scholarly journals Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ryszard Tomaszewski ◽  
Jacek Kler ◽  
Karol Pethe ◽  
Agnieszka Zachurzok

Abstract Background Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. Methods During the years 2013–2020, 6 pediatric patients with OCFs, aged 14–18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. Results Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2–11) and 9.62% (4.4–24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41–99.44). Conclusion The Anderson-Montesano and Tuli’s classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 530
Author(s):  
Ryszard Tomaszewski ◽  
Artur Gap ◽  
Magdalena Lucyga ◽  
Erich Rutz ◽  
Johannes M. Mayr

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson–Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson–Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson–Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5–14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3–11 points) and SF-36 score (median: 91 points; range: 64–96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.


2018 ◽  
Vol 8 (7) ◽  
pp. 703-708 ◽  
Author(s):  
Andreas Kiilerich Andresen ◽  
Rune Tendal Paulsen ◽  
Frederik Busch ◽  
Alexander Isenberg-Jørgensen ◽  
Leah Y. Carreon ◽  
...  

Study Design: Retrospective cohort study. Objectives: It is estimated that 10 000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20% undergo surgery for cervical degenerative disease every year in Denmark. We aim to evaluate the patient-reported results and satisfaction of anterior cervical decompression and fusion over a 5-year period from a single Danish center for spine surgery. Methods: This study is a retrospective study based on prospectively collected data from 318 consecutive patients treated with anterior cervical decompression and fusion over 1 to 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), and Short Form-36 Physical Component Summary (SF-36 PCS). Results: Of 318 cases enrolled, 272 (85.5%) had follow-up data available at a minimum 1-year postoperatively. The mean preoperative NDI was 40.0 and improved to 22.7. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 60.4 improved to 26.4. All improvements were statistically significant. A total of 74.3% were back to work 1 year after surgery. Achieving minimal clinically important difference (MCID) in VAS neck and SF-36 PCS was strongly correlated to patient satisfaction. Conclusion: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 74.3% of patients reporting a positive change in health status after surgery.


2019 ◽  
Vol 21 (2) ◽  
pp. 55-58
Author(s):  
Marcos Iae Sato ◽  
Luiz Fernando Aguiar ◽  
Melissa Nóbrega Vasques de Freitas ◽  
Isabella Guerra ◽  
José Eduardo Martinez

Introdução: A cervicalgia afeta cerca de 50% da população. Predomina em mulheres e se relaciona a esforços repetitivos e má postura. O tempo de estudos e a utilização de livros, computadores e tablets pode gerar posturas inadequadas que podem causar cervicalgia. Objetivo: Conhecer a prevalência dessa afecção nos alunos de medicina da Pontifícia Universidade Católica de São Paulo (PUC-SP) e o respectivo perfil. Materiais e métodos: Foram avaliados cem estudantes de medicina da PUC-SP e aplicados questionários sobre dados demográficos, características clínicas, o Neck Disability Index (NDI) e o Medical Outcome Study Short Form 36 Survey (SF-36). Resultados: A prevalência de cervicalgia foi de 34%, com predomínio feminino. O quadro foi referido como crônico em 16%, enquanto 19% apresentaram apenas 1 episódio. Em relação ao NDI, observa-se que, entre aqueles com 17 a 19 anos, 3 não apresentaram incapacidade e 3 tinham incapacidade leve. De 20 a 22 anos, 6 não apresentaram incapacidade e 12, leve. De 23 a 25 anos, 2 não apresentaram incapacidade, 7 tinham incapacidade leve e 1, moderada. Acima de 26 anos, 1 apresentou incapacidade leve. Houve impacto na qualidade de vida nos domínios aspectos físicos, dor e vitalidade. A análise mostrou que os escores do SF-36 se correlacionam com os valores do NDI, com exceção do domínio aspectos sociais para ambos os sexos e os domínios vitalidade e saúde mental para o sexo masculino. Conclusão: Existe uma prevalência relevante de cervicalgia entre os alunos do curso de medicina da PUC-SP, gerando impacto na qualidade de vida.


