Transoral approach using a tubular retractor system in the treatment of atlantoaxial Pott’s disease: a novel method of surgical decompression

2021 ◽  
Vol 14 (3) ◽  
pp. e239240
Author(s):  
Karla Teresa Saldaña Araneta ◽  
Rafael Bundoc
Keyword(s):  
Soft Tissues ◽  
Transoral Approach ◽  
Os Odontoideum ◽  
Halo Vest ◽  
Tubular Retractor ◽  
Suitable Alternative ◽  
Pott’S Disease ◽  
Upper Cervical ◽  
Novel Method ◽  
Minimally Invasive Spine

The use of tubular retractors in minimally invasive spine surgery has been described extensively in the literature. However, there are only select reports discussing their use specifically in a transoral approach for upper cervical pathologies such as an epidural abscess and a dystrophic os odontoideum.We report the first use of a transtubular transoral approach in a rare case of an adult presenting with severe neck pain with progressing neurologic signs secondary to atlantoaxial Pott’s disease. Debridement and partial odontoidectomy performed using this approach allowed less trauma to surrounding soft tissues without sacrificing an excellent visualisation of the operative field. A halo vest was applied to provide temporary stability. The patient transitioned out of his halo vest after 6 months while completing medical therapy after a year without need for further intervention. The transtubular transoral approach is a suitable alternative to the conventional approach in patients with atlantoaxial Pott’s disease.

scholarly journals Osteoid Osteoma of the Atlas in a Boy: Clinical and Imaging Features–A Case Report and Review of the Literature

2020 ◽  
Author(s):  
Adelaide Valluzzi ◽  
Salvatore Donatiello ◽  
Graziana Gallo ◽  
Monica Cellini ◽  
Antonino Maiorana ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Osteoid Osteoma ◽  
Soft Tissues ◽  
Tissue Reaction ◽  
Imaging Features ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Radiological Findings ◽  
First Case ◽  
Upper Cervical

AbstractOsteoid osteoma is a benign osteoblastic tumor, quite uncommon in the spine. We report a case of an osteoid osteoma involving the atlas in a 6-year-old boy, who presented with suboccipital pain and torticollis. Initial radiological findings were ambiguous as magnetic resonance imaging showed mainly edema of upper cervical soft tissues. The subsequent computed tomography depicted a lesion of left lamina of C1. As conservative treatment failed, the lesion was surgically resected and the patient became pain free. To our knowledge, this is the first case of osteoid osteoma involving the atlas associated with abnormal soft tissue reaction reported in literature.

A Novel Non-Destructive Method for Measuring Elastic Moduli of Cultivated Cartilage Tissues

2007 ◽  
Vol 342-343 ◽  
pp. 853-856 ◽  
Author(s):  
Duk Young Jung ◽  
Yu Bong Kang ◽  
Toshie Tsuchiya ◽  
Sadami Tsutsumi
Keyword(s):  
Mechanical Properties ◽  
Bulk Modulus ◽  
Soft Tissues ◽  
Articular Chondrocytes ◽  
Collagen Gel ◽  
Accuracy And Precision ◽  
Novel Method ◽  
Silicone Rubbers ◽  
High Degree ◽  
Non Destructive

Accurate measurement of the mechanical properties of artificial or cultivated cartilage is a major factor for determining successive regeneration of defective soft tissues. In this study, we developed a novel method that enabled the bulk modulus (k-modulus) to be measured nondestructively using the relationship between volume and pressure of living soft tissues. In order to validate this method we estimated the bulk modulus of soft silicone rubbers using our new method and a conventional method. The results showed a 5 ~ 10% difference between the results obtained with the two methods. Our method was used subsequently to measure the mechanical properties of cultivated cartilage samples (collagen gel type), that had been incubated for four weeks in the presence or absence of human articular chondrocytes (HACs). Our experiments showed that cultivated cartilage tissues grown in the presence of HACs had a higher bulk modulus (120 ± 20 kPa) than samples grown without HACs (90 ± 15 kPa). The results indicated that our novel method offered an effective method for measurement of volume changes in minute living soft tissues, with the measurements having a high degree of accuracy and precision. Furthermore, this method has significant advantages over conventional approaches as it can be used to rapidly and accurately evaluate the strength of soft tissues during cultivation without causing damage to the specimen.

