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Diaz S, Zenkhri S, Omoumi P, Maeder B, Penet N, Rothenfluh D, Barges-Coll J. C2 Odontoid Fracture Associated with C1-C2 Rotatory Dislocation: A Retrospective Analysis of 2 Surgical Techniques. World Neurosurg 2023; 180:e460-e467. [PMID: 37777174 DOI: 10.1016/j.wneu.2023.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Odontoid fractures in association with a C1-C2 rotatory luxation reports are seldom found in the literature. The fusion between the lateral mass of C1 and C2 could be of interest to ensure adequate treatment in these particular cases. We report 23 cases where there was coexistence of an odontoid fracture and rotatory subluxation, which were treated surgically using cages between C1 and C2 or just traditional Goel-Harms technique. We evaluated the radiologic fusion rate, reoperation rate, and complications. METHODS This was a single-center, retrospective, cohort study of patients with C2 fractures (mixed type and C1-C2 rotatory luxation according to the Fielding classification) who were treated surgically. Radiologic computed tomography scans were used to assess fusion (presence of bridging trabecular bone end plate or pseudoarthrosis) between 6 months and 1.5 years after the surgery. RESULTS Twenty-three patients were diagnosed with C2 fractures and C1-C2 rotatory luxation that were treated surgically and were suitable for the analysis; 11 patients underwent C1-C2 fusion with intra-articular cages, and 12 underwent a classical Goel-Harms technique. The fusion rate at the C1-C2 joint was higher in the cages group. Only 12 patients exhibited fusion at the level of the odontoid fracture. CONCLUSIONS C2 fractures associated with C1-C2 rotatory dislocation are rare. The fusion rate at the level of the odontoid in these patients appears to be lower than that reported in patients without rotatory dislocation. It may be of special interest to obtain a clear fusion at the C1-C2 joint, where this type of implant seems to offer an advantage.
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Affiliation(s)
- Simon Diaz
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland; Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Salim Zenkhri
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Benoit Maeder
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Penet
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Dominique Rothenfluh
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Juan Barges-Coll
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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Ren J, Liu X, Chen F, Jing X, Cui X. Association Between Vertebral Rotatory Subluxation and the Apical Vertebra in Degenerative Lumbar Scoliosis. World Neurosurg 2021; 154:e627-e632. [PMID: 34329750 DOI: 10.1016/j.wneu.2021.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the apical vertebra is relate to the occurrence of vertebral rotatory subluxation (VRS) in degenerative lumbar scoliosis. METHODS In total, 86 patients with degenerative lumbar scoliosis included in this retrospective study were divided into 2 groups: with VRS and without VRS. Coronal and sagittal parameters were measured on whole-spine anteroposterior and lateral radiographs. The impact of VRS on the spine and pelvis parameters was statistically analyzed, and the correlation between the occurrence of VRS and the apical vertebra was analyzed by using logistic regression. RESULTS VRS was present in 49 patients with degenerative lumbar scoliosis and absent in 37 patients. Compared with the patients without VRS, the patients with VRS had a smaller lumbar lordosis and thoracic kyphosis (P < 0.05) and a larger apical vertebra translation, apical vertebra tilt angle, Cobb angle, and pelvic incidence-lumbar lordosis (P < 0.05). Logistic regression analysis showed that apical vertebra translation and apical vertebra tilt angle were risk factors for the occurrence of VRS. The receiver operating characteristic curve analysis showed that apical vertebra translation greater than 23.2 mm and apical vertebra tilt angle greater than 11.8° were related to a greater probability of VRS in patients with degenerative lumbar scoliosis. CONCLUSIONS VRS is an important characteristic to consider in degenerative lumbar scoliosis that can affect the coronal and sagittal alignment. The apical vertebra is correlated with the occurrence of VRS; an apical vertebra translation greater than 23.2 mm and apical vertebra tilt angle greater than 11.8° are highly correlate with the occurrence of VRS.
