of the spinal canal is associated with the development of cervical myelopathy. While studies have addressed the sagittal diameter of the cervical spinal canal, few evaluated the correlation between the size of the spinal canal and the vertebral level. We addressed this issue. METHODS Our retrospective study included 102 patients with cranial or spinal disorders. We examined the correlation between the cervical spinal canal diameter (SCD) at C1 to C7 and the inner anteroposterior diameter (IAPD) of the atlas on CT images. RESULTS At C1, the SCD was largest, at C4 it was smallest. While there was a strong correlation between the IAPD and the SCD at C1 (r = 0.8), the correlation between the size of the atlas and the SCD at C4 to C7 was weak (r = 0.2-0.3). We divided our patients into a normal group (n = 34, SCD ≥ 12 mm at any levels) and a stenosis group (n = 68, SCD < 12 mm at all levels). The mean SCD at C2 to C7 was significantly larger in the normal group. There was no significant difference between the two groups with respect to the IAPD and the SCD at C1. CONCLUSIONS The size of the subaxial spine does not necessarily affect the size of the atlas. The pathophysiology of spinal canal stenosis should be considered separately at the C1- and the subaxial level.
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Chinese normative values of C1 sagittal canal diameter and definition of C1 hypoplasia. Chin Med J (Engl) 2021; 134:1362-1363. [PMID: 34075902 PMCID: PMC8183768 DOI: 10.1097/cm9.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yamahata H, Niiro T, Mori M, Yamaguchi S, Yonenaga M, Sugata J, Hiwatari T, Okada T, Atsuchi M, Arita K, Yoshimoto K. Is the atlas size associated with the pathophysiology of symptomatic spinal canal stenosis at the C1 level? J Clin Neurosci 2018; 57:58-62. [DOI: 10.1016/j.jocn.2018.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023]
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9
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Kunakornsawat S, Pluemvitayaporn T, Pruttikul P, Piyasakulkaew C, Wasinpongwanich K, Kittithamvongs P. Variation of C1 spinolaminar line and prevalence of C1 stenosis in normal population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1029-1032. [PMID: 29502319 DOI: 10.1007/s00590-018-2159-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The variation of C1 spinolaminar line in normal population is not fully understood. The relative position of C1 lamina to C3-C2 spinolaminar line is reported as good screening tool for determination of C1 canal stenosis. OBJECTIVE To determine the variation of C1 spinolaminar line and find the prevalence of C1 canal stenosis in normal population using C3-C2 spinolaminar test. MATERIALS AND METHODS Three hundred and fifteen lateral cervical radiographs from 315 volunteers without neurological symptoms were analyzed. The relative position of C1 spinolaminar line was determined by C3-C2 spinolaminar and considered positive if C1 lamina lay ventral to C3-C2 line. C1 space available for cord (SAC) was measured from posterior border of dens to the C1 lamina to determine the sagittal diameter. RESULTS The mean sagittal spinal canal diameter of C1 was 22.2 mm (13-26 mm). Of 315, 14 (4.4%) had positive, 184 (58.4%) had neutral, and 117 (37.1%) had negative C1 spinolaminar line in relation to C3-C2 line. The mean SAC among positive group was 14.9 mm compared to neutral and negative groups which were 22.2 and 23.3 mm, respectively. 21.4% of positive group had SAC of less than 12 mm. The 92.8% of positive C1 spinolaminar line was found in age ≥ 60 years. CONCLUSION In a normal population, 4.4% has positive C1 spinolaminar line. The C1 stenosis is more prevalent in positive C1 spinolaminar line group.
