scholarly journals Rheumatoid Arthritis Affecting the Upper Cervical Spine: Biomechanical Assessment of the Stabilizing Ligaments

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Carolin Meyer ◽  
Jan Bredow ◽  
Elisa Heising ◽  
Peer Eysel ◽  
Lars Peter Müller ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Neurological Disorders ◽  
Cord Compression ◽  
Upper Cervical Spine ◽  
Neutral Position ◽  
Transverse Ligament ◽  
Alar Ligaments ◽  
Upper Cervical

Diameters of anterior and posterior atlantodental intervals (AADI and PADI) are diagnostically conclusive regarding ongoing neurological disorders in rheumatoid arthritis. MRI and X-ray are mostly used for patients’ follow-up. This investigation aimed at analyzing these intervals during motion of cervical spine, when transverse and alar ligaments are damaged. AADI and PADI of 10 native, human cervical spines were measured using lateral fluoroscopy, while the spines were assessed in neutral position first, in maximal inclination second, and in maximal extension at last. First, specimens were evaluated under intact conditions, followed by analysis after transverse and alar ligaments were destroyed. Damage of the transverse ligament leads to an increase of the AADI’s diameter about 0.65 mm in flexion and damage of alar ligaments results in significant enhancement of 3.59 mm at mean. In extension, the AADI rises 0.60 mm after the transverse ligament was cut and 0.90 mm when the alar ligaments are damaged. After all ligaments are destroyed, AADI assessed in extension closely resembles AADI at neutral position. Ligamentous damage showed an average significant decrease of the PADI of 1.37 mm in the first step and of 3.57 mm in the second step in flexion, while it is reduced about 1.61 mm and 0.41 mm in the extended and similarly in the neutrally positioned spine. Alar and transverse ligaments are both of obvious importance in order to prevent AAS and movement-related spinal cord compression. Functional imaging is necessary at follow-up in order to identify patients having an advanced risk of neurological disorders.

Atlantal fracture with transverse ligament disruption in a child

2009 ◽  
Vol 4 (3) ◽  
pp. 196-198 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Eric C. Peterson
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Upper Cervical Spine ◽  
Transverse Ligament ◽  
Jefferson Fracture ◽  
Fractures In Children ◽  
Upper Cervical ◽  
Almost All ◽  
Ligament Disruption

Even though fractures in children with immature spines occur predominantly in the upper cervical spine, isolated C-1 fractures are relatively rare. The fractures in almost all cases reported to date were considered stable due to the presence of the intact transverse ligament. The authors report the case of a young child who sustained a Jefferson fracture and in whom MR imaging revealed disruption of the transverse ligament. Although surgical treatment has been suggested as the treatment of choice for children with unstable atlantoaxial injuries, external immobilization alone allowed a full recovery in the patient with no evidence of instability at follow-up.

Mechanism of Craniovertebral Ligamentous System Injuries and Their Effect on Spinal Arteries Blood Flow (Experimental Study)

2004 ◽  
Vol 11 (3) ◽  
pp. 30
Author(s):  
S. V Kolesov
Keyword(s):  
Blood Flow ◽  
Cervical Spine ◽  
Dynamic Compression ◽  
Ligament Injury ◽  
Upper Cervical Spine ◽  
Transverse Ligament ◽  
Alar Ligament ◽  
Alar Ligaments ◽  
Upper Cervical ◽  
Unilateral Injury

In 22 anatomic preparations of the cervical spine block various injuries of the ligamentous system were simulated and the evaluation of their effect upon the spinal arteries blood flow was per­formed. It has been shown that within craniovertebral segment the alar and transverse ligaments play the basic stabilizing role. Bending rotative, straightening rotative and bending mechanisms of injury may cause different volume of ligamentous system injuries. Three types of injuries have been detected: unilateral injury of the alar ligament, unilateral injury of the alar injury in combination with the transverse ligament injury and bilateral injury of the alar ligaments in combination with the transverse ligament injury. Injury of the upper cervical spine ligamentous structures results in the development of spine instability; especially in instability of atlantoaxial junction that causes dynamic compression of spinal arteries at atlantoaxial segment rotation.

Evaluation of flexion/extension of the upper cervical spine in patients with rheumatoid arthritis: an MRI study with a dedicated positioning device compared to conventional radiographs

2005 ◽  
Vol 46 (1) ◽  
pp. 55-66 ◽  
Author(s):  
J. O. Karhu ◽  
R. K. Parkkola ◽  
S. K. Koskinen
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Healthy Subjects ◽  
Upper Cervical Spine ◽  
Imaging Method ◽  
Neutral Position ◽  
Segmental Motion ◽  
Flexion Extension ◽  
Upper Cervical ◽  
Positioning Device