Non-Invasive Measurement of In-Vivo Elasticity of Skeletal Muscles with MR-Elastography

2007 ◽  
Vol 342-343 ◽  
pp. 901-904
Author(s):  
Yu Bong Kang ◽  
T. Oida ◽  
Duk Young Jung ◽  
A. Fukuma ◽  
T. Azuma ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Shear Modulus ◽  
Skeletal Muscles ◽  
Soft Tissues ◽  
Viscosity Coefficient ◽  
Non Invasive ◽  
Novel Method ◽  
Human Calf ◽  
Invasive Measurement

In order to evaluate the mechanical properties of the human skeletal muscles, the elasticity and viscosity of the human calf muscles were measured with Magnetic Resonance Elastography (MRE). MRE is a novel method to measure the mechanical properties of living soft tissues in vivo quantitatively by observing the strain waves propagated in the object. In this study, the shear modulus and viscosity coefficient were measured with MRE. The shear modulus was 3.7 kPa in relaxed state, and increased with increasing the muscle forces. Interestingly, the viscosity was changed with the vibration frequency applied to the muscles, that was 4.5 Pa·s at 100Hz vibration and 2.4 Pa·s at 200Hz vibration. This shows clearly the visco-elastic property.

Current Uses of Ultrasound Imaging in Musculoskeletal Rehabilitation

2017 ◽  
Vol 19 (6) ◽  
pp. 0-0 ◽  
Author(s):  
Robert Jopowicz ◽  
Małgorzata Jopowicz ◽  
Łukasz Czarnocki ◽  
Jarosław Michał Deszczyński ◽  
Jarosław Deszczyński
Keyword(s):  
Ultrasound Imaging ◽  
Soft Tissues ◽  
Pain Treatment ◽  
Dynamic Assessment ◽  
Physical Activities ◽  
Lower Back ◽  
Novel Method ◽  
Clinical Potential ◽  
Postoperative Improvement ◽  
Musculoskeletal Rehabilitation

The term Rehabilitative Ultrasound Imaging (RUSI) refers to the use of ultrasound imaging by physiothera­pists. Ultrasound is used by physiotherapists to evaluate the morphology of muscles and other associated soft tissues not only at rest but also for a dynamic assessment of those structures during physical activities and tasks. RUSI is most commonly utilized as part of a biofeedback mechanism, which shows good efficacy in lower back pain treatment. Several possibilities have been also described for clinically adapting this method in the rehabilitation of the shoulder and knee and postoperative improvement of tendons. RUSI is a novel method with a high clinical potential to support physiotherapeutic therapies.

Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Jimmy Miller ◽  
Andrew D. Parent
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Odontoid Process ◽  
Transoral Approach ◽  
Upper Cervical Spine ◽  
Basilar Impression ◽  
Odontoid Fractures ◽  
Surgical Microscope ◽  
The Past ◽  
Upper Cervical

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.

Os odontoideum associated with hypertrophic ossiculum terminale

2001 ◽  
Vol 94 (1) ◽  
pp. 140-144 ◽  
Author(s):  
Hiroshi Sakaida ◽  
Shiro Waga ◽  
Tadashi Kojima ◽  
Yoshichika Kubo ◽  
Shigehiko Niwa ◽  
...  
Keyword(s):  
Transoral Approach ◽  
Os Odontoideum ◽  
Autogenous Bone ◽  
Current Case ◽  
Content Type ◽  
Rare Association ◽  
Considerable Confusion ◽  
Ossiculum Terminale ◽  
Fine Print

✓ The authors report on the case of a 20-year-old man who presented with a transient tetraparesis. Neuroimaging studies demonstrated atlantoaxial dislocation and ventral compression of the rostral spinal cord caused by a quite rare association of os odontoideum and hypertrophic ossiculum terminale. The patient underwent removal of two free ossicula via a transoral approach and posterior fusion in which an autogenous bone graft was placed. The majority of cases of os odontoideum are believed to be an acquired form; however, controversy with regard to the congenital causes of os odontoideum remains. One hypothesis is that os odontoideum results from the failure of fusion and the hypertrophy of the proatlas, although considerable confusion surrounds this hypothesis because definitive classification of os odontoideum—to differentiate between similar anomalies—has not been established. This rare coincidence in the current case supports the belief that os odontoideum has a different embryological origin from ossiculum terminale, which is thought to be a proatlantal remnant.