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Affiliation(s)
| | | | | | | | - Kanthika Wasinpongwanich
- Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
- Department of Orthopaedics, Suranaree University of Technology, Nakhon Ratchasima, Thailand
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10
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Yamahata H, Hirano H, Yamaguchi S, Mori M, Niiro T, Tokimura H, Arita K. What Is the Most Representative Parameter for Describing the Size of the Atlas? CT Morphometric Analysis of the Atlas with Special Reference to Atlas Hypoplasia. Neurol Med Chir (Tokyo) 2017; 57:461-466. [PMID: 28747589 PMCID: PMC5638789 DOI: 10.2176/nmc.oa.2017-0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The spinal canal diameter (SCD) is one of the most studied factors for the assessment of cervical spinal canal stenosis. The inner anteroposterior diameter (IAP), the SCD, and the cross-sectional area (CSA) of the atlas have been used for the evaluation of the size of the atlas in patients with atlas hypoplasia, a rare form of developmental spinal canal stenosis, however, there is little information on their relationship. The aim of this study was to identify the most useful parameter for depicting the size of the atlas. The CSA, the IAP, and the SCD were measured on computed tomography (CT) images at the C1 level of 213 patients and compared in this retrospective study. These three parameters increased with increasing patient height and weight. There was a strong correlation between IAP and SCD (r = 0.853) or CSA (r = 0.822), while correlation between SCD and CSA (r = 0.695) was weaker than between IAP and CSA. Partial correlation analysis showed that IAP was positively correlated with SCD (r = 0.687) and CSA (r = 0.612) when CSA or SCD were controlled. SCD was negatively correlated with CSA when IAP was controlled (r = −0.21). The IAP can serve as the CSA for the evaluation of the size of the atlas ring, while the SCD does not correlate with the CSA. As the patient height and weight affect the size of the atlas, analysis of the spinal canal at the C1 level should take into account physiologic patient data.
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Affiliation(s)
- Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Hirofumi Hirano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Satoshi Yamaguchi
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical Sciences
| | - Masanao Mori
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Tadaaki Niiro
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Hiroshi Tokimura
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
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Oshima Y, Kelly MP, Song KS, Park MS, Chuntarapas T, Vo KD, Yeom JS, Takeshita K, Riew KD. Spinolaminar Line Test as a Screening Tool for C1 Stenosis. Global Spine J 2016; 6:370-4. [PMID: 27190740 PMCID: PMC4868590 DOI: 10.1055/s-0035-1564418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022] Open
Abstract
Study Design Retrospective cohort. Objective To clarify the sensitivity of C3-C2 spinolaminar line test as a screening tool for the stenosis of C1 space available for the cord (SAC). Methods Spine clinic records from April 2005 to August 2011 were reviewed. The C1 SAC was measured on lateral radiographs, and the relative positions between a C1 posterior arch and the C3-C2 spinolaminar line were examined and considered "positive" when the C1 ring lay ventral to the line. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were utilized to measure precise diameters of C1 and C2 SAC and to check the existence of spinal cord compression. Results Four hundred eighty-seven patients were included in this study. There were 246 men and 241 women, with an average age of 53 years (range: 18 to 86). The mean SAC at C1 on radiographs was 21.2 mm (range: 13.5 to 28.2). Twenty-one patients (4.3%) were positive for the spinolaminar line test; all of these patients had C1 SAC of 19.4 mm or less. Eight patients (1.6%) had C1 SAC smaller than C2 on CT examination; all of these patients had a positive spinolaminar test, with high sensitivity (100%) and specificity (97%). MRI analysis revealed that two of the eight patients with a smaller C1 SAC had spinal cord compression at the C1 level. Conclusion Although spinal cord compression at the level of atlas without instability is a rare condition, the spinolaminar line can be used as a screening of C1 stenosis.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States,Address for correspondence Michael P. Kelly, MD Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110United States
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University, Heukseok-dong, Dongjak-gu, Republic of Korea
| | - Moon Soo Park
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | | | - Katie D. Vo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
| | - Jin S. Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - K. Daniel Riew
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York, New York, United States
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Kanaya K, Ito K, Horiuchi T, Hongo K. "Dynamic" Rotational Canal Stenosis Caused by Osteoma of the Atlas: A Case Report and Review of Literature. NMC Case Rep J 2015; 3:17-20. [PMID: 28663990 PMCID: PMC5386156 DOI: 10.2176/nmccrj.cr.2015-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022] Open
Abstract
The upper cervical canal stenosis is relatively rare compared to other cervical regions. We report a rare case of upper cervical canal stenosis caused by osteoma of C1 lamina related to dynamic factor of cervical rotation. A 43-year-old woman had a 2-year history of numbness and pain in the right hand. Because of aggravation of the numbness and loss of the fine movement and strength in the right hand, she visited our outpatient clinic. Computed tomographic (CT) scan revealed an ovoid bony lesion at the right side of the C1 lamina. And magnetic resonance (MR) imagings of the cervical spine showed intramedullary high intensity signals in T2-weighted imaging at a site slightly distant from the bony lesion. Rotational dynamic myelo-CT scan was performed because aggravation of the radiating pain was observed with neck rotation to the right. Dynamic CT scan of the craniocervical junction with neck rotation to the right revealed that the bony lesion was moved to the dorsal side and posteriorly compressed the spinal cord. The symptoms were relieved following surgical removal of this bony lesion. The histopathological examination was compatible for osteoma. The dynamic rotational factor for cervical canal stenosis should be taken in consideration, especially in dealing with upper cervical lesions.