Purpose: Using flexion/extension magnetic resonance imaging (MRI) with a dedicated positioning device, our purpose was to analyze pathologic cranio‐vertebral joint anatomy and motion in patients with rheumatoid arthritis in comparison to normal patients, and to compare flexion/extension MRI with conventional radiographs (CRs) in patients with rheumatoid arthritis. Material and Methods: The 31 patients with rheumatoid arthritis and 20 healthy subjects included in the study were imaged in an open MRI scanner during flexion/extension. A dedicated positioning device was used. Additionally, we compared flexion/extension MRI with CRs in patients with rheumatoid arthritis. In MRI, the orientation and segmental motion of C0, C1, and C2 were assessed and structure of the dens and amount of pannus tissue were observed. Configuration of the cerebrospinal fluid space and the cord was evaluated in each position. In both MRI and CRs, anterior atlanto‐axial subluxation and vertical dislocation were assessed and sagittal diameter of the dural sac was measured. Results: In the neutral position, C1 of the patients was oriented in a more flexed position in relation to both C0 and C2 compared to that in healthy subjects. The patients had more extension in the upper cervical spine than did healthy subjects. In flexion, atlanto‐axial subluxation was greater in CRs than in MRI. In MRI, the amount of vertical dislocation did not depend on position. In the patients, there was considerably more cord impingement in flexion than in other positions. Conclusion: Evaluation of the rheumatoid cervical spine is optimized using MR images in the neutral, flexed, and extended positions. Measurements and relationships between structures should be compared in all positions. CRs with flexion‐extension views are recommended as the first imaging method.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

2021 ◽  
pp. 219256822110391
Author(s):  
Yakubu Ibrahim ◽  
Hao Li ◽  
Geng Zhao ◽  
Suomao Yuan ◽  
Yiwei Zhao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Neck Disability Index ◽  
Pedicle Screws ◽  
Rotary Motion ◽  
Upper Cervical Spine ◽  
Complex Fractures ◽  
Upper Cervical ◽  
Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

scholarly journals The Upper Cervical Spine in Rheumatoid Arthritis.

1996 ◽  
Vol 45 (2) ◽  
pp. 427-429
Author(s):  
Masao Kifune ◽  
Daishiro Yuge ◽  
Hiroshi Mimura ◽  
Toshihiko Taguchi ◽  
Takashi Hashiguchi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Upper Cervical Spine ◽  
Upper Cervical

scholarly journals Post-operative Results for Instability of the Upper Cervical Spine Due to Rheumatoid Arthritis.

1995 ◽  
Vol 44 (2) ◽  
pp. 761-763
Author(s):  
Tatsunori Oda ◽  
Shinya Kawai ◽  
Minoru Saika ◽  
Kozo Nomura ◽  
Mitsuhiro Kimura ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Upper Cervical Spine ◽  
Operative Results ◽  
Upper Cervical

Three-Dimensional Motion of the Upper Cervical Spine in Rheumatoid ARthritis

Spine ◽  
1994 ◽  
Vol 19 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Hiroshi lai ◽  
Sumio Goto ◽  
Masatsune Yamagata ◽  
Tamotsu Tamaki ◽  
Hideshige Moriya ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Three Dimensional ◽  
Upper Cervical Spine ◽  
Upper Cervical

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. .

Ventral C1 Fracture Combined with Congenital Posterior Cleft: What to Do?

2017 ◽  
Vol 79 (01) ◽  
pp. 066-072
Author(s):  
Philipp Dammann ◽  
Tobias Schoemberg ◽  
Yahya Ahmadipour ◽  
Michael Payer ◽  
Ulrich Sure ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Full Range ◽  
Rare Condition ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Spine Mobility ◽  
Upper Cervical ◽  
Congenital Cleft ◽  
Transverse Atlantal Ligament

Background and Objective We present a treatment approach for a rare condition of patients with a ventral C1 fracture and a congenital cleft in the posterior arch (half-ring Jefferson fracture) with an intact transverse atlantal ligament. Our technique aims to achieve stability of the atlanto-occipital and atlantoaxial joints while preserving mobility of the upper cervical spine. Patients and Methods Two male patients, 43 years and 29 years of age, respectively, were admitted to our hospital due to a fracture of the ventral arch of the atlas with no damage of the transverse atlantal ligament. Both men also presented a congenital cleft of the posterior arch. Initial conservative management with a halo-thoracic vest was performed in one case and failed. As a result, surgical treatment was performed in both cases using bilateral C1 mass screws and a transverse connector. Results The patients showed no neurologic deficits on follow-up examination 4 weeks after surgery with a full range of head and neck motion. Computed tomography (CT) showed no dislocation of the implanted material with good dorsal alignment and a stable ventral fracture distance. Follow-up CT showed osseous stability in both cases with the beginning of bony ossification of the bone graft. Conclusion Isolated instable fractures of the ventral arch of the atlas with a congenital cleft of the posterior arch with no damage of the transverse atlantal ligament can be stabilized using bilateral C1 mass screws and a transverse connector preserving upper cervical spine mobility.

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