Occipital Condyle Fractures

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A56-A59 ◽  
Author(s):  
Youssef R. Karam ◽  
Vincent C. Traynelis
Keyword(s):  
Computed Tomography ◽  
Clinical Presentation ◽  
Craniovertebral Junction ◽  
Diagnosis And Treatment ◽  
Occipital Condyle ◽  
Occipitocervical Fusion ◽  
Radiologic Evaluation ◽  
Serious Injury ◽  
Occipital Condyle Fractures ◽  
Prompt Diagnosis

Abstract OBJECTIVE The anatomy, clinical presentation, radiologic evaluation, treatment, and outcome of occipital condyle fractures are reviewed. METHODS We review and discuss the literature on occipital condyle fractures. RESULTS Occipital condyle fractures are best diagnosed with computed tomography. The neurologic presentation is variable. The majority of these injuries may be treated nonoperatively, but an occipitocervical fusion is necessary to restore stability across the craniovertebral junction. CONCLUSION Occipital condyle fractures are a rare but serious injury that requires prompt diagnosis and treatment.

Occipital condyle fractures: clinical presentation and imaging findings in 76 patients

2005 ◽  
Vol 11 (6) ◽  
pp. 342-347 ◽  
Author(s):  
Joseph M. Aulino ◽  
Leslie K. Tutt ◽  
Jeremy J. Kaye ◽  
Philip W. Smith ◽  
John A. Morris
Keyword(s):  
Clinical Presentation ◽  
Occipital Condyle ◽  
Imaging Findings ◽  
Occipital Condyle Fractures

scholarly journals Occipital Condyle Fracture: A Case Report of a Typically Stable Fracture That Required Surgical Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Takeshi Suzuki ◽  
Satoshi Maki ◽  
Masaaki Aramomi ◽  
Tomonori Yamauchi ◽  
Manato Horii ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Facet Joint ◽  
Atlantoaxial Instability ◽  
Occipital Condyle ◽  
Asian Woman ◽  
Atlantoaxial Joint ◽  
Occipitocervical Fusion ◽  
Occipital Condyle Fracture ◽  
Condyle Fracture

An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2.0 mm) and C1-C2 translation treated with a halo vest and occipitocervical fusion surgery. An 87-year-old Asian woman fell from a 4-meter height and hit her head. She was transferred to our emergency room. Computed tomography revealed a nondisplaced impaction OCF with a 2.5 mm occipital condyle-C1 interval and a 5 mm C1-C2 translation. The fracture pattern was considered stable. However, since craniocervical misalignment and C1-C2 translation were present, the patient was placed in a halo device, and we reduced the occipitoatlantoaxial joint, adjusting the halo ring position preoperatively. Confirming reduction of the atlantooccipital facet joint and the atlantoaxial joint by computed tomography, we performed an occipitocervical fusion. This is the first report of a nondisplaced OCF with craniocervical misalignment and C1-C2 translation that required surgical treatment. Clinicians should be aware of craniocervical misalignment and atlantoaxial instability even in Tuli type 1 OCFs.

scholarly journals Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

2021 ◽  
Vol 12 ◽  
pp. 524
Author(s):  
Enyinna Nwachuku ◽  
Confidence Njoku-Austin ◽  
Kevin P. Patel ◽  
Austin W. Anthony ◽  
Aditya Mittal ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Collar ◽  
Occipital Condyle ◽  
Type I ◽  
Occipitocervical Fusion ◽  
Orthopedic Injury ◽  
Trauma Population ◽  
Cervical Orthosis ◽  
Cervical Spine Fractures ◽  
Occipital Condyle Fractures

Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

Lateral Transcondylar Approach for Tumors at the Anterior Aspect of the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A104-A112 ◽  
Author(s):  
Chandranath Sen ◽  
Raj Shrivastava ◽  
Shuman Anwar ◽  
Aymara Triana
Keyword(s):  
Nerve Palsy ◽  
Tumor Resection ◽  
Complete Removal ◽  
Craniovertebral Junction ◽  
Occipital Condyle ◽  
Occipitocervical Fusion ◽  
Presenting Symptoms ◽  
Transcondylar Approach ◽  
Age Range ◽  
Headache And Neck Pain