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Affiliation(s)
- Jiabin Ren
- Department of Spine Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Xiaoyang Liu
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Feifei Chen
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xingzhi Jing
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Ferrero E, Khalifé M, Marie-Hardy L, Regnard N, Feydy A, De Loubresse CG, Zakine S, Guigui P. Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis? Spine Deform 2019; 7:472-480. [PMID: 31053318 DOI: 10.1016/j.jspd.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis and its related clinical symptoms. INTRODUCTION Adults with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debatable. METHODS Patients operated for symptomatic LSS with lumbar scoliosis (Cobb angle >20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic examination. Coronal and sagittal radiographic parameters, rotatory subluxation (RS), and spondylolisthesis were analyzed on full spine radiographs. Computed tomographic scan multiplanar reconstructions were performed to measure central, foraminal, and lateral recess stenosis, from T10 to the sacrum. RESULTS A total of 76 patients were included (69 ± 9 years old, 77% female). Sixty percent had neurogenic claudication, and L5 was the most common radicular pain (41%). The mean Cobb angle was 33° ± 16°. Overall, 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. Sixty patients had RS (most frequent level L3-L4). In 50% of the cohort, RS was located at the junction between the lumbar and lumbosacral curves. In 70% (n = 53) of the patients, central stenosis occurred at the junction between the lumbar and lumbosacral curves. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbosacral curve. L5 radicular pain was significantly more frequent in case of lumbosacral contra-curve and right coronal malalignment. CONCLUSION LSS is frequent in lumbar scoliosis. Relationships exist between curve characteristics and symptomatic LSS in lumbar scoliosis; especially, concavity of the lumbosacral contra-curve and the junctional level between the lumbar curve and the lumbosacral contra-curve. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least perform decompression because perfect planned treatment for stenosis and scoliosis correction might not always be possible because of the patient's general health status. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- E Ferrero
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France.
| | - M Khalifé
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - L Marie-Hardy
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - N Regnard
- Radiology Department, Hôpital Cochin, APHP, Paris V University, 75014 Paris, France
| | - A Feydy
- Radiology Department, Hôpital Cochin, APHP, Paris V University, 75014 Paris, France
| | - C Garreau De Loubresse
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
| | - S Zakine
- Orthopedic Surgery Department, Clinique les Maussins, 75019 Paris, France
| | - P Guigui
- Orthopedic Surgery Department, Hôpital Européen Georges-Pompidou, APHP, Paris V University, 20 rue Leblanc, 75908 Paris, Cedex 15, France
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Pillai MK, Kariyattil R, Kumar R, Govindaraju V, Kochummen K. Complex congenital atlantoaxial dislocation in an infant: case report. Childs Nerv Syst 2018; 34:1255-1258. [PMID: 29380113 DOI: 10.1007/s00381-018-3733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/19/2018] [Indexed: 11/25/2022]
Abstract
The authors report the case of congenital atlantoaxial dislocation in a 9-month-old female infant, who presented with progressive quadriparesis and respiratory failure. The problems in management due to such an early age of presentation, including atypical clinical presentation, unique radiological findings, limited management options, and variable clinical outcomes discussed. This is the youngest case of non-syndromic congenital atlantoaxial dislocation, reported to date, and is a unique combination of lateral, rotatory, and antero-posterior atlantoaxial dislocation.
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Affiliation(s)
- Mahesh Krishna Pillai
- Department of Neurosurgery, Sultan Qaboos University Hospital, PB 38, Al Khaud, 123, Muscat, Oman.
