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Zhang Q, Zhang Y, Meng W, Zhao Y, Zhang J. Clinical Diagnosis and Treatment of 43 Cases of Occipital Condylar Fractures: A Single-Center Retrospective Study. World Neurosurg 2024; 185:e1086-e1092. [PMID: 38490441 DOI: 10.1016/j.wneu.2024.03.027] [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: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification. METHODS A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and 2023. RESULTS The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3-8 points, 9.3% had moderate injuries with GCS scores of 9-12 points, and 65.1% exhibited mild injuries with GCS scores of 13-15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance. CONCLUSIONS OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.
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Affiliation(s)
- Qiushun Zhang
- School of Clinical Medicine, Jining Medical Uinversity, Jining, China
| | - Yongyi Zhang
- School of Pharmacy, Weifang Medical University, Weifang, China
| | - Wei Meng
- Department of Neurosurgery, Affiliated hospital of Jining medical University, Jining, China
| | - Yifeng Zhao
- Department of Traumatic Orthopedics, Affiliated hospital of Jining medical University, Jining, China
| | - Junchen Zhang
- Department of Neurosurgery, Affiliated hospital of Jining medical University, Jining, China.
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2
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Jones-Dellaportas MJ, Keitley JA, Donald Bullough R, Graham B. Major traumatic injury sustained during use of a virtual reality (VR) headset. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the first documented case of significant, potentially life-changing trauma sustained during use of virtual reality (VR). A male in his fifties fell from standing whilst immersed in a VR game and sustained injuries including bilateral occipital condyle fractures, spinal cord contusion resulting in central cord syndrome, right vertebral artery occlusion, and left hypoglossal nerve palsy. His injuries were managed conservatively with a lengthy recovery period. The patient made a good recovery with full resolution of his symptoms and has returned to full-time employment. This case discusses how these injuries are commonly related and considers the implications of VR on a person’s balance and whether the headset may make neck extension injuries more likely.
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Affiliation(s)
| | | | | | - Blair Graham
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
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3
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Batista AVDES, Aguiar GB, Bennett P, Umigi MR, Veiga JCE. Observational study of patients with occipital condyle fracture at a brazilian referral trauma center. Rev Col Bras Cir 2021; 48:e20213024. [PMID: 34852040 PMCID: PMC10683456 DOI: 10.1590/0100-6991e-20213024] [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: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. METHODS this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. RESULTS a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. CONCLUSION the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.
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Affiliation(s)
| | | | - Priscilla Bennett
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
| | - Márcia Ramos Umigi
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
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4
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Lam KS, Carriço G, Fernandes FM, Nanni F, de La Torre Escobar C. A rare case of bilateral occipital condyle fractures associated with inferior clivus separation fracture resulting in craniocervical dislocation: a case report and modification of the Anderson and Montesano classification is proposed. Acta Neurochir (Wien) 2021; 163:2307-2311. [PMID: 33987717 DOI: 10.1007/s00701-021-04855-7] [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: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
The authors report a very rare case of bilateral occipital condyle fractures (OCF) that was associated with complete separation fracture of the inferior clivus resulting in craniocervical dislocation alongside dissociation of C1-C2 joint complex. Also, a new type of the Anderson and Montesano classification system is presented with two subtypes of injuries. Type IVA occurs when the OCF is associated a clivus avulsion fracture, while Type IVB occurs when the OCF is associated with complete "en piece" separation fracture of the inferior clivus. Both Type IV injuries are considered highly unstable, and surgical fixation is the recommended treatment option.
