Anterolateral C1–C2 Transarticular Fixation for Atlantoaxial Arthrodesis: Landmarks, Working Area, and Angles of Approach

2010 ◽  
Vol 67 (3) ◽  
pp. ons38-ons42 ◽  
Author(s):  
Daniel D. Cavalcanti ◽  
Abhishek Agrawal ◽  
Ulises Garcia-Gonzalez ◽  
Neil R. Crawford ◽  
Paulo L.M.S. Tavares ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Cervical Region ◽  
Atlantoaxial Instability ◽  
Anterolateral Approach ◽  
Upper Cervical Spine ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Ramus Communicans ◽  
Transarticular Fixation ◽  
Atlantoaxial Arthrodesis

Abstract BACKGROUND: An alternative route must be used for atlantoaxial arthrodesis to avoid the risks of transoral route or when posterior approaches are contraindicated. OBJECTIVE: To assess relevant quantitative anatomic parameters for C1–C2 anterolateral transarticular fixation and to demonstrate the nuances of an anterolateral approach to the upper cervical spine. METHODS: Five cadaveric necks were dissected bilaterally to demonstrate anatomic landmarks and surgical technique. The C2 pars interarticularis was used as the entry for inserting screws toward the C1 lateral mass. Ten computed tomography scans were analyzed to quantify working area and optimal angles of approach. RESULTS: The medial surface of sternocleidomastoid muscle was dissected extensively but not divided. The C2 transverse process was a landmark for guiding dissection posterior to the carotid sheath. In all specimens, the gray ramus communicans from the superior cervical ganglion to the C2 nerve was a landmark for locating the C2 pars. Slightly below that branch, the longus capitis muscle could be displaced medially to reach the C2 pars. The ideal angles for screw placement were 22.9 ± 5.7° medial to the sagittal plane and 25.3 ± 7.4° posterior to the coronal plane. The mean working area was 71.2 mm2 (range, 49–103 mm2). CONCLUSION: We propose a new anterolateral stabilization technique for atlantoaxial instability based on less traumatic dissection of the upper cervical region, different instrumentation, and guidance by reliable landmarks. For anterolateral transarticular C1–C2 screw fixation, the gray ramus communicans to the C2 nerve is a reliable landmark for locating the entry for a screw on the C2 pars.

Anterolateral approach to the upper cervical spine: Case report and operative technique

Head & Neck ◽  
2015 ◽  
Vol 37 (9) ◽  
pp. E115-E119 ◽  
Author(s):  
Yohan Song ◽  
Suzanne Tharin ◽  
Vasu Divi ◽  
Laura M. Prolo ◽  
Davud B. Sirjani
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Operative Technique ◽  
Anterolateral Approach ◽  
Upper Cervical Spine ◽  
Upper Cervical ◽  
Spine Case

Fractures of the C-2 vertebral body

1994 ◽  
Vol 81 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Body Fracture ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Type 3 ◽  
Fine Print

✓ Vertical C-2 body fractures are presented in 15 patients with clinical and imaging correlations that suggest the existence of a variety of mechanisms of injury. In these patients, clinical and imaging correlations were derived by: 1) defining the point of impact by clinical examination; 2) defining the point of impact by soft-tissue changes on cranial magnetic resonance (MR) imaging or computerized tomography (CT); 3) obtaining an accurate history of the mechanism of injury; and 4) spine imaging (x-ray studies, CT, and MR imaging) of the C-2 body fracture and surrounding bone and soft tissue. The cases presented involve the region located between the dens and the pars interarticularis of the axis. Although these fractures are rarely reported, they are not uncommon. An elucidation of their pathological anatomy helps to further the understanding of the mechanistic etiology of upper cervical spine trauma. A spectrum of mechanisms of injury causing upper cervical spine fractures was observed. The type of injury incurred is determined predominantly by the force vector applied during impact and the intrinsic strength and anatomy of C-2 and its surrounding spinal elements. From this clinical experience, two types of vertical C-2 body fractures are defined and presented: coronally oriented (Type 1) and sagittally oriented (Type 2). A third type of C-2 body fracture, the horizontal rostral C-2 fracture (Type 3), is added for completeness; this Type 3 fracture is the previously described Type III odontoid process fracture described by Anderson and D'Alonzo.

MOBILITY OF THE UPPER CERVICAL SPINE IN HEALTH AND DISEASE

PEDIATRICS ◽  
1952 ◽  
Vol 10 (5) ◽  
pp. 567-574
Author(s):  
EDWARD H. TOWNSEND ◽  
M. LAURENS ROWE
Keyword(s):  
Cervical Spine ◽  
Muscle Spasm ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Upper Respiratory Infection ◽  
Erroneous Diagnosis ◽  
Upper Cervical ◽  
Health And Disease ◽  
Cervical Subluxation ◽  
Upper Respiratory

Four cases of cervical "subluxation" have been presented due to muscle spasm in the cervical region, which occurred during an upper respiratory infection. This syndrome differs from the atlanto-axial subluxation. Roentgenograms in the diagnosis of this condition may lead to erroneous diagnosis and treatment. The normal anatomic and functional ranges of the cervical spine were studied and are discussed. The degree of mobility of the cervical spine is greater than previously assumed.

scholarly journals Upper cervical spine fusion in the pediatric population

1997 ◽  
Vol 3 (3) ◽  
pp. E1 ◽  
Author(s):  
David W. Lowry ◽  
Ian F. Pollack ◽  
Brent Clyde ◽  
A. Leland Albright ◽  
P. David Adelson
Keyword(s):  
Pediatric Population ◽  
Young Patients ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Spinal Instability ◽  
Upper Cervical Spine ◽  
Upper Cervical ◽  
Initial Procedure ◽  
Pin Site ◽  
Cervical Spine Fusion

The outcomes of 25 pediatric patients who underwent upper cervical or occipitocervical fusion at the authors' institution since 1983 were reviewed. At a mean age of 9 years, the patients presented with spinal instability that was associated with os odontoideum in 11 cases, rotatory subluxation in five cases, odontoid fracture in two cases, atlantooccipital dislocation in two cases, and congenital atlantoaxial instability in five patients, four of whom had Down's syndrome (trisomy 21). Ten children had abnormal findings on neurological examination preoperatively; however, nine experienced improvement or resolution of deficits as of their latest follow-up evaluation (mean 17 months). Fusion was achieved with the first operation in 21 of 25