scholarly journals Os odontoideum: case report

2012 ◽  
Vol 11 (4) ◽  
pp. 333-335
Author(s):  
André Rodrigues Pinho ◽  
Vitorino Veludo Moutinho ◽  
Nuno Paulo Alegrete Silva ◽  
António Francisco Martingo Serdoura ◽  
Joana Manuel Ferreira Freitas ◽  
...  
Keyword(s):  
Neurological Status ◽  
High Rate ◽  
Os Odontoideum ◽  
Cervical Trauma ◽  
Halo Vest ◽  
Second Surgery ◽  
Solid Fusion ◽  
Additional Support ◽  
Rate Of Success

OBJECTIVE: To report the difficulties in managing a case of os odontoideum. METHODS: Female patient, 12 years old who developed a quadiparesis after minor cervical trauma in October 2005. In the emergency department a congenital cervical anomaly was identified. The patient was placed in a Stryker® frame and, few days later, in a halo bracing. After 3 months, an infection around the pins emerged and the halo vest had to be removed. A severe C1-2 instability persisted and a C1-C2 Gallie procedure was attempted. In the following weeks the bone disappeared and another procedure was attempted in June 2006 - C1 laminectomy and occiput-C3 fusion. In the following months the neurological status of the patient improved and a complete mass of occiput-C3 fusion was observed. RESULTS: We choose a posterior cervical arthrodesis of C1-C2 using the Gallie technique. Since the condition was not resolved we performed a second surgery, C1 laminectomy (determined by SAC of 8, 3 mm in MRI) followed by posterior occiput-C3 fusion. In our case, until now, there is no evidence of axial decompensation, but a more prolonged follow-up is needed. CONCLUSIONS: The treatment of os odontoideum has many considerations but the essential that in the presence of instability and neurological deficit a solid fusion is achieved. In case of failure of posterior atlantoaxial wiring, the occiput-C2 or C3 fusion with rods seems to be an excellent option with a high rate of success, avoiding the need for additional support.

scholarly journals Upper Cervical Spine Fracture-Dislocation in Patients With Ankylosing Spondylitis: Application of Halo Vest Before and During Posterior Surgery

2021 ◽  
Author(s):  
Haisong Yang ◽  
Yuling Sun ◽  
Liang Wang ◽  
Chunyan Gao ◽  
Fengbin Yu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Spine Fracture ◽  
Fracture Dislocation ◽  
Cervical Spine Fracture ◽  
Upper Cervical Spine ◽  
Halo Vest ◽  
Posterior Surgery ◽  
Upper Cervical

Abstract Background It is a challenge to reduce and immobilize the broken “bamboo spine”, especially for the upper cervical spine, in patients with ankylosing spondylitis (AS) before and during posterior surgery. Methods We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 17 patients with AS and upper cervical spine fracture-dislocation who underwent surgical treatment in three clinical spine center from 2010 to 2019. A halo vest was used to reduce and immobilize fractured spinal column ends. The neurological injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score and Japanese Orthopaedic Association (JOA) score before and after operation. Complications and time of bone fusion were recorded. Results Fourteen patients achieved closed anatomical reduction after halo vest application. No displacement in fracture ends and loss of reduction occurred after prone position. No patient presented with secondary neurological deterioration. All patients was performed posterior surgery. The surgery improved the ASIA grade in all patients (P < 0.001). The mean JOA score also increased significantly at last follow-up compared to preoperation (14.5 ± 2.3 vs. 9.2 ± 2.4, P < 0.01). No severe complication and death occurred. All patients reached solid bony fusion at 12-month follow-up. Conclusions Use of a halo vest before and during the operation is safe and effective in patients with AS who develop upper cervical spine fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration. .

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