| | - Rajeev Kariyattil
- Department of Neurosurgery, Sultan Qaboos University Hospital, PB 38, Al Khaud, 123, Muscat, Oman
| | - Rajinder Kumar
- Department of Neurosurgery, Sultan Qaboos University Hospital, PB 38, Al Khaud, 123, Muscat, Oman
| | - Venkatesh Govindaraju
- Department of Neurosurgery, Sultan Qaboos University Hospital, PB 38, Al Khaud, 123, Muscat, Oman
| | - Koshy Kochummen
- Department of Neurosurgery, Sultan Qaboos University Hospital, PB 38, Al Khaud, 123, Muscat, Oman
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Ferrero E, Lafage R, Diebo BG, Challier V, Ilharreborde B, Schwab F, Skalli W, Guigui P, Lafage V. Tridimensional Analysis of Rotatory Subluxation and Sagittal Spinopelvic Alignment in the Setting of Adult Spinal Deformity. Spine Deform 2017. [PMID: 28622901 DOI: 10.1016/j.jspd.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective single-center. OBJECTIVE To investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes. BACKGROUND Recent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes. However, there is still a lack of knowledge regarding the clinical impact of 3D evaluation and rotatory subluxation. Recent developments in stereoradiography allow clinicians to obtain full-body standing radiographs with low-dose radiation and 3D reconstruction. METHODS One hundred thirty lumbar ASD patients underwent full-spine biplanar radiographs (EOS Imaging, Paris, France). Clinical outcomes were recorded. Using sterEOS software, spinopelvic parameters and lateral listhesis were measured. 3D transverse plane parameters included apical axial vertebral rotation, axial intervertebral rotation (AIR), and torsion index (sum of AIR in the curve). ASD patients were divided in three groups: AIR <5°, 5°< AIR <10°, AIR >10°. Groups were compared with respect to radiographic and clinical data. Correlations were performed between the transverse and sagittal plane parameters and clinical outcomes. RESULTS Patients with AIR >10° were significantly older, with larger Cobb angle (39.5°) and greater sagittal plane deformity (pelvic incidence-lumbar lordosis mismatch 11.7° and pelvic tilt 22.6°). The AIR >10° group had significantly greater apical vertebra axial rotation apex (24.8°), torsion index (45°), and upper-level AIR (21.5°) than the two other groups. Overall, 27% of AIR patients did not have two-dimensional (2D) lateral listhesis. Patients with AIR >10° had significantly worse Oswestry Disability Index and more low back pain. CONCLUSION For patients in which lateral listhesis was unreadable in 2D imaging, rotatory subluxation was revealed using stereoradiography and at an earlier disease stage. Moreover, different 3D transverse plane parameters are related to different patient-reported outcomes. Therefore, axial rotation can be considered in evaluation of lumbar degenerative scoliosis severity and prognosis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emmanuelle Ferrero
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA; Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France.
| | - Renaud Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Bassel G Diebo
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Vincent Challier
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Brice Ilharreborde
- Orthopaedic Surgery, Robert Debré Hospital, 48 Bd Sérurier, 75019 Paris, France
| | - Frank Schwab
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Wafa Skalli
- Laboratoire de Biomécanique, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France
| | - Virginie Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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Ferrero E, Lafage R, Challier V, Diebo B, Guigui P, Mazda K, Schwab F, Skalli W, Lafage V. Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation. Orthop Traumatol Surg Res 2015; 101:613-8. [PMID: 26194209 DOI: 10.1016/j.otsr.2015.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/13/2015] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose. HYPOTHESIS 3D stereoradiography improves analysis of RS and of its relations with transverse plane and spinopelvic parameters and clinical impact. MATERIAL AND METHODS One hundred and thirty adults with lumbar ASD and full-spine EOS® radiographs (EOS Imaging, Paris, France) were included. Spinopelvic sagittal parameters and lateral listhesis in the coronal plane were measured. The transverse plane study parameters were: apical axial vertebral rotation (apex AVR), axial intervertebral rotation (AIR) and torsion index (TI). Two groups were compared: with RS (lateral listhesis>5mm) and without RS (without lateral listhesis exceeding 5mm: non-RS). Correlations between radiologic and clinical data were assessed. RESULTS RS patients were significantly older, with larger Cobb angle (37.4° vs. 26.6°, P=0.0001), more severe sagittal deformity, and greater apex AVR and TI (respectively: 22.9° vs. 11.3°, P<0.001; and 41.0° vs. 19.9°, P<0.001). Ten percent of patients had AIR>10° without visible RS on 2D radiographs. RS patients reported significantly more frequent low back pain and radiculalgia. DISCUSSION In this EOS® study, ASD patients with RS had greater coronal curvature and sagittal and transverse deformity, as well as greater pain. Further transverse plane analysis could allow earlier diagnosis and prognosis to guide management. LEVEL OF EVIDENCE 4, retrospective study.
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Affiliation(s)
- E Ferrero
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA; Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France; Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France.
| | - R Lafage
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - V Challier
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - B Diebo
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - P Guigui
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - K Mazda
- Service de chirurgie, hôpital universitaire Robert-Debré, boulevard Sérurier, 75019 Paris, France
| | - F Schwab
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - W Skalli
- Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France
| | - V Lafage
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
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