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5
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Lassila H, Puolakkainen T, Brinck T, Wilson M, Snäll J. Occipital condyle fracture-A rare but severe injury in cranial fracture patients. J Craniomaxillofac Surg 2021; 49:381-386. [PMID: 33642118 DOI: 10.1016/j.jcms.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/12/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
We clarified occurrence, severity, and associated injuries of occipital condyle fractures (OCFs) in a cranial fracture population. Retrospective data of cranial fracture patients were analyzed. The outcome variable was presence of OCF in cranial fracture patients. Predictor variables were type of associated injury, Glasgow Coma Scale (GCS) value under 6, and death during hospital care. In addition, occurrence of OCF was assessed according to cranial fracture subtypes. Explanatory variables were age, sex, injury mechanism, involvement of alcohol, and high-energy injury. Treatment and outcome of OCFs were analyzed. Of 637 cranial fracture patients, 19 (3.0%) sustained an OCF, eight of whom had no other cranial fractures. In the multivariate adjusted model, increased risk for OCF was detected in patients with cervical injuries (OR 18.66, 95% CI 5.52, 63.12; p < 0.001) and facial fractures (OR 5.99, 95% CI 1.01, 35.45; p = 0.049). Patients with fractures not extending to the skull base were less likely to have OCF (OR 0.01, 95% CI 0.001, 0.25; p = 0.004), and fractures localized solely to the base of the skull offered a protective effect for OCF (OR 0.19, 95% CI 0.06, 0.58; p = 0.003). All OCFs were treated non-operatively with a cervical collar without complications. OCF patients typically sustain other severe injuries, particularly cervical injuries and facial fractures. Careful screening for associated injuries is therefore crucial when examining a patient with OCF. The classification scheme of Mueller et al. seems to be useful in guiding the treatment of OCFs, at least type 1 and 2 fractures.
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Affiliation(s)
- Henri Lassila
- Department of Surgery, Central Hospital of Päijät-Häme, Keskussairaalankatu 7, 15850, Lahti, Finland.
| | - Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
| | - Tuomas Brinck
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO Box 266, 00029 HUS, Helsinki, Finland.
| | - Michael Wilson
- Injury Epidemiology and Prevention (IEP), Turku Brain Injury Center, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
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6
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van der Burg SJ, Pouw MH, Brink M, Dekker H, Kunst HPM, Hosman AJF. Clinical relevance of occipital condyle fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:173-179. [PMID: 33100766 PMCID: PMC7546049 DOI: 10.4103/jcvjs.jcvjs_100_20] [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: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Context: No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists. Aims: The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance. Settings and Design: This was a retrospective analysis of a prospective follow-up study. Materials and Methods: From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320. Statistical Analysis Used: A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion. Results: Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures. Conclusions: Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.
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Affiliation(s)
- Stijn J van der Burg
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Martin H Pouw
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Helena Dekker
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen.,Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Allard J F Hosman
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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7
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Hadley MN, Walters BC. The case for the future role of evidence-based medicine in the management of cervical spine injuries, with or without fractures. J Neurosurg Spine 2019; 31:457-463. [PMID: 31574462 DOI: 10.3171/2019.6.spine19652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
The authors believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed using well-designed medical evidence-based comparative investigations with meaningful follow-up, has both merit and the remarkable potential to identify optimal strategies for assessment, characterization, and clinical management. However, they recognize that there is inherent difficulty in attempting to apply evidence-based medicine (EBM) to identify ideal treatment strategies for individual cervical fracture injuries. First, there is almost no medical evidence reported in the literature for the management of specific isolated cervical fracture subtypes; specific treatment strategies for specific fracture injuries have not been routinely studied in a rigorous, comparative way. One of the vulnerabilities of an evidenced-based scientific review in spinal cord injury (SCI) is the lack of studies in comparative populations and scientific evidence on a given topic or fracture pattern providing level II evidence or higher. Second, many modest fracture injuries are not associated with vascular or neural injury or spinal instability. The application of the science of EBM to the care of patients with traumatic cervical spine injuries and SCIs is invaluable and necessary. The dedicated multispecialty author groups involved in the production and publication of the two iterations of evidence-based guidelines on the management of acute cervical spine and spinal cord injuries have provided strategic guidance in the care of patients with SCIs. This dedicated service to the specialty has been carried out to provide neurosurgical colleagues with a qualitative review of the evidence supporting various aspects of care of these patients. It is important to state and essential to understand that the science of EBM and its rigorous application is important to medicine and to the specialty of neurosurgery. It should be embraced and used to drive and shape investigations of the management and treatment strategies offered patients. It should not be abandoned because it is not convenient or it does not support popular practice bias or patterns. It is the authors' view that the science of EBM is essential and necessary and, furthermore, that it has great potential as clinician scientists treat and study the many variations and complexities of patients who sustain acute cervical spine fracture injuries.
