scholarly journals Atlantoaxial Subluxation due to an Os Odontoideum in an Achondroplastic Adult: Report of a Case and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Abolfazl Rahimizadeh ◽  
Housain F. Soufiani ◽  
Valiolah Hassani ◽  
Ava Rahimizadeh
Keyword(s):  
Foramen Magnum ◽  
Atlantoaxial Subluxation ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Review Of The Literature ◽  
Suboccipital Craniectomy ◽  
Neural Tissues ◽  
Frequent Site ◽  
Small Foramen ◽  
Achondroplastic Dwarf

The authors report the first example of an adult achondroplastic dwarf with progressive quadriparesis secondary to atlantoaxial subluxation as a consequence of an os odontoideum. Actually, craniocervical region is a frequent site of compression and myelopathy in achondroplasia particularly in children as a result of small foramen magnum and hypertrophied opisthion. Moreover, very rarely in achondroplastic patients, coexistence of atlantoaxial instability as the sequel of os odontoideum can result in further compression of the already compromised cervicomedullary neural tissues, the scenario that has been reported only in five achondroplastic children. Herein, a 39-year-old achondroplastic male suffering such an extremely rare combination is presented. With C1-C2 screw rod instrumentation, atlas arch laminectomy, limited suboccipital craniectomy, and release of dural fibrous bands, reduction, decompression, and stabilization could be achieved properly resulting in steady but progressive recovery.

Os Odontoideum with Posterior Atlantoaxial Instability

Spine ◽  
1991 ◽  
Vol 16 (7) ◽  
pp. 706-715 ◽  
Author(s):  
NOBUKI SHIRASAKI ◽  
KOZO OKADA ◽  
SHIRO OKA ◽  
NOBORU HOSONO ◽  
KAZUO YONENOBU ◽  
...  
Keyword(s):  
Atlantoaxial Instability ◽  
Os Odontoideum

Use of a titanium mesh cage for posterior atlantoaxial arthrodesis

2002 ◽  
Vol 96 (1) ◽  
pp. 127-130 ◽  
Author(s):  
Morio Matsumoto ◽  
Kazuhiro Chiba ◽  
Takashi Tsuji ◽  
Hirofumi Maruiwa ◽  
Yoshiaki Toyama ◽  
...  
Keyword(s):  
Donor Site ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Posterior Arch ◽  
Rigid Fixation ◽  
Titanium Mesh ◽  
Content Type ◽  
Atlantoaxial Fixation ◽  
Mesh Cage ◽  
Atlantoaxial Arthrodesis

✓ The authors placed titanium mesh cages to achieve posterior atlantoaxial fixation in five patients with atlantoaxial instability caused by rheumatoid arthritis or os odontoideum. A mesh cage packed with autologous cancellous bone was placed between the C-1 posterior arch and the C-2 lamina and was tightly connected with titanium wires. Combined with the use of transarticular screws, this procedure provided very rigid fixation. Solid fusion was achieved in all patients without major complications. The advantages of this method include more stable fixation, better control of the atlantoaxial fixation angle, and reduced donor-site morbidity compared with a conventional atlantoaxial arthrodesis in which an autologous iliac crest graft is used.

Cough headache

2020 ◽  
pp. 220-224
Author(s):  
Julio Pascual ◽  
Peter van den Berg
Keyword(s):  
Posterior Fossa ◽  
Foramen Magnum ◽  
Type I ◽  
Chiari Type I Malformation ◽  
Cough Headache ◽  
Suboccipital Craniectomy ◽  
Secondary Form ◽  
Structural Lesion ◽  
Chiari Type I ◽  
Tonsillar Descent

Cough headache exists in a primary and secondary form. The latter is due to tonsillar descent or, more rarely, to other space-occupying lesions in the posterior fossa/foramen magnum. Up to 40% of patients have an underlying structural lesion. Most patients with primary cough headache respond to indomethacin and suboccipital craniectomy with posterior fossa reconstruction can relieve cough headache in Chiari type I malformation.

scholarly journals Chronic posterior atlantoaxial subluxation associated with os odontoideum: a rare condition. A case report and literature review

2018 ◽  
Vol 4 (1) ◽  
Author(s):  
Tinnakorn Pluemvitayaporn ◽  
Sombat Kunakornsawat ◽  
Chaiwat Piyaskulkaew ◽  
Pritsanai Pruttikul ◽  
Warongporn Pongpinyopap
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Rare Condition ◽  
Atlantoaxial Subluxation ◽  
Os Odontoideum

Surgical Treatment of Chiari I Malformation—Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 365-380 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Clinical Symptoms ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Outcome Data ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Surgical Morbidity ◽  
Suboccipital Craniectomy ◽  
Chiari I

Abstract BACKGROUND: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial. OBJECTIVE: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes. METHODS: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics. RESULTS: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years. CONCLUSION: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.

Anatomical suitability of C1–2 transarticular screw placement in pediatric patients

2000 ◽  
Vol 92 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Douglas L. Brockmeyer ◽  
Julie E. York ◽  
Ronald I. Apfelbaum
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Vascular Complications ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. Craniovertebral instability is a challenging problem in pediatric spinal surgery. Recently, C1–2 transarticular screw fixation has been used to assist in craniovertebral joint stabilization in pediatric patients. Currently there are no available data that define the anatomical suitability of this technique in the pediatric population. The authors report their experience in treating 31 pediatric patients with craniovertebral instability by using C1–2 transarticular screws. Methods. From March 1992 to October 1998, 31 patients who were 16 years of age or younger with atlantooccipital or atlantoaxial instability, or both, were evaluated at our institution. There were 21 boys and 10 girls. Their ages ranged from 4 to 16 years (mean age 10.2 years). The most common causes of instability were os odontoideum (12 patients) and ligamentous laxity (eight patients). Six patients had undergone a total of nine previous attempts at posterior fusion while at outside institutions. All patients underwent extensive preoperative radiological evaluation including fine-slice (1-mm) computerized tomography scanning with multiplanar reconstruction to evaluate the anatomy of the C1–2 joint space. Preoperatively, of the 62 possible C1–2 joint spaces in 31 patients, 55 sides (89%) were considered suitable for transarticular screw placement. In three patients the anatomy was considered unsuitable for bilateral screw placement. In three patients the anatomy was considered inadequate on one side. Fifty-five C1–2 transarticular screws were subsequently placed, and there were no neurological or vascular complications. Conclusions. The authors conclude that C1–2 transarticular screw fixation is technically possible in a large proportion of pediatric patients with craniovertebral instability.

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