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Tan Y, Wang Y, Ding H, Zhang S, Li X, Zhou X, Lai J. Resection of cervical hemivertebra with occipitocervical - fusion: report on two torticollis cases and literature review. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 36823981 DOI: 10.1080/02648725.2023.2178182] [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: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 02/25/2023]
Abstract
The objective of this study is to present the two cases of cervical hemivertebra and torticollis, and To describe technique and result of cervical hemivertebra resection and torticollis correction via a anterior-posterior surgical approach and occipitocervical fusion. Cervical hemivertebra, accompanied by abipartite atlas, agenesis of odontoid and C2 segmental type of vertebral artery (VA), is a rare, but complex congenital anomalies, associated with cervical scoliosis and occipitocervical instability. To the best of our knowledge, this is the first report on such congenital anomaly and deformity correction via anterior-posterior hemivertebra resection with occipitocervical fusion. Two patients were presented with torticollis due to congenital cervical hemivertebra accompanied by abipartite atlas, agenesis of odontoid and C2 segmental type of VA. Deformity correction was executed by an anterior-posterior hemivertebra resection and occipitocervical fusion with segment instrumentation. The treatment course was uneventful and clinical outcomes was favorable. The radiographs showed a satisfactory deformity correction with a well-balanced coronal and sagittal alignment. Hemivertebra resection with occipitocervical fusion could correct torticollis with satisfactory clinical and radiographical outcome.
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Affiliation(s)
- Yixuan Tan
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Yu Wang
- Department of Language, Huzhou University, Huzhou, Zhejiang, China
| | - Hao Ding
- Department of Orthopaedics, Medical School of Nanjing University, Huzhou, Zhejiang, China
| | - Shuhan Zhang
- Department of Anesthesiology, Shanghai changzheng Hospital, Shanghai, China
| | - Xiaoming Li
- Department of Orthopedics, Huzhou University, Huzhou, Zhejiang, China
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Jin Lai
- Department of Orthopedics, Huzhou University, Huzhou, Zhejiang, China
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Siempis T, Tsakiris C, Anastasia Z, Alexiou GA, Voulgaris S, Argyropoulou MI. Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis. Rheumatol Int 2023; 43:195-208. [PMID: 36378323 PMCID: PMC9898347 DOI: 10.1007/s00296-022-05239-5] [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: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reported in 0-13% of cases. When it comes to surgical outcomes, Atlanto-axial joint (AAJ) fusion success rates ranged from 45.16 to 100% of cases. Furthermore, the incidence of postoperative subluxation ranged from 0 to 77.7%. With regards to AADI it is evident that its value decreased in all studies. Furthermore, an improvement in Ranawat classification was variable between studies with a report improvement frequency by at least one class ranging from 0 to 54.5%. In conclusion, through careful radiographic and clinical evaluation, cervical spine involvement in patients with RA can be detected. Surgery is a valuable option for these patients and can lead to improvement in their symptoms.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Charalampos Tsakiris
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Zikou Anastasia
- Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece
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Streufert BD, Onyedimma C, Yolcu YU, Ghaith AK, Elder BD, Nassr A, Currier B, Sebastian AS, Bydon M. Rheumatoid Arthritis in Spine Surgery: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1583-1595. [PMID: 35302407 PMCID: PMC9393968 DOI: 10.1177/21925682211057543] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review and Meta-analysis. OBJECTIVE The purpose of this study is to synthesize recommendations for perioperative medical management of RA patients and quantify outcomes after spine surgery when compared to patients without RA. METHODS A search of available literature on patients with RA and spine surgery was performed. Studies were included if they provided a direct comparison of outcomes between patients undergoing spine surgery with or without RA diagnosis. Meta-analysis was performed on operative time, estimated blood loss, hospital length of stay, overall complications, implant-related complications, reoperation, infection, pseudarthrosis, and adjacent segment disease. RESULTS Included in the analysis were 9 studies with 703 patients with RA undergoing spine surgery and 2569 patients without RA. In RA patients compared to non-RA patients undergoing spine surgery, the relative risk of infection was 2.29 times higher (P = .036), overall complications 1.61 times higher (P < .0001), implant-related complications 3.93 times higher (P = .009), and risk of reoperation 2.45 times higher (P < .0001). Hospital length of stay was 4.6 days longer in RA patients (P < .0001). CONCLUSIONS Treatment of spinal pathology in patients with RA carries an increased risk of infection and implant-related complications. Spine-specific guidelines for perioperative management of antirheumatic medication deserve further exploration. All RA patients should be perioperatively co-managed by a rheumatologist. This review helps identify risk profiles in RA specific to spine surgery and may guide future studies seeking to medically optimize RA patients perioperatively.