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Affiliation(s)
- Mark N Hadley
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Beverly C Walters
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
- 2Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
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8
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Martin-Giménez T, Cruz AM, Barragán A, Montero E, Sanchez PG, Caballero G, Corradini I. Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse. J Vet Intern Med 2019; 33:2780-2785. [PMID: 31556150 PMCID: PMC6872609 DOI: 10.1111/jvim.15581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022] Open
Abstract
Occipital condylar fractures (OCFs) causing delayed onset lower cranial nerve paralysis (LCNPs) are rare. We present a 7‐year‐old Friesian horse with delayed onset dysphagia caused by vagus nerve (CNX) paralysis and suspicion of glossopharyngeal nerve (CNIX) paralysis developed several days after a minor head injury. Endoscopic examination revealed right laryngeal hemiplegia and intermittent dorsal displacement of the soft palate. An area of submucosal hemorrhage and bulging was appreciated over the dorsal aspect of the medial compartment of the right guttural pouch. Radiological examination of the proximal cervical region showed rotation of the atlas and the presence of a large bone fragment dorsal to the guttural pouches. Occipital condyle fracture with delayed onset cranial nerve paralysis was diagnosed. Delayed onset cranial nerve paralysis causing dysphagia might be a distinguishable sign of OCF in horses. Delayed onset dysphagia after head injury should prompt equine clinicians to evaluate the condition of the atlanto‐occipital articulation and skull base.
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Affiliation(s)
- Tamara Martin-Giménez
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Antonio M Cruz
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Agustín Barragán
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Estefanía Montero
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Pedro G Sanchez
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Guillermo Caballero
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Ignacio Corradini
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.,Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
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9
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Occipital Condyle Fractures and Concomitant Cervical Spine Fractures: Implications for Management. World Neurosurg 2018; 115:e238-e243. [DOI: 10.1016/j.wneu.2018.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
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10
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Nguyen HS, Choi H, Kurpad S, Soliman H. Delayed Retroclival and Cervical Spinal Subdural Hematoma Complicated by Preexisting Chiari Malformation in Adult Trauma Patient. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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11
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Bulthuis VJ, Cornips EMJ, Dings J, van Santbrink H, Postma AA. Unexpected death after occipital condylar fracture. Acta Neurochir (Wien) 2017; 159:1163-1166. [PMID: 28432520 PMCID: PMC5425500 DOI: 10.1007/s00701-017-3165-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
Abstract
We present a rare fatal complication of an occipital condylar fracture. The patient was initially neurologically intact, but showed secondary clinical deterioration. Imaging revealed extensive extra-axial hemorrhage at the craniocervical junction and an acute obstructive hydrocephalus. MR imaging demonstrated a T2 hyperintens signal in both the lower brainstem and upper cervical spinal cord, likely caused by the extra-axial hemorrhage. As prognosis was estimated infaust, supportive treatment was discontinued and the patient died soon thereafter. This case report illustrates a rare, delayed complication and unexpected death in a patient having sustained an occipital condylar fracture.
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12
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The spectrum of traumatic injuries at the craniocervical junction: a review of imaging findings and management. Emerg Radiol 2017; 24:377-385. [DOI: 10.1007/s10140-017-1490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022]
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13
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Vadivelu S, Masood Z, Krueger B, Marciano R, Chen D, Houseman C, Insinga S. Long-term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: Case report and review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:149-152. [PMID: 28694600 PMCID: PMC5490350 DOI: 10.4103/jcvjs.jcvjs_34_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a patient that demonstrates resolution of delayed onset hypoglossal nerve palsy (HNP) subsequent to occipital condyle fracture following a motor vehicle accident. Decompression of the hypoglossal nerve and craniocervical fixation led to satisfactory long-term (>5 years) outcome. There is a scarcity of literature in recognizing HNPs following trauma and a lack of pathophysiological understanding to both a delayed presentation and to resolution versus persistence. This is the first report demonstrating long-term resolution of hypoglossal nerve injury following trauma to the craniocervical junction.
