CT evaluation of the pattern of odontoid fractures in the elderly?relationship to upper cervical spine osteoarthritis

Abstract For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.

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Conservative treatment of upper cervical spine injuries with the halo vest: an appropriate option for all patients independent of their age?

Journal of Neurosurgery Spine ◽

10.3171/2009.2.spine08484 ◽

2009 ◽

Vol 10 (6) ◽

pp. 543-550 ◽

Cited By ~ 18

Author(s):

Dorothea Daentzer ◽

Thilo Flörkemeier

Keyword(s):

Cervical Spine ◽

The Elderly ◽

Upper Cervical Spine ◽

Halo Vest ◽

Cervical Spine Injuries ◽

Radiological Results ◽

Spine Injuries ◽

Upper Cervical ◽

Patient Groups ◽

Clinical And Radiological Results

Object Most upper cervical spine injuries are able to heal conservatively by halo vest application. The acceptance of the halo is different among patients due to the weight of the apparatus and the limited mobility it causes. Additionally, the fracture healing rate in older patients seems to be inferior to that in younger patients, which would make an operative stabilization procedure more appropriate for the elderly. Furthermore, the risk of complications is assumed to be higher in older people. The purpose of this retrospective study was to find out if there are differences in the clinical and radiological results and in complication rates between 2 patient groups with upper cervical spine injuries and halo vest treatment with special interest of their age group. Methods A total of 29 patients with upper cervical spine injuries were treated by halo vest application. The clinical and radiological results and the complication and revision surgery rates were identified. Patients were divided into 2 groups (18 patients were < 65 years and 11 were > 65 years), and the results were evaluated to examine whether there were any differences. Results The clinical and radiological results and the complication rate were not statistically significantly different between the 2 patient groups; however, there was a tendency for a longer time interval for fracture healing and more complications in the elderly people. Conclusions If the conditions for conservative treatment of upper cervical spine injuries with halo fixation are right, the clinical and radiological results are good and almost similar in patients regardless of their age, although there is a tendency for more complications in older people.

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Diagnosis and Treatment of Upper Cervical Spine Trauma in the Elderly

European Instructional Lectures ◽

10.1007/978-3-642-54030-1_10 ◽

2014 ◽

pp. 117-126

Author(s):

Christian Garreau de Loubresse

Keyword(s):

Cervical Spine ◽

The Elderly ◽

Diagnosis And Treatment ◽

Upper Cervical Spine ◽

Cervical Spine Trauma ◽

Spine Trauma ◽

Upper Cervical

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Endonasal Surgery of the Upper Cervical Spine: A Morphometric Analysis

Skull Base ◽

10.1055/s-2008-1093170 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Harminder Singh ◽

Bartosz Grobelny ◽

Adam Flanders ◽

Marc Rosen ◽

Paul Schiffmacher ◽

...

Keyword(s):

Cervical Spine ◽

Morphometric Analysis ◽

Upper Cervical Spine ◽

Endonasal Surgery ◽

Upper Cervical

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Defining the Nasopalatine Line: Anatomic Limitations for Endoscopic Endonasal Surgery of the Odontoid Process and Upper Cervical Spine

Skull Base ◽

10.1055/s-2008-1093252 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

John de Almeida ◽

Adam Zanation ◽

Ricardo Carrau ◽

Amin Kassam ◽

Carl Snyderman

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

Upper Cervical Spine ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Upper Cervical

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A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

Pediatric Neurosurgery ◽

10.1159/000514248 ◽

2021 ◽

pp. 1-7

Author(s):

Marko Jug

Keyword(s):

Cervical Spine ◽

3D Model ◽

Intraoperative Complications ◽

Tumor Resection ◽

Upper Cervical Spine ◽

Spine Instrumentation ◽

Cord Injury ◽

Spinal Navigation ◽

Upper Cervical ◽

3D Printed

Introduction: In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. Case Presentation: We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. Discussion/Conclusion: Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

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