Craniocervical Stabilization Using Luque&sol;Hartshill Rectangles

Abstract Unteated craniocervical instability is associated with a high morbidity and a significant mortality. Existing methods using bone grafts, interlaminar wires, or acrylic eventually produce stability but require prolonged periods of immobility and have a high failure rate. The ideal method of fixation should provide for permanent correction of deformity and relief of symptoms, with immediate stabilization, at a single procedure. Posterior fixation of the occiput to a stable part of the cervical spine with a molded metal rectangle held in place by interlaminar wires was used to accomplish this. We report 20 patients treated consecutively who have undergone craniocervical fusion by this method using Luque/Hartshill rectangles. Fourteen patients had preexisting atlantoaxial instability and 6 had cord compression, but would become unstable after decompression. All operations were performed under general anesthesia; 9 patients (40%) were awake for intubation/positioning, and 7 patients had a simultaneous decompression. Sixteen patients made an uncomplicated recovery and became mobile 3 days postoperatively. Symptomatic and neurological improvement occurred in 70% of all patients. Neurological complications occurred in 4 patients (20%), reflecting the serious nature of the condition; 2 patients (10%) showed no change. Scrutiny of their presentations and operations failed to identify avoidable risk factors, except faulty wiring techniques. In all patients, permanent stabilization was achieved immediately, facilitating early mobilization with a real chance of improvement, which indicates that the method merits wider application. (Neurosurgery 26:32-36, 1990)

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Atlantoaxial instability in Dyggve-Melchior-Clausen syndrome

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.1.0112 ◽

2002 ◽

Vol 96 (1) ◽

pp. 112-117 ◽

Cited By ~ 2

Author(s):

Frank Kandziora ◽

Luitgard Neumann ◽

Klaus John Schnake ◽

Cyrus Khodadadyan-Klostermann ◽

Stefan Rehart ◽

...

Keyword(s):

Screw Fixation ◽

Cord Compression ◽

Atlantoaxial Instability ◽

Posterior Fixation ◽

Content Type ◽

First Case ◽

Solid Fusion ◽

Specific Care ◽

Preventable Complication

✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to open his mouth sufficiently. Therefore, the patient underwent anterior transarticular screw fixation. Follow-up examination 36 weeks after surgery showed solid fusion without implant failure. In conclusion, treatment of atlantoaxial instability in DMC syndrome must be considered. Specific care must be taken to determine the course of the VA. If posterior and transoral fusion are impossible, anterior transarticular atlantoaxial screw fixation might be the only alternative.

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Cervical Spine Trauma Management

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.92 ◽

2018 ◽

Vol 1 (2) ◽

pp. 14

Author(s):

Rully Hanafi Dahlan ◽

Sevline Estethia Ompusunggu ◽

Farid Yudoyono

Keyword(s):

Spinal Cord ◽

Spinal Cord Injuries ◽

Early Mobilization ◽

Cord Compression ◽

Spinal Injuries ◽

Spine Injury ◽

Spine Trauma ◽

Neurological Improvement ◽

Operative Care ◽

Cord Injury

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital.Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (<72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI.In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre.

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Vertical mobile and reducible atlantoaxial dislocation

Journal of Neurosurgery Spine ◽

10.3171/2009.3.spine08927 ◽

2009 ◽

Vol 11 (1) ◽

pp. 9-14 ◽

Cited By ~ 50

Author(s):

Atul Goel ◽

Abhidha Shah ◽

Sanjay Rajan

Keyword(s):