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Affiliation(s)
- Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano
| | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano
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Abstract
STUDY DESIGN Cadaveric study. OBJECTIVE To define congenital hypoplasia of the atlas. SUMMARY OF BACKGROUND DATA Little has been written about hypoplasia of the atlas and it is usually described in the setting of other skeletal dysplasias or syndromes. METHODS A total of 543 cervical spine specimens were randomly selected from the Hamann-Todd collection. Sagittal and coronal diameters of the atlas, axis, and C3 (when available), and the dens diameter were measured using digital calipers. Correction for modern size and radiographical magnification was performed. Hypoplasia of the atlas was defined as the lowest 2.5% of measurements. The correlation between inner sagittal diameters at C1 and C3 was calculated. RESULTS The mean C1 inner sagittal diameter was 30.8 ± 2.4 mm (range, 23.5-38.1 mm). We defined C1 hypoplasia as an inner sagittal diameter value representing the smallest 2.5% of subjects. Because the mean was 30.8 mm, hypoplasia was defined as a diameter of ≤26.1 mm or less. Correcting for size and magnification of radiographs, hypoplasia is defined as an inner sagittal diameter of the atlas of 28.9 mm. Approximately 10% of cases had a dens that occupied more than 40% of the spinal canal at C1, thus not following Steel's Rule of Thirds. There was only a moderate correlation between the spinal canal diameter at C1 and at C3 (r = 0.483, N = 345; P < 0.001). CONCLUSION With an inner sagittal diameter of 26 mm or less, one may describe the atlas as hypoplastic. Ten percent of the specimens had an odontoid process that occupied more than 40% of the spinal canal at C1. There was little correlation between the inner sagittal diameter at C1 and the diameter at C3. LEVEL OF EVIDENCE N/A.
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Verbeek INE, Vollebregt A, Halbertsma FJ, van Lindert E, Andriessen P. Acquired progressive hypotonia in infancy: consider compressive cervical myelopathy. Acta Paediatr 2011; 100:e128-9. [PMID: 21352355 DOI: 10.1111/j.1651-2227.2011.02207.x] [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] [Indexed: 11/28/2022]
Abstract
UNLABELLED This case report presents a rare cause of progressive hypotonia due to a congenital bony defect of the atlas in a 2-month-old girl. The patient was initially referred to the paediatric department with feeding problems. Within days after admission she developed progressive hypotonia and showed decreased reflexes of the upper extremities. Magnetic resonance imaging showed compressive myelopathy at the level of vertebra C1. After laminectomy of the C1-vertebra the neurological symptoms resolved. CONCLUSION Most anomalies of the vertebras are asymptomatic. Only symptomatic anomalies with compression and neurological symptoms need surgery.
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Affiliation(s)
- I N E Verbeek
- Pediatrics, Máxima Medical Centre, Veldhoven, The Netherlands
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