scholarly journals Occipitocervical Fixation: General Considerations and Surgical Technique

2019 ◽  
Vol 10 (5) ◽  
pp. 647-656 ◽  
Author(s):  
Andrei Fernandes Joaquim ◽  
Joseph A. Osorio ◽  
K. Daniel Riew
Keyword(s):  
Surgical Technique ◽  
Vascular Complications ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fixation ◽  
Fixation Techniques ◽  
Narrative Literature ◽  
Craniocervical Instability ◽  
Narrative Literature Review ◽  
Improve Patient

Study Design: Narrative literature review. Objective: To review and present details on the occipitocervical fixation (OCF) technique as well as considerations for planning the procedure. Methods: We present the surgical technique of OCF in a step-by-step didactic and practical manner with surgical tips and tricks, including C1 and C2 screw fixation techniques. Additionally, we discuss complications, the extension of fusion, types of OCF, and how to avoid common side effects associated with OCF. Results: The complex and mobile anatomy of the craniocervical junction, when requiring fixation and fusion, warrants rigid instrumentation that can be achieve using a modern screw-plate-rod construct. Indications for OCF are craniocervical instability, and atlantoaxial instability when selective atlantoaxial fusion is not feasible. OCF generally involves occiput-C2 fusion. C1 fixation is generally unnecessary, since it increases the surgical time and is associated with the risk of vascular complications. Selective occiput-C2 fusion is recommended when there is no need for including the cervical subaxial region (eg, when stenosis or fractures coexist in the subaxial spine), and good fixation is achieved at C2. Most instrumentation systems now have occipital plates that are not pre-integrated to rods, making fixation much simpler. Surgical steps, from position to wound closure, are presented in detail, with pearls for practice and discussion of cervical alignment. Conclusions: OCF is a challenging procedure, with potential risk of severe adverse effects. Understanding the surgical indications, as well as the nuances of the surgical technique, is required to improve patient outcomes and avoid complications.

scholarly journals Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review

Heliyon ◽  
2021 ◽  
Vol 7 (4) ◽  
pp. e06626
Author(s):  
Paulina Cecula ◽  
Jiakun Yu ◽  
Fatema Mustansir Dawoodbhoy ◽  
Jack Delaney ◽  
Joseph Tan ◽  
...  
Keyword(s):  
Mental Health ◽  
Artificial Intelligence ◽  
Literature Review ◽  
Patient Flow ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
Inpatient Units ◽  
Improve Patient

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

scholarly journals ODONTOID PROCESS HYPOPLASIA AND BIPARTITE ATLAS ASSOCIATED WITH ATLANTO-AXIAL INSTABILITY

2016 ◽  
Vol 15 (4) ◽  
pp. 330-333 ◽  
Author(s):  
Luis Miguel Sousa Marques ◽  
Clara Romero ◽  
José Gabriel Monteiro de Barros Cabral
Keyword(s):  
Imaging Techniques ◽  
Previous History ◽  
Three Dimensional ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Diagnostic Process ◽  
Fixation Techniques ◽  
Bipartite Atlas

ABSTRACT Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.

Occipitocervical fusion using a contoured rod and wire construct in children: a reappraisal of a vintage technique

2013 ◽  
Vol 11 (2) ◽  
pp. 160-169 ◽  
Author(s):  
Paul Klimo ◽  
Nelson Astur ◽  
Kyle Gabrick ◽  
William C. Warner ◽  
Michael S. Muhlbauer
Keyword(s):  
Epithelioid Sarcoma ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Trauma Patients ◽  
Occipitocervical Fusion ◽  
Csf Leakage ◽  
Fixation Techniques

Object Many methods to stabilize and fuse the craniocervical junction have been described. One of the early designs was a contoured (Luque) rod fixated with wires, the so-called Hartshill-Ransford loop. In this study, the authors report their 20-year experience with this surgical technique in children. Methods The authors reviewed the medical records of patients 18 years of age or younger who underwent dorsal occipitocervical fusion procedures between March 1992 and March 2012 at Le Bonheur Children's Hospital using a contoured rod and wire construct. Data on basic patient characteristics, causes of instability, neurological function at presentation and at last follow-up, details of surgery, complications, and radiographic outcome were collected. Results Twenty patients (11 male) were identified, with a mean age of 5.5 years (range 1–18 years) and a median follow-up of 43.5 months. Fourteen patients had atlantooccipital dislocation, 2 patients had atlantoaxial fracture–dissociations, 2 had Down syndrome with occipitocervical and atlantoaxial instability, 1 had an epithelioid sarcoma from the clivus to C-2, and 1 had an anomalous atlas with resultant occipitocervical instability. Surgical stabilization extended from the occiput to C-1 in 3 patients, C-2 in 6, C-3 in 8, and to C-4 in 3. Bone morphogenetic protein was used in 2 patients. Two patients were placed in a halo orthosis; the rest were kept in a hard collar for 6–8 weeks. All patients were neurologically stable after surgery. One patient with a dural tear experienced wound dehiscence with CSF leakage and required reoperation. Eighteen patients went on to achieve fusion within 6 months of surgery; 1 patient was initially lost to follow-up, but recent imaging demonstrated a solid fusion. There were no early hardware or bone failures requiring hardware removal, but radiographs obtained 8 years after surgery showed that 1 patient had an asymptomatic fractured rod. There were no instances of symptomatic junctional degeneration, and no patient was found to have increasing lordosis over the fused segments. Five (31%) of the 16 trauma patients required a shunt for hydrocephalus. Conclusions Despite the proliferation of screw-fixation techniques for craniocervical instability in children, the contoured rod–wire construct remains an effective, less expensive, and technically easier alternative that has been in use for almost 30 years. It confers immediate stability, and therefore most patients will not need to be placed in a halo device postoperatively. A secondary observation in our series was the high (30%) rate of hydrocephalus requiring a shunt in patients with traumatic instability.