Abstract BACKGROUND Tumors at the craniovertebral junction are difficult to remove because of their location and complex anatomic relations. The lateral transcondylar approach is a versatile approach to this area and allows access to a variety of intra- and extradural tumors. The lateral transcondylar approach has been used for a series of chordomas in this location. OBJECTIVE The nuances of this operation and its effectiveness in this group of patients are presented. METHODS There were 29 chordomas (1991–2007) in this region treated by one of the authors (CS) that were retrospectively reviewed. The imaging studies and medical records were evaluated. The location and extent of the tumor were defined, and the postoperative images were studied to determine the degree of resection. RESULTS There were 11 male and 18 female patients; their age range was 7 to 67 years. Headache and neck pain were the predominant presenting symptoms, and hypoglossal nerve palsy was the most common cranial nerve palsy. Twelve patients had previous surgery and 9 had previous radiation. Anterior midline and lateral approaches were used independently or in combination to treat these patients. Dural invasion was found in 27 patients requiring resection of the dura. Surgery was performed in 1 stage in 19 patients, and the tumor resection in the remaining patients was done in 2 stages. The lateral transcondylar approach was used in 19 patients. The occipital condyle was involved in all these patients. Radical tumor resection was achieved in 17 patients. Patients who had complete removal of the occipital condyle required occipitocervical fusion (20 patients) in the immediate postoperative period. CONCLUSION The lateral transcondylar approach is an effective approach to chordomas in this region. Most of the tumors were large and extended into multiple anatomic compartments. The approach allowed resection of all the involved tissues, intra- and extracranial, and afforded excellent neurovascular control.

scholarly journals Splenic abscess after laparoscopic sleeve gastrectomy. A rare complication—case report and literature review

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Esam Batayyah ◽  
Waed Yaseen ◽  
Faris Alshareef
Keyword(s):  
Computed Tomography ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Clinical Presentation ◽  
Rare Complication ◽  
Splenic Abscess ◽  
Definitive Treatment ◽  
Gastric Fistula ◽  
Upper Gastrointestinal ◽  
Prompt Diagnosis

Abstract Laparoscopic sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. Its rareness and nonspecific clinical presentation could make the diagnosis difficult and could be easily confused with leak and subdiaphragmatic abscess. A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation. Computed tomography of abdomen revealed a large splenic abscess, upper gastrointestinal studies were unremarkable. Patient was taken for laparoscopic exploration with finding of splenic abscess and gastric fistula, splenectomy and clipping of fistula was performed. The management of splenic abscess remains controversial. Splenectomy and antibiotics have generally been the definitive treatment particularly with large multilobulated collection. Familiarity with the rare complications as splenic abscess will allow for a prompt diagnosis and treatment.

Occipital condyle fractures: clinical decision rule and surgical management

2009 ◽  
Vol 11 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Matthew B. Maserati ◽  
Bradley Stephens ◽  
Zohny Zohny ◽  
Joon Y. Lee ◽  
Adam S. Kanter ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Cervical Collar ◽  
Classification Systems ◽  
Ct Scans ◽  
Occipital Condyle ◽  
Neural Element ◽  
Spine Trauma ◽  
Occipitocervical Fusion ◽  
Occipital Condyle Fractures

