Atlantoaxial Subluxation after Pyogenic Spondylitis around the Odontoid Process

Study Design. A case report and review of the literature.Objective. The aim of this study was to describe the conservative management of pyogenic spondylitis around the odontoid process.Summary of Background Data. Atlantoaxial subluxation after pyogenic spondylitis is rare. The therapeutic approach to infection of the upper cervical spine is controversial.Methods. Medical chart and radiological images of a 76-year-old male patient were retrospectively reviewed. Radiography revealed atlantoaxial subluxation, and an abscess was seen around the odontoid process on magnetic resonance images. Intravenous antibiotics and a halo vest were used to treat the patient. We then observed the patient’s conservative treatment course.Results. C-reactive protein levels returned to normal 4 weeks after administration of the intravenous antibiotics. The patient’s muscle weakness also completely recovered 8 weeks after administration of the intravenous antibiotics. Because the patient was able to walk without any support, surgical treatment was not necessary.Conclusions. Pyogenic spondylitis of the upper cervical spine is a rare manifestation. Surgical or conservative treatment must be selected carefully based on the patient’s symptoms. If early diagnosis and treatment can be provided to the patients, conservative treatment can be achieved.

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Biomechanics of upper cervical spine and peculiarities of treatment of patients with odontoid process fractures

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto64068 ◽

1996 ◽

Vol 3 (1) ◽

pp. 18-21

Author(s):

V. A. Moiseenko

Keyword(s):

Cervical Spine ◽

Conservative Treatment ◽

Odontoid Process ◽

Upper Cervical Spine ◽

Traction Method ◽

Cervical Muscles ◽

Halo Traction ◽

Upper Cervical ◽

Extension Fracture

In transdental injuries of atlantoaxial region the indications for conservative treatment and authors bipolar Halo-traction method were worked out on the base of spine biomechanical peculiarities (anterior shifting moment and extensor conditionality of the posterior cervical muscles) as well as depending on the mechanism of the development of plane fracture of C2 odontoid process. In flexion fracture of the odontoid process without dislocation as well as in extension fracture with dislocation within the limits of 1/3 of its diameter the successful conservative treatment with plaster thoracocranial bandage was possible. In the rest of cases the authors method of bipolar Halo-traction was indicated. The experience of treatment of 32 patients was used in the work.

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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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Odontoid process fracture in 2 year old child: a rare case report

Romanian Neurosurgery ◽

10.1515/romneu-2017-0080 ◽

2017 ◽

Vol 31 (4) ◽

pp. 522-525

Author(s):

Prajapati Hanuman Prasad ◽

Singh Deepak Kumar ◽

Singh Rakesh Kumar ◽

Yadav Kuldeep

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

The Body ◽

Upper Cervical Spine ◽

Age Group ◽

Spine Injuries ◽

Rare Case Report ◽

Upper Cervical ◽

Cervical Spine Fractures ◽

Odontoid Process Fracture

Abstract In small childrens spine injuries are rare. In this age group upper cervical spine is commonally affected. Odontoid process fracture involve only a subset of cervical spine fractures. In small childrens, this fracture typically involves the cartilaginousplate that separates the odontoid process from the body of the axis. Odontoid processfracture is rare in children less than 7 years of age.

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

Neurosurgery ◽

10.1227/00006123-198405000-00012 ◽

1984 ◽

Vol 14 (5) ◽

pp. 583-587 ◽

Cited By ~ 8

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.

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Pyogenic Spondylitis of the Upper Cervical Spine. Case Report.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.50.34 ◽

2001 ◽

Vol 50 (1) ◽

pp. 34-38

Author(s):

Keisuke Nishida ◽

Toshinori Nakao

Keyword(s):

Case Report ◽

Cervical Spine ◽

Upper Cervical Spine ◽

Pyogenic Spondylitis ◽

Upper Cervical ◽

Spine Case

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UPPER CERVICAL SPINE INJURIES: DIAGNOSTICS, CLASSIFICATIONS AND TREATMENT PECULIARITIES

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.1.25-44 ◽

2005 ◽

pp. 025-044

Author(s):

Edvard Aleksandrovich Ramikh

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

Upper Cervical Spine ◽

Treatment Technique ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Upper Cervical ◽

Methods Of Treatment ◽

Traumatic Spondylolisthesis ◽

Selection Of

Comprehensive diagnostics, accepted classifications, and selection of pathogenetic methods of treatment (including surgery) for axis injuries, odontoid process fractures, axis traumatic spondylolisthesis and hangman’s fractures are discussed in the paper. The presented data prove the necessity and possibility of early exhaustive diagnosing to differentiate the type of a craniocervical disorder and to provide a timely choice of pathogenetic treatment technique, especially of a surgical one.

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DIAGNOSTICS AND TREATMENT FOR UPPER CERVICAL SPINE INJURIES

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.1.16-20 ◽

2005 ◽

pp. 016-020

Author(s):

Stepan Timofeyevich Vetrile ◽

Sergey Vasilyevich Kolesov

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

Upper Cervical Spine ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Upper Cervical

The experience of diagnostics and treatment of 82 patients with various injuries of the upper cervical spine was analyzed. The most frequent injuries were fractures of C2 odontoid process and arch. The treatment included a wide application of halo apparatus, and, when indicated, a surgical instrumention stabilization of the upper cervical spine.

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Atlantoaxial Subluxation in Different Intraoperative Head Positions in Patients with Rheumatoid Arthritis

Anesthesiology ◽

10.1097/00000542-200604000-00010 ◽

2006 ◽

Vol 104 (4) ◽

pp. 675-679 ◽

Cited By ~ 28

Author(s):

Daisaku Tokunaga ◽

Hitoshi Hase ◽

Yasuo Mikami ◽

Tatsuya Hojo ◽

Kazuya Ikoma ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

General Anesthesia ◽

Perioperative Period ◽

Head Position ◽

Lateral View ◽

Atlantoaxial Subluxation ◽

Upper Cervical Spine ◽

Upper Cervical ◽

Atlantodental Interval

Background Disorders of the cervical spine are often observed in patients with rheumatoid arthritis (RA). However, the best head position for RA patients with atlantoaxial subluxation in the perioperative period is unknown. This study investigated head position during general anesthesia for the patients with RA and proven atlantoaxial subluxation. Methods During anesthesia of patients with RA and proven atlantoaxial subluxation, the authors used fluoroscopy to obtain a lateral view of the upper cervical spine in four different positions: the mask position, the intubation position, the flat pillow position, and the protrusion position. Copies of the still fluoroscopic images were used to determine the anterior atlantodental interval, the posterior atlantodental interval, and the angle of atlas and axis (C1-C2 angle). Results The anterior atlantodental interval was significantly smaller in the protrusion position (2.3 mm) than in the flat pillow position (5.1 mm) (P < 0.05). The posterior atlantodental interval was significantly greater in the protrusion position (18.9 mm) than in the flat pillow position (16.2 mm) (P < 0.05). The C1-C2 angle was, on average, 9.3 degrees greater in the protrusion position than in the flat pillow position (P < 0.05). Conclusion This study showed that the protrusion position using a flat pillow and a donut-shaped pillow during general anesthesia reduced the anterior atlantodental interval and increased the posterior atlantodental interval in RA patients with atlantoaxial subluxation. This suggests that the protrusion position, which involves support of the upper cervical spine and extension at the craniocervical junction, might be advantageous for these patients.

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