Neurosurgery ◽  
2013 ◽  
Vol 74 (2) ◽  
pp. 206-214 ◽  
Author(s):  
Brenda Auffinger ◽  
Sandi Lam ◽  
Jingjing Shen ◽  
Ben Z. Roitberg

Abstract BACKGROUND: Although the concept of minimum clinically important difference (MCID) as a measurement of surgical outcome has been extensively studied, there is lack of consensus on the most valid or clinically relevant MCID calculation approach. OBJECTIVE: To compare the range of MCID threshold values obtained by different anchor-based and distribution-based approaches to determine the best clinically meaningful and statistically significant MCID for our studied group. METHODS: Eighty-eight consecutive patients undergoing surgery for subaxial degenerative cervical spine disease were analyzed from a prospective blinded database. Preoperative, 3-, and 6-month postoperative patient reported outcome (PRO) scores and blinded surgeon ratings were collected. Four calculation methods were used to calculate MCID threshold values: average change, change difference, minimum detectable change, and receiver operating characteristic (ROC) curve. Three anchors were used to evaluate meaningful improvement postsurgery: health transition item, patient overall status, and surgeon ratings. RESULTS: On average, all patients had a statistically significant improvement (P < .001) postoperatively for neck disability index (score 27.42 preoperatively to 19.42 postoperatively), physical component of the Short Form of the Medical Outcomes Study (SF-36) (33.02–42.23), mental component of the SF-36 (44–50.74), and visual analog scale (2.85–1.93). The 4 MCID approaches yielded a range of values for each PRO: 2.23 to 16.59 for physical component of the SF-36, 0.11 to 16.27 for mental component of the SF-36, and 2.72 to 12.08 for neck disability index. In comparison with health transition item and patient overall status anchors, the area under the ROC curve was consistently greater for surgeon ratings for all 4 PROs. CONCLUSION: Minimum detectable change together with surgeon ratings anchor appears to be the most appropriate MCID method. Based on our findings, this combination offers the greatest area under the ROC curve (threshold above the 95% confidence interval). The choice of the anchor did not significantly affect this result.


2011 ◽  
Vol 15 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Vedat Deviren ◽  
Justin K. Scheer ◽  
Christopher P. Ames

Object Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. This study details the cervicothoracic PSO technique in 11 cases and correlates clinical kyphosis (chin-brow to vertical angle [CBVA]) with radiographic measurements. Methods Between February 2008 and September 2010, 11 patients (mean age 70 years) underwent a modified PSO (10 at C-7, 1 at T-1) for treatment of sagittal imbalance. Preoperative and postoperative sagittal plane radiographic measurements were made. The CBVA was measured on clinical photographs. Operative technique and perioperative correction were reported for all 11 patients and long-term follow-up data was reported for 9 patients, in whom the mean duration of follow-up was 23 months. Outcome measures used for these 9 patients were the Neck Disability Index, the 36-Item Short Form Health Survey (SF-36), and a visual analog scale for neck pain. Results The mean values for estimated blood loss, surgical time, and hospital stay in the 11 patients were 1100 ml, 4.3 hours, and 9.9 days, respectively. The mean preoperative and immediate postoperative values (± SD) for cervical sagittal imbalance were 7.9 ± 1.4 cm and 3.4 ± 1.7 cm. The mean overall correction was 4.5 ± 1.5 cm (42.8%), the mean PSO correction 19.0°, and the mean CBVA correction 36.7°. There was essentially no correlation between preoperative C2–T1 radiographic kyphosis and preoperative CBVA (R2 = 0.0165). There was a moderate correlation with PSO correction angle and postoperative CBVA (R2 = 0.38). There was a significant decrease in both the Neck Disability Index (51.1 to 38.6, p = 0.03) and visual analog scale scores for neck pain (8.1 to 3.9, p = 0.0021). The SF-36 physical component summary scores increased by 18.4% (30.2 to 35.8) with no neurological complications. Conclusions The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in health-related quality-of-life measures even at early time points.


2019 ◽  
Vol 30 (01) ◽  
pp. 26-32
Author(s):  
Cheng Zang ◽  
Yanyan Zhou ◽  
Yonghui Liu ◽  
Binbin Wu

Abstract Introduction Stabilization exercise may be an important approach to alleviate neck pain. However, its use has not been well established. We conduct a narrative review and meta-analysis to evaluate the efficacy of stabilization exercise to control neck pain. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of stabilization exercise on neck pain are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model. Results Five RCTs involving 217 patients are included in the meta-analysis. Compared with control intervention for neck pain, stabilization exercises has no notable impact on pain intensity (Std. MD=−0.55; 95% CI=−1.24 to 0.14; P=0.12), neck disability index (Std. MD=−0.44; 95% CI=−1.01 to 0.13; P=0.13), SF-36 physical health (Std. MD=−0.18; 95% CI=−0.61 to 0.26; P=0.43), SF-36 mental health (Std. MD=−0.03; 95% CI=−0.47 to 0.41; P=0.89), but can remarkably decrease depression scale (Std. MD=−1.05; 95% CI=−1.59 to −0.50; P=0.0002). Conclusions Stabilization exercises shows similar impact on pain intensity, neck disability index, SF-36 physical health and SF-36 mental health, but significant reduced depression scale compared with control intervention in patients with neck pain.