Object Occipital condyle fractures (OCFs) are rare injuries and their treatment remains controversial. Several classification systems have been proposed, first by Anderson and Montesano and more recently by Tuli and colleagues and Hanson and associates, who sought to stratify these fractures in a manner that would guide treatment that has typically ranged from semirigid collar immobilization to halo fixation or occipitocervical fusion. It has been the authors' impression, based on experience with OCFs at their institution, that classification is cumbersome and contributes little to the clinical decision-making process, while the identification of craniocervical misalignment and neural element compromise is paramount, and sufficient, for the planning of treatment. Methods The authors performed a retrospective review of 24,745 consecutive trauma presentations to a single Level I trauma center (UPMC Presbyterian Hospital) over a 6-year period, identifying 100 patients with 106 OCFs. All patients were evaluated by the spine trauma service and underwent imaging of the craniocervical junction using reconstructed CT scans. Patient characteristics, fracture characteristics (including fracture classification according to the 2 major classification systems), initial management, and status at follow-up were recorded. Results The incidence of OCF in this trauma population was 0.4%. Two patients had evidence of craniocervical misalignment on reconstructed CT imaging at the time of admission; both patients underwent occipitocervical fusion. One patient underwent occipitocervical fusion for unrelated C1–2 fractures. The remainder of those surviving to discharge, whose fractures represented all fracture subtypes, received treatment with a rigid cervical collar or counseling alone. No patients, including 4 patients with bilateral OCFs, were found to have developed delayed craniocervical instability or misalignment on follow-up, or to require further neurosurgical intervention for an OCF. Neural element compression was not identified in any of the patients, and there were no cases of delayed cranial neuropathy. Conclusions Beyond the identification of craniocervical misalignment on reconstructed CT scans at admission, further classification of OCFs is unnecessary. Management should consist of up-front occipitocervical fusion or halo fixation in cases demonstrating occipitocervical misalignment, or of immobilization in a rigid cervical collar followed by delayed clinical and radiographic evaluation in a spine trauma clinic if misalignment is not present.

scholarly journals An investigation of craniocervical stability post-condylectomy

2021 ◽  
Vol 12 ◽  
pp. 380
Author(s):  
Brian Fiani ◽  
Ryan Jarrah ◽  
Erika Sarno ◽  
Athanasios Kondilis ◽  
Kory Pasko ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Craniovertebral Junction ◽  
Surgical Approaches ◽  
Occipital Condyle ◽  
Neurosurgical Procedures ◽  
Occipitocervical Fusion ◽  
Surgical Access ◽  
Craniocervical Instability ◽  
Far Lateral ◽  
Occipital Condyles

Background: Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping. Methods: In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy. Results: The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy. Conclusion: Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.

scholarly journals Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 1: A clinical study

2016 ◽  
Vol 24 (6) ◽  
pp. 897-902 ◽  
Author(s):  
Luis Perez-Orribo ◽  
Laura A. Snyder ◽  
Samuel Kalb ◽  
Ali M. Elhadi ◽  
Forrest Hsu ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Ct Scanning ◽  
Japanese Orthopaedic Association Score ◽  
Craniovertebral Junction ◽  
Occipital Condyle ◽  
Injury Treatment ◽  
Occipital Condyle Fractures ◽  
Atlas Fractures ◽  
Transverse Atlantal Ligament ◽  
Lateral Diameter

OBJECTIVE Craniovertebral junction (CVJ) injuries complicated by transverse atlantal ligament (TAL) disruption often require surgical stabilization. Measurements based on the atlantodental interval (ADI), atlas lateral diameter (ALD1), and axis lateral diameter (ALD2) may help clinicians identify TAL disruption. This study used CT scanning to evaluate the reliability of these measurements and other variants in the clinical setting. METHODS Patients with CVJ injuries treated at the authors' institution between 2004 and 2011 were evaluated retrospectively for demographics, mechanism and location of CVJ injury, classification of injury, treatment, and modified Japanese Orthopaedic Association score at the time of injury and follow-up. The integrity of the TAL was evaluated using MRI. The ADI, ALD1, and ALD2 were measured on CT to identify TAL disruption indirectly. RESULTS Among the 125 patients identified, 40 (32%) had atlas fractures, 59 (47.2%) odontoid fractures, 31 (24.8%) axis fractures, and 4 (3.2%) occipital condyle fractures. TAL disruption was documented on MRI in 11 cases (8.8%). The average ADI for TAL injury was 1.8 mm (range 0.9–3.9 mm). Nine (81.8%) of the 11 patients with TAL injury had an ADI of less than 3 mm. In 10 patients (90.9%) with TAL injury, overhang of the C-1 lateral masses on C-2 was less than 7 mm. ADI, ALD1, ALD2, ALD1 – ALD2, and ALD1/ALD2 did not correlate with the integrity of the TAL. CONCLUSIONS No current measurement method using CT, including the ADI, ALD1, and ALD2 or their differences or ratios, consistently indicates the integrity of the TAL. A more reliable CT-based criterion is needed to diagnose TAL disruption when MRI is unavailable.