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Affiliation(s)
- Sudhakar Vadivelu
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zihan Masood
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bryan Krueger
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rudy Marciano
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - David Chen
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Cliff Houseman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
| | - Salvatore Insinga
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA
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14
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Martinez-del-Campo E, Turner JD, Kalb S, Rangel-Castilla L, Perez-Orribo L, Soriano-Baron H, Theodore N. Occipitocervical Fixation. Neurosurgery 2016; 79:549-60. [DOI: 10.1227/neu.0000000000001340] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Occipitocervical junction instability can lead to serious neurological injury or death. Open surgical fixation is often necessary to provide definitive stabilization. However, long-term results are limited to small case series.
OBJECTIVE
To review the causes of occipitocervical instability, discuss the indications for surgical intervention, and evaluate long-term surgical outcomes after occipitocervical fixation.
METHODS
The charts of all patients undergoing posterior surgical fixation of the occipitocervical junction by the senior author were retrospectively reviewed. A total of 120 consecutive patients were identified for analysis. Patient demographic characteristics, occipitocervical junction pathology, surgical indications, and clinical and radiographic outcomes are reported.
RESULTS
The study population consisted of 64 male and 56 female patients with a mean age of 39.9 years (range, 7 months to 88 years). Trauma was the most common cause of instability, occurring in 56 patients (47%). Ninety patients (75%) were treated with screw/rod constructs; wiring was used in 30 patients (25%). The median number of fixated segments was 5 (O-C4). Structural bone grafts were implanted in all patients (100%). Preoperative neurological deficits were present in 83 patients (69%); 91% of those patients improved with surgery. Mean follow-up was 35.1 ± 27.4 months (range, 0-123 months). Two patients died, and 10 were lost to follow-up before the end of the 6-month follow-up period. Fusion was confirmed in 107 patients (89.1%). The overall complication rate was 10%, including 3 patients with vertebral artery injuries and 2 patients who required revision surgery.
CONCLUSION
Occipitocervical fixation is a durable treatment option with acceptable morbidity for patients with occipitocervical instability.
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Affiliation(s)
- Eduardo Martinez-del-Campo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D. Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Luis Perez-Orribo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hector Soriano-Baron
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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15
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Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C. Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know. Radiographics 2016; 35:2121-34. [PMID: 26562241 DOI: 10.1148/rg.2015150035] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. Understanding the anatomy of the CCJ is crucial in properly evaluating the cervical spine, allowing the radiologist to assess its stability in the trauma setting. The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Thin-section multidetector computed tomography with sagittal and coronal reformats is the study of choice in evaluating the extent of injury, allowing the radiologist to thoroughly evaluate the stability of the cervical spine. Furthermore, magnetic resonance (MR) imaging is increasingly being used to evaluate the spinal soft tissues and ligaments, and to identify associated spinal cord injury, if present. MR imaging is also indicated in patients whose neurologic status cannot be evaluated within 48 hours of injury. .