Nuances of Occipitocervical Fixation

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A141-A146 ◽  
Author(s):  
Daniel C. Lu ◽  
Andrew C. Roeser ◽  
Valli P. Mummaneni ◽  
Praveen V. Mummaneni
Keyword(s):  
Surgical Technique ◽  
Pertinent Literature ◽  
Occipitocervical Fixation ◽  
Fixation Techniques

Abstract OBJECTIVE To describe the indications and techniques for occipitocervical (OC) fixation. METHODS The operative nuances of current OC fixation techniques are described. A surgical technique video is included. RESULTS Pertinent literature is reviewed regarding OC fixation techniques. CONCLUSION OC fixation systems have evolved from wire and cable techniques to plates, rods, and screws. Screw-rod constructs are easy to implant and biomechanically more rigid than wire techniques.

Giving and receiving written feedback on research reports: a narrative review and guidance for supervisors and students

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Kerith Duncanson ◽  
David Schmidt ◽  
Emma Webster
Keyword(s):  
Research Report ◽  
Emotional Impact ◽  
Written Feedback ◽  
Supervisory Relationship ◽  
Factors Associated ◽  
Researcher Development ◽  
Teacher Student ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
Educational Component

PurposeWritten feedback on research-related writing is an important educational component of novice researcher development. Limited evidence exists to inform effective written feedback, particularly in relation to research reports by novice researchers. The aim of this narrative literature review was to explore supervisor and novice researcher perspectives on the provision of written feedback, particularly in the context of their evolving supervisory relationship. MethodsA systematic search of peer-reviewed journals in educational and health databases was undertaken for the terms ‘written feedback’ and ‘research report’, from January 2001 to August 2020. Identified literature was critiqued for methodological quality. Findings were coded, grouped and described as themes. Next, the themes and their parts were applied to the development of a two-part written feedback checklist that includes separate but related recommendations for supervisors and novice researchers.FindingsFrom 35 included papers, the four main themes that related to written feedback on research reports by novice researchers were: the emotional impact of receiving or giving written feedback; written feedback in the supervisory power dynamic; communicating written feedback; and the content and structure of written feedback. The changing nature and complexity of factors associated with written feedback from research supervisors reflected the transition from a supervisory relationship to a peer relationship. The checklist developed from the synthesised data is intended to provide guidance for supervisors and students about their respective and shared responsibilities within a supervisory relationship.  ImplicationsIncreased awareness of the characteristics, roles and impact of written feedback will assist supervisors of novice researchers to provide effective written feedback, and for students to effectively utilise written feedback. Progression of written feedback throughout the supervisory period is proposed as a means of transitioning from a teacher-student to a peer researcher relationship. 

Reproductive health issues in female patients with beta-thalassaemia major: a narrative literature review

2020 ◽  
Vol 40 (7) ◽  
pp. 902-911 ◽  
Author(s):  
Malihe Nourollahpour Shiadeh ◽  
Elena Cassinerio ◽  
Maryam Modarres ◽  
Armin Zareiyan ◽  
Zeinab Hamzehgardeshi ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Literature Review ◽  
Thalassaemia Major ◽  
Health Issues ◽  
Female Patients ◽  
Beta Thalassaemia ◽  
Narrative Literature ◽  
Narrative Literature Review

scholarly journals Participatory Research Approaches in Times of Covid-19: A Narrative Literature Review

2021 ◽  
Vol 20 ◽  
pp. 160940692110100
Author(s):  
Johanna Hall ◽  
Mark Gaved ◽  
Julia Sargent
Keyword(s):  
Participatory Research ◽  
Participatory Methods ◽  
Research Issue ◽  
Participatory Approaches ◽  
Face To Face ◽  
Narrative Literature ◽  
Geographically Distributed ◽  
Literature Base ◽  
Narrative Literature Review ◽  
Participatory Research Methods

This review aims to collate and organize the current literature base on the use of participatory research methods within Covid-19 and pandemic contexts. Participatory approaches rely on establishing trust and rapport between researchers and participants and advocate actively involving participants in the planning, implementation and evaluation of a research issue. However, by transitioning such approaches to an online and geographically distributed context, the openness and equitability of participatory approaches may be reduced or lost. By providing an overview of current empirical and guidance literature on the use of participatory approaches within the context of Covid-19, this review not only offers a basis for how a variety of methods may be used and adapted to distanced contexts, but also explicates the challenges associated with the use of these methods and the wider methodological implications posed by the Covid-19 pandemic. Furthermore, this review outlines the issues associated with conducting this type of research more generally, providing implications for how distance-based participatory methods may be used in wider contexts where face-to-face interaction may not be appropriate, or fieldwork may be disrupted due to logistical reasons.

Sign in / Sign up

Export Citation Format

Share Document