An Unrecognized Ligament and its Ossification in the Craniocervical Junction: Prevalence, Patient Characteristics, and Anatomic Evidence

Analysis of surgical treatment of cervical spondylotic amyotrophy

Background

Cervical spondylotic amyotrophy (CSA) is a special type of cervical spondylosis based on cervical degeneration, which is mainly manifested by weakness and atrophy of upper limb muscles without obvious sensory impairment. Various diagnostic and treatment strategies used; however, discrepancies exist. We tried to discuss diagnosing and treating CSA.

Methods

15 patients with CSA were diagnosed in the Orthopedics Department of the First Affiliated Hospital of Zhengzhou University, aged 42-70 years old. The duration of preoperative symptoms of amyotrophy was 6 to 240 months. 12 patients received surgical treatment, and 3 patients received conservative treatment. The patients were divided into two groups according to the site of preoperative amyotrophy. The manual muscle test was used to evaluate the patients' muscle strength pre-and postoperatively.

Results

During postoperative follow-up, the muscle strength of 12 patients improved to different degrees compared to before surgery. The improvement effect was excellent in 2 cases, good in 6, and moderate in 4. There was no decrease in postoperative muscle strength compared with that before surgery. The satisfaction rate of the effect was 66.7%. The two groups had no statistically significant difference in preoperative muscle strength. The postoperative muscle strength of the proximal group was significantly better than that of the distal group.

Conclusion

The surgical effect of CSA of the proximal type is significantly better than that of the distal type. The recovery effect of amyotrophy after surgery for distal type CSA is poor; thus, surgical treatment should be carefully considered.

A retrospective study of the prevalence of calcium deposits around the dens axis via cone beam computed tomography

OBJECTIVE

This study aimed to evaluate the relationship between the presence of calcium deposits (CDs) around the dens axis and patients' age, gender, and systemic diseases.

METHODS

This retrospective study was carried out by examining CBCT. Basic descriptive statistical analyses and normality tests were performed on all variables. The assumption of normality was checked using the Shapiro-Wilk method. The statistical significance level was accepted as a p-value less than 0.05.

RESULTS

CDs were observed in a total of 99 (21.9%) individuals. The incidence of CDs statistically significantly increased with age (p < .01),while it didn't statistically significantly differ between genders (p = .47). 13% were systemically healthy, while 55% had hypertension. The incidence of CDs was statistically significantly higher in individuals with hypertension.

CONCLUSIONS

In the presence of CDs, the patient should be referred to a medical doctor to confirm the diagnosis of CDS and prevent possible complications.

Cervical MRI assessment of traumatic anterior atlanto-occipital membrane complex injuries with evaluation of ancillary findings

BACKGROUND AND PURPOSE

The purpose of this study was to identify and classify the different types of anterior atlanto-occipital membrane complex injuries on MRI and evaluate for the presence, size, and location of a prevertebral effusion on the preceding CT exams.

MATERIALS AND METHODS

Patients who suffered an anterior atlanto-occipital membrane complex injury were identified retrospectively utilizing Nuance mPower software. An anatomic-based description of the location of the anterior atlanto-occipital membrane complex injury was recorded along with any additional osteoligamentous trauma of the craniocervical junction. The preceding cervical CT exams for these patients were reviewed for the presence and location of a prevertebral effusion.

RESULTS

Fifty patients were identified with an acute, post-traumatic anterior atlanto-occipital membrane complex injury. Three distinct patterns of anterior atlanto-occipital membrane complex injury were observed. Nineteen patients demonstrated increased STIR signal with disruption of the anterior atlanto-occipital membrane, ten patients demonstrated increased STIR signal with disruption of the anterior atlanto-axial membrane, and twenty-one patients demonstrated increased STIR signal with disruption of both the anterior atlanto-occipital membrane and anterior atlanto-axial membrane. An effusion at the C1-C2 level was present in greater than 90% of patients with anterior atlanto-occipital membrane complex injury.

CONCLUSIONS

The presence of a craniocervical prevertebral effusion on CT in trauma patients may raise suspicion for an injury to the anterior atlanto-occipital membrane complex and potentially trigger additional investigation with cervical MRI.

Clinical impact of 3-level anterior cervical decompression and fusion (ACDF) on the occipito-atlantoaxial complex: a retrospective study of patients who received a zero-profile anchored spacer versus cage-plate construct

PURPOSE

To evaluate changes in the sagittal parameters of the occipito-atlantoaxial complex after three-level anterior cervical decompression and fusion (ACDF) and identify the influential factors by comparing ACDF with a zero-profile anchored spacer (ACDF-Z) versus a cage-plate construct (ACDF-P).

METHODS

The cohort comprised 106 patients who underwent three-level contiguous ACDF-Z or ACDF-P for cervical radiculopathy and/or myelopathy. Standing, flexion, and extension radiographs of cervical spine were obtained preoperatively, and 3 and 12 months postoperatively. The assessed cervical sagittal parameters were the platform angle of the axis, Cobb angle, and range of motion (ROM) of C2⁃7, C0⁃1, and C1⁃2.

RESULTS

In both the ACDF-Z and ACDF-P groups, the Cobb angle of the upper cervical spine decreased and the C0-1 ROM increased from preoperatively to 3 and 12 months postoperatively (P < 0.01). The alignment restoration was lost at 12 months compared with 3 months in the ACDF-Z group, but not in the ACDF-P group (P < 0.01). The ACDF-P group showed more loss of C2-7 ROM and more compensatory changes in C0-2 ROM than the ACDF-Z group (P < 0.05).

CONCLUSION

The Cobb angle decreased and ROM increased significantly as compensatory changes of the atlantooccipital or atlantoaxial joint after both types of ACDF, which may accelerate degeneration. The zero-profile anchored spacer had less impact on the occipito-atlantoaxial complex but was worse at maintaining the alignment restoration, which were contrary to the cage-plate construct. Surgeons should be aware of the impact of multi-level ACDFs on the occipito-atlantoaxial complex.