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Affiliation(s)
- Roy Riascos
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Eliana Bonfante
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Claudia Cotes
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Mary Guirguis
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Reza Hakimelahi
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Clark West
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
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16
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Ducis K, Florman JE, Rughani AI. Appraisal of the Quality of Neurosurgery Clinical Practice Guidelines. World Neurosurg 2016; 90:322-339. [PMID: 26947727 DOI: 10.1016/j.wneu.2016.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The rate of neurosurgery guidelines publications was compared over time with all other specialties. Neurosurgical guidelines and quality of supporting evidence were then analyzed and compared by subspecialty. METHODS The authors first performed a PubMed search for "Neurosurgery" and "Guidelines." This was then compared against searches performed for each specialty of the American Board of Medical Specialties. The second analysis was an inventory of all neurosurgery guidelines published by the Agency for Healthcare Research and Quality Guidelines clearinghouse. All Class I evidence and Level 1 recommendations were compared for different subspecialty topics. RESULTS When examined from 1970-2010, the rate of increase in publication of neurosurgery guidelines was about one third of all specialties combined (P < 0.0001). However, when only looking at the past 5 years the publication rate of neurosurgery guidelines has converged upon that for all specialties. The second analysis identified 49 published guidelines for assessment. There were 2733 studies cited as supporting evidence, with only 243 of these papers considered the highest class of evidence (8.9%). These papers were used to generate 697 recommendations, of which 170 (24.4%) were considered "Level 1" recommendations. CONCLUSION Although initially lagging, the publication of neurosurgical guidelines has recently increased at a rate comparable with that of other specialties. However, the quality of the evidence cited consists of a relatively low number of high-quality studies from which guidelines are created. Wider implications of this must be considered when defining and measuring quality of clinical performance in neurosurgery.
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Affiliation(s)
- Katrina Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
| | - Jeffrey E Florman
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Anand I Rughani
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA; Center for Excellence in Neuroscience, University of New England, Biddeford, Maine, USA
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17
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Burke SM, Huhta TA, Mackel CE, Riesenburger RI. Occipital condyle fracture in a patient with occipitalisation of the atlas. BMJ Case Rep 2015; 2015:bcr-2015-209623. [PMID: 25976203 DOI: 10.1136/bcr-2015-209623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Occipital condyle fractures and occipitalisation of the atlas are rare entities of the craniocervical junction. To the best of our knowledge, a patient presenting with a traumatic occipital condyle fracture and pre-existing occipitalisation of the atlas has not been previously reported. We report the case of a 79-year-old man presenting with an Anderson and Montesano type III fracture through a fused occipital condyle and lateral mass. This fracture was noted to extend into the transverse foramen and the C1-C2 joint space. The transverse ligament and ligamentum flavum were calcified but not disrupted and the atlantodental interval was within normal limits. The neurological examination was unremarkable with the exception of neck pain. The patient was treated conservatively and placed in a rigid cervical collar for 10 weeks with serial CT studies to monitor healing of the fracture. At 4 months of follow-up, the patient was pain free with nearly complete resolution of his occipital condyle fracture.
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Affiliation(s)
- Shane M Burke
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Taylor A Huhta
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
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Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015; 38:E2. [DOI: 10.3171/2015.1.focus14807] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The craniovertebral junction (CVJ) has unique anatomical structures that separate it from the subaxial cervical spine. In addition to housing vital neural and vascular structures, the majority of cranial flexion, extension, and axial rotation is accomplished at the CVJ. A complex combination of osseous and ligamentous supports allow for stability despite a large degree of motion. An understanding of anatomy and biomechanics is essential to effectively evaluate and address the various pathological processes that may affect this region. Therefore, the authors present an up-to-date narrative review of CVJ anatomy, normal and pathological biomechanics, and fixation techniques.
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Affiliation(s)
- Alejandro J. Lopez
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
| | - Justin K. Scheer
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
| | - Kayla E. Leibl
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
| | - Zachary A. Smith
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
| | - Brian J. Dlouhy
- 2Department of Neurological Surgery, The University of Iowa, Carver School of Medicine, Iowa City, Iowa
| | - Nader S. Dahdaleh
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and
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19
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Brotis AG, Paraskevi TM, Tsitsopoulos P, Tasiou A, Fotakopoulos G, Fountas KN. An evidence-based approach towards the cranio-cervical junction injury classifications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:931-9. [DOI: 10.1007/s00586-015-3877-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/07/2015] [Accepted: 03/11/2015] [Indexed: 12/12/2022]
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