Facet Joint ◽

Odontoid Process ◽

Causative Factor ◽

Basilar Invagination ◽

Atlantoaxial Dislocation ◽

Atlantoaxial Instability ◽

Posterior Fixation ◽

Neurological Improvement ◽

Cervical Traction ◽

King Edward Memorial Hospital

Object The authors' experience with treatment of 8 patients with “vertical mobile and reducible” atlantoaxial dislocation is reviewed. The probable pathogenesis, radiological and clinical features, and management issues in such cases are discussed. Methods Between January 2006 and March 2008, 8 patients who presented with vertical mobile and reducible atlantoaxial dislocations were treated at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. The vertical atlantoaxial dislocation/basilar invagination reduced completely on extension of the neck, with no need of any cervical traction. According to the extent of superior migration of the odontoid process, and measurements based on the vertical atlantoaxial instability index, the dislocation was graded as mild, moderate, or severe. All patients were treated using the C-1 lateral mass and C-2 pars plate and screw method of fixation. Results The study group was composed of 5 male and 3 female patients (mean age 24 years, age range 8–54 years). All patients presented with the physical features of short neck, torticollis, pain in the nape of the neck, and varying degrees of quadriparesis. In 6 patients there was a history of trauma prior to the onset of major neurological symptoms. The dislocation was mild in 3 cases, moderate in 1, and severe in 4. All patients had clinical neurological improvement following surgery. The follow-up duration ranged from 4 to 30 months (mean 18 months). Conclusions Vertical mobile and reducible atlantoaxial dislocation is a discrete clinical entity. Abnormal inclination and incompetence of the facet joint appears to be the primary causative factor that resulted in vertical dislocation or basilar invagination. Posterior fixation in the reduced dislocation position forms the basis of treatment.

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Craniocervical instability in children with Down’s syndrome

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors4371-77 ◽

2016 ◽

Vol 4 (3) ◽

pp. 71-77

Author(s):

Nikita O Khusainov ◽

Sergei V Vissarionov ◽

Dmitriy N Kokushin

Keyword(s):

Surgical Treatment ◽

Treatment Options ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Neurological Complications ◽

Neurological Deficits ◽

Medical Specialties ◽

Radiological Criteria ◽

Neurological Improvement ◽

Craniocervical Instability

Introduction. Pathology of the craniovertebral zone in children with Down’s syndrome is a very important topic, because of the high risk for developing neurological complications in these patients, after even a minor trauma.Material and methods. We performed a review of the literature highlighting the disorders of the cervical spine in children with Down’s syndrome.Results. We gathered data on the etiology, pathogenesis, and clinical presentation of craniocervical instability in children with Down’s syndrome. We reviewed the existing surgical treatment options, and presented our own clinical cases. We also developed a protocol for the management of these patients.Discussions. Understanding the several forms of craniocervical instability in children with Down’s syndrome is very important. As it is a very dangerous condition that can lead to devastating neurological deficits, all medical specialties working with these patients should be aware of them. There are clinical and radiological criteria for this condition that can help in the management of such patients. Surgical treatment is an effective option, but it has a high complication rate and rarely results in neurological improvement.

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Cervical Spine Trauma Management

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.59 ◽

2018 ◽

Vol 1 (2) ◽

Author(s):

Rully Hanafi Dahlan ◽

Sevline Estethia Ompusunggu ◽

Farid Yudoyono

Keyword(s):

Spinal Cord ◽

Spinal Cord Injuries ◽

Early Mobilization ◽

Cord Compression ◽

Spinal Injuries ◽

Spine Injury ◽

Spine Trauma ◽

Neurological Improvement ◽

Operative Care ◽

Cord Injury

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Scheuermann's Dorsal Kyphosis and Spinal Cord Compression: Case Report

Neurosurgery ◽

10.1227/00006123-198605000-00020 ◽

1986 ◽

Vol 18 (5) ◽

pp. 628-631 ◽

Cited By ~ 16

Author(s):

David M. Klein ◽

Richard L. Weiss ◽

James E. Allen

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Neurological Complications ◽

Cord Compression ◽

Posterior Fixation ◽

Childhood And Adolescence ◽

Disc Protrusion ◽

Scheuermann’S Disease ◽

Scheuermann's Disease ◽

Thoracic Disc

Abstract Although Scheuermann's disease (juvenile dorsal kyphosis) is a common problem of late childhood and adolescence, its potential for neurological complications is not widely appreciated. In rare instances, spinal cord compression appears to be produced by the kyphotic protrusion alone, and we present an example of this unusual problem. Although the results of surgical treatment in this situation cannot be substantiated, anterior spondylotomy and decompression followed by posterior fixation appear to offer the best mechanical relief. Spinal cord compression can also be produced by extradural cysts, with which Scheuermann's disease is frequently associated. Scheuermann's disease also is reported to occur in combination with thoracic disc protrusion, but the coincidence here may be random. Pertinent literature is reviewed.