2010 ◽  
Author(s):  
Βικτωρία Μισαηλίδου

Σκοπός της παρούσας ερευνητικής μελέτης ήταν να διερευνηθεί η επίδραση τριών προγραμμάτων θεραπευτικής άσκησης στην αίσθηση πόνου, στη λειτουργική ικανότητα, στην αποφυγή λόγω φόβου, στην ποιότητα ζωής, στο εύρος κίνησης της αυχενικής μοίρας της Σ.Σ., στην αντοχή των καμπτήρων και εκτεινόντων μυών της αυχενικής μοίρας της Σ.Σ. και στην αναπνευστική λειτουργία σε ασθενείς με χρόνιο αυχενικό πόνο. Στην έρευνα έλαβαν μέρος 60 ασθενείς με χρόνιο αυχενικό πόνο οι οποίοι χωρίστηκαν σε τρεις ομάδες των 20 ατόμων. Στην πρώτη ομάδα έγινε αξιολόγηση και εφαρμόστηκε θεραπεία σύμφωνα με τις αρχές της μεθόδου McKenzie, στη δεύτερη ομάδα έγινε αξιολόγηση και εφαρμόστηκε θεραπεία με ένα εξελικτικό πρόγραμμα ασκήσεων διάτασης, ενδυνάμωσης, αντοχής και ιδιοδεκτικότητας και στην τρίτη ομάδα έγινε εφαρμογή αναπνευστικών ασκήσεων και τεχνικών χαλάρωσης. Όλοι οι συμμετέχοντες έλαβαν 12 συνεδρίες σε διάστημα 4-6 εβδομάδων ενώ οι μετρήσεις πραγματοποιήθηκαν πριν από την έναρξη και μετά την ολοκλήρωση της θεραπευτικής παρέμβασης. Για την αξιολόγηση της αίσθησης πόνου χρησιμοποιήθηκε το ερωτηματολόγιο McGill Pain Questionnaire – short form (SF-MPQ), της λειτουργικής ικανότητας το Neck Disability Index (NDI), της αποφυγής λόγω φόβου το Fear Avoidance Beliefs Questionnaire (FABQ) και για την ποιότητα ζωής το SF-36 Health Survey. Το εύρος κίνησης μετρήθηκε με ειδικό γωνιόμετρο κεφαλής Cervical Range of Motion Instrument(CROM), η αντοχή των καμπτήρων και εκτεινόντων μυών με χρονόμετρο χειρός και η αναπνευστική λειτουργία με φορητό σπιρόμετρο. Σύμφωνα με τα αποτελέσματα διαπιστώθηκε στατιστικά σημαντική βελτίωση στην αίσθηση πόνου, στη λειτουργική ικανότητα, στην αποφυγή λόγω φόβου, στην ποιότητα ζωής, στο εύρος κίνησης της αυχενικής μοίρας της Σ.Σ., στην αντοχή των καμπτήρων και εκτεινόντων μυών της αυχενικής μοίρας της Σ.Σ. και στην αναπνευστική λειτουργία μετά την εφαρμογή των θεραπευτικών προγραμμάτων και στις τρεις πειραματικές ομάδες με διαφοροποιήσεις στα ποσοστά βελτίωσης της κάθε ομάδας. Η ομάδα McKenzie, παρουσίασε τη μεγαλύτερη βελτίωση στον πόνο, στη λειτουργική ικανότητα , στην έκταση της αυχενικής μοίρας και στην αντοχή των καμπτήρων και εκτεινόντων μυών του αυχένα. Η ομάδα ενδυνάμωσης παρουσίασε τη μεγαλύτερη βελτίωση στην αποφυγή λόγω φόβου, στην ποιότητα ζωής, και στην κάμψη και στροφές της αυχενικής μοίρας ενώ η ομάδα των αναπνευστικών ασκήσεων παρουσίασε τη μεγαλύτερη βελτίωση στην αναπνευστική λειτουργία. Όλα τα θεραπευτικά προγράμματα είχαν θετικά αποτελέσματα αλλά κάποια κλινικά χαρακτηριστικά των ασθενών φαίνεται ότι ανταποκρίνονται καλύτερα σε συγκεκριμένους τύπους θεραπείας. Προτείνεται έρευνα που να ταξινομεί τους ασθενείς με χρόνιο αυχενικό πόνο σε υποομάδες με κοινά κλινικά χαρακτηριστικά με σκοπό να διερευνηθεί αν η ταξινόμηση αυτή βοηθάει στην βελτίωση του θεραπευτικού αποτελέσματος.