Occipital Condyle Fractures

Neurosurgery ◽  
1997 ◽  
Vol 41 (2) ◽  
pp. 368-377 ◽  
Author(s):  
Sagun Tuli ◽  
Charles H. Tator ◽  
Michael G. Fehlings ◽  
Margot Mackay
Keyword(s):  
Computed Tomography ◽  
Neck Pain ◽  
Retrospective Review ◽  
Cranial Nerve ◽  
Occipital Condyle ◽  
X Rays ◽  
Computed Tomographic ◽  
Ligamentous Instability ◽  
Displaced Fracture ◽  
Occipital Condyle Fractures

Abstract OBJECTIVE: Occipital condyle fractures (OCFs) are infrequently recognized. Three recent cases of OCF in our center prompted a review of the incidence, clinical presentation, diagnosis, and treatment of this entity. METHODS: A retrospective review of medical records and radiographic results was performed for 93 of 316 consecutive patients who were victims of trauma, who presented at the Toronto Hospital during a 13-month period, and who had undergone computed tomography of the occiput. RESULTS: A review of the literature regarding OCF revealed that cranial nerve deficits occurred in 31% of the patients with OCFs; of those, the deficits were delayed in 38%. Three new cases of OCF, with neck pain but without cranial nerve deficits, have been reported. The cervical spine x-rays revealed nothing abnormal in 96% of the reported cases. In our retrospective review, asymptomatic OCF was revealed by computed tomography for 1 of the 93 patients. CONCLUSION: OCF is a diagnostic challenge. We suggest that computed tomographic scans of 0-C2 be obtained in the following circumstances: presence of lower cranial nerve deficits, associated head injury or basal cranial fracture, or persistent severe neck pain despite normal radiographic results. We propose a new classification system for the management and treatment of OCF based on the stability of the 0-C1-C2 joint complex reflected by the presence of displacement of the condyle, computed tomographic or radiographic evidence of 0-C1-C2 instability, and magnetic resonance evidence of ligamentous injury. OCFs are divided into the following types: Type 1 (stable), undisplaced fracture; Type 2A (stable), displaced fracture with no ligamentous instability; and Type 2B (unstable), displaced fracture with ligamentous instability.

Three-Dimensional Computed Tomography in the Diagnosis of Vertebral Column Pathological Conditions

Neurosurgery ◽  
1987 ◽  
Vol 21 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Mark N. Hadley ◽  
Volker K. H. Sonntag ◽  
Rob M. Amos ◽  
John A. Hodak ◽  
Lynda J. Lopez
Keyword(s):  
Computed Tomography ◽  
Vertebral Column ◽  
Three Dimensional ◽  
Lumbar Vertebrae ◽  
Diagnostic Technique ◽  
Craniovertebral Junction ◽  
Diagnosis And Treatment ◽  
Computed Tomographic ◽  
Pathological Conditions ◽  
Valuable Adjunct

Abstract Three-dimensional computed tomographic scanning is a valuable adjunct in the diagnosis and treatment of disease processes involving the spine. We present our experience with this noninvasive radiological diagnostic technique in 32 patients with vertebral column abnormalities ranging from craniovertebral junction disorders to fractures of lumbar vertebrae. The three-dimensional CT images often demonstrate pathological conditions and occult lesions that are not adequately defined by conventional radiographic means.

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