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Paget's Cervical Disease with Spinal Cord Compression and Atlantoaxial Instability: Case Report

Skull Base ◽

10.1055/s-2007-984292 ◽

2007 ◽

Vol 17 (S 1) ◽

Author(s):

Enrico Tessitore

Keyword(s):

Spinal Cord ◽

Case Report ◽

Spinal Cord Compression ◽

Cord Compression ◽

Atlantoaxial Instability ◽

Cervical Disease

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Odontoid cervical gout causing atlantoaxial instability: case report

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18122 ◽

2019 ◽

Vol 30 (4) ◽

pp. 541-544

Author(s):

Justin Slavin ◽

Marcello DiStasio ◽

Paul F. Dellaripa ◽

Michael Groff

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Cord ◽

Case Report ◽

Physical Examination ◽

Odontoid Process ◽

Signs And Symptoms ◽

Cord Compression ◽

Atlantoaxial Instability ◽

Posterior Stabilization ◽

Rotatory Subluxation

The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.

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Epidural Lipomatosis Simulating an Epidural Abscess: Case Report and Literature Review

Neurosurgery ◽

10.1227/00006123-198711000-00029 ◽

1987 ◽

Vol 21 (5) ◽

pp. 744-747 ◽

Cited By ~ 23

Author(s):

Regis W. Haid ◽

Howard H. Kaufman ◽

Sydney S. Schochet ◽

Gary D. Marano

Keyword(s):

Spinal Cord ◽

Epidural Abscess ◽

Cord Compression ◽

Fatty Tissue ◽

Epidural Lipomatosis ◽

Neurological Improvement ◽

Computed Tomographic ◽

Dose Corticosteroid ◽

Staphylococcus Aureus Pneumonia ◽

And Staphylococcus Aureus

Abstract A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation. (Neurosurgery 21:744-747, 1987)

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Surgical Management and Outcome of Tuberculous Atlantoaxial Dislocation: A 15-year Experience

Neurosurgery ◽

10.1227/01.neu.0000043930.28934.fe ◽

2003 ◽

Vol 52 (2) ◽

pp. 331-339 ◽

Cited By ~ 48

Author(s):

Sanjiv Sinha ◽

Anil Kumar Singh ◽

Vikas Gupta ◽

Daljit Singh ◽

Masakazu Takayasu ◽

...

Keyword(s):

Early Mobilization ◽

Craniovertebral Junction ◽

Magnetic Resonance Images ◽

Atlantoaxial Dislocation ◽

Direct Access ◽

Posterior Fixation ◽

Radical Excision ◽

Histopathological Analysis ◽

X Rays ◽

Delay In Diagnosis

Abstract OBJECTIVE Tuberculous atlantoaxial dislocation is a rare disease entity. However, tuberculosis continues to be endemic in developing countries. Its earliest clinical presentation may be nonspecific, and delay in diagnosis may lead to irreversible neurological deficit. The management of tuberculous atlantoaxial dislocation includes ventral cervicomedullary decompression, occipitocervical arthrodesis, and administration of antituberculous medications. METHODS Eighteen patients with tuberculous atlantoaxial dislocation who presented with neck pain and/or occipital headache, restriction of neck movement, difficulty swallowing, and signs of myelopathy were studied. Four patients had evidence of associated pulmonary tuberculosis. Plain x-rays of the cervical spine, computed tomographic scans, and magnetic resonance images were obtained in all patients for diagnosis and to assess the degree of dislocation and cervicomedullary compression. Simultaneous anterior neural decompression, via a transcervical retropharyngeal approach, and posterior arthrodesis were performed on all patients while they remained under anesthesia. Antituberculous chemotherapy was continued for 18 months. RESULTS Histopathological analysis of excised tissue was consistent with tuberculosis in all patients. However, Ziehl-Neelsen staining for acid-fast bacilli was positive in two cases, and culture for Mycobacterium tuberculosis was negative in all patients. Patients with severe myelopathy experienced marked improvement. One patient died of fulminant resistant tuberculous meningitis. CONCLUSION The transcervical retropharyngeal approach to the craniovertebral junction provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity. It also prevents the development of persistent fistulae. Posterior stabilization should be performed directly after anterior neural decompression, while the patient remains under anesthesia, to prevent neurological deterioration before subsequent posterior fixation. This technique also is helpful for early mobilization of patients. The aim of surgical treatment should be to obtain biopsy tissue and to perform radical excision of epidural granulation tissue/abscess and infected bone using microsurgical technique. Antituberculous medication must be continued for 18 months with four drug regimens, and continuous monitoring of drug toxicity should be performed throughout the course of treatment.

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