2013 ◽  
Vol 19 (5) ◽  
pp. 569-575 ◽  
Author(s):  
Jun Jae Shin ◽  
Sang Hyun Kim ◽  
Yong Eun Cho ◽  
Samuel H. Cheshier ◽  
Jon Park

Object Several controversial issues arise in the management of unstable hangman's fractures. Some surgeons perform external reduction and immobilize the patient's neck in a halo vest, while others perform surgical reduction and internal fixation. The nonsurgical treatments with rigid collar or halo vest immobilization present problems, including nonunion, pseudarthrosis, skull fracture, and scalp laceration and may also fail to achieve anatomical realignment of the local C2–3 kyphosis. With recent advances in surgical technique and technology, surgical intervention is increasingly performed as the primary treatment in high cervical fractures. The outcomes of such surgeries are often superior to those of conservative treatment. The authors propose that surgical intervention as a primary management for hangman's fracture may avoid risks inherent in conservative management when severe circumferential discoligamentous instability is present and may reduce the risk of catastrophic results at the fracture site. The purposes of this study were to assess fracture healing following expedient reduction and surgical fixation and to propose a guideline for treatment of unstable hangman's fractures. Methods From April 2006 to December 2011, the authors treated 105 patients with high cervical fractures. This study included 23 (21.9%) of these patients (15 men and 8 women; mean age 46.4 years) with Type II, IIa, and III hangman's fractures according to the Levine and Edwards classification. The patient's age, sex, mechanism of injury, associated injuries, neurological status, and complications were ascertained. The authors retrospectively assessed the clinical outcome (Neck Disability Index), radiological findings (disc height, translation, and angulation), and bony healing. Results The average follow-up period was 28.9 months (range 12–63.2 months). The overall average Neck Disability Index score at the time of this study was 6.6 ± 2.3. The average duration of hospitalization was 20.3 days, and fusion was achieved in all cases by 14.8 ± 1.6 weeks after surgery, as demonstrated on dynamic radiographs and cervical 3D CT scans. The mean pretreatment translation was 6.9 ± 3.2 mm, and the mean postoperative translation was 1.6 ± 1.8 mm (mean reduction 5.2 ± 3.1 mm). The initial angulation was 4.7° ± 5.3° and the postoperative angulation was 2.5° ± 1.8° (mean reduction 6.1° ± 5.3°). The preoperative and postoperative values for translation and angulation differed significantly (p < 0.05). The overall C2–3 disc height was 6.7 ± 1.2 mm preoperatively, whereas 3 months after surgery it was 6.4 ± 1.1 mm. These values did not differ significantly (p = 0.0963). Conclusions The authors observed effective reduction and bony healing in cases of unstable hangman's fractures after fixation, and all patients experienced favorable clinical outcomes with neck pain improvement. The protocols allowed for physiological reconstruction of the fractured deformities and avoided external fixation. The authors suggest that posterior reduction and screw fixation should be used as a primary treatment to promote stability of hangman's fracture in the presence of discoligamentous instability or combined fractures.


Author(s):  
I Rezaei ◽  
M Razeghi ◽  
S Ebrahimi ◽  
S Kayedi ◽  
A Rezaeian Zadeh

Background: Despite the potential benefits of virtual reality technology in physical rehabilitation, only a few studies have evaluated the efficacy of this type of treatment in patients with neck pain.Objective: The aim of this study was to compare the effects of virtual reality training (VRT) versus conventional proprioceptive training (CPT) in patients with neck pain.Methods: Forty four participants with nonspecific chronic neck pain were randomly assigned to VRT or CPT in this assessor-blinded clinical trial. A novel videogame called Cervigame® was designed for VRT. It comprises of 50 stages divided into unidirectional and two-directional stages ordered from easy to hard. CPT consisted of eye-follow, gaze stability, eye-head coordination and position and movement sense training. Both groups completed 8 training sessions over 4 weeks. Visual analogue scale score, neck disability index and Y-balance test results were recorded at baseline, immediately after and 5 weeks post-intervention. Mixed repeated measure ANOVA was used to analyze differences between mean values for each variable at an alpha level of 0.05.Results: There were significant improvements in all variables in both groups immediately after and 5 weeks after the intervention. Greater improvements were observed in the visual analogue scale and neck disability index scores in VRT group, and the results for all directions in Y-balance test were similar in both groups. No side effects were reported.Conclusion: Improvements in neck pain and disability were greater in VRT than CPT group. Cervigame® is a potentially practical tool for rehabilitation in patients with neck pain.


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