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Affiliation(s)
- Benjamin D. Streufert
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Benjamin D Streufert MD, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55901, USA.
| | | | - Yagiz U. Yolcu
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bradford Currier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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Bunmaprasert T, Trirattanapikul V, Sugandhavesa N, Phanphaisarn A, Liawrungrueang W, Phinyo P. Reducible Nonunited Type II Odontoid Fracture with Atlantoaxial Instability: Outcomes of Two Different Fixation Techniques. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157990. [PMID: 34360289 PMCID: PMC8345345 DOI: 10.3390/ijerph18157990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl's C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl's C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated with Magerl's C1-C2 transarticular screw fixation technique augmented with supplemental wiring, and 11 were treated with Harms-Goel C1-C2 screw-rod fixation technique. The bony fusion rate was 100% in both groups. The mean time to fusion was 69.7 (95%CI 53.1, 86.3) days in Magerl's C1-C2 transarticular screw fixation technique and 75.2 (95%CI 51.8, 98.6) days in Harms-Goel C1-C2 screw-rod fixation technique. No severe complications were observed in either group. Displaced reducible, nonunited type II odontoid fracture with cervical myelopathy should be treated by surgery. Both fixation techniques promote bony fusion and provide substantial construct stability.
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Affiliation(s)
- Torphong Bunmaprasert
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.B.); (V.T.); (N.S.); (A.P.); (W.L.)
| | - Vorapop Trirattanapikul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.B.); (V.T.); (N.S.); (A.P.); (W.L.)
| | - Nantawit Sugandhavesa
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.B.); (V.T.); (N.S.); (A.P.); (W.L.)
| | - Areerak Phanphaisarn
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.B.); (V.T.); (N.S.); (A.P.); (W.L.)
| | - Wongthawat Liawrungrueang
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (T.B.); (V.T.); (N.S.); (A.P.); (W.L.)
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR) Cluster, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53-935-180
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Guo J, Lu W, Ji X, Ren X, Tang X, Zhao Z, Hu H, Song T, Du Y, Li J, Shao C, Xu T, Xi Y. Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation. BMC Musculoskelet Disord 2020; 21:239. [PMID: 32290830 PMCID: PMC7158009 DOI: 10.1186/s12891-020-03273-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Background Atlantoaxial subluxation (AAS) is a not rare abnormality between the atlas (C1) and axis (C2). For AAS patients with persistent neck pain and neurologic symptoms, surgical intervention is a good choice. Nevertheless, there were still few reports about the use of intraoperative skull traction and different fixation methods in treatment of AAS. Methods From January 2012 to December 2018, a total of 86 cases were admitted to our hospital and diagnosed as AAS. All the patients received atlantoaxial reduction with the help of intraoperative skull traction and C1-C2 fixation. Clinical and radiological parameters were collected through chart review. Results There were 86 cases included in this study. The mean operative time was 153.9 ± 73.9 min, and the mean amount of intraoperative blood loss was 219.1 ± 195.6 ml. 81 patients underwent posterior reduction, internal fixation and fusion. 5 patients underwent anterior release, followed by posterior internal fixation and fusion. 82 patients got satisfactory postoperative outcomes while complications occurred in 4 patients. Significant neurologic improvement was observed in these patients. Bone fusion was achieved on the midline sagittal reconstructed CT images at the latest follow-up in all these patients except 1 case. All the patients were followed up for 34.84 ± 15.86 months at average (range 12–60 months). The mean ADI value was 7.55 ± 1.67 mm at average preoperatively, and improved to 4.03 ± 1.21 mm postoperatively, and to 4.21 ± 0.99 mm at the latest follow-up. The mean A-A angle was 15.48 ± 9.82 degrees at average preoperatively, and improved to 21.61 ± 10.43 degrees postoperatively, and to 19.73 ± 8.13 degrees at the latest follow-up. The mean A-A height was 35.61 ± 7.66 mm at average preoperatively, and improved to 40.08 ± 8.5 mm postoperatively, and to 38.83 ± 6.97 mm at the latest follow-up. There were complications in 4 patients, including pedicle misplacement, pedicle screw fracture, infection and one death. Conclusion Intraoperative skull traction can effectively facilitate the surgical procedures for ASS caused by different etiologies. Further research will be needed to investigate the safety and effectiveness of this method in the future.
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Affiliation(s)
- Jianwei Guo
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Wencan Lu
- Department of Spine Surgery, Shenzhen University General Hospital, Xueyuan AVE 1098, Nanshan District, Shenzhen, Guangdong, People's Republic of China
| | - Xiangli Ji
- Department of Intensive Care Unit, Qilu Hospital of Shandong University (Qingdao), 758 Hefei Road, Qingdao, 266035, Shandong Province, People's Republic of China
| | - Xianfeng Ren
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Xiaojie Tang
- Department of Orthopedics, Yantai Affiliated Hospital of Binzhou Medical University, 717 Jinbu Street, Muping District, Yantai, 264000, Shandong Province, People's Republic of China
| | - Zheng Zhao
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Huiqiang Hu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Tao Song
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Yukun Du
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Jianyi Li
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Cheng Shao
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Tongshuai Xu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Yongming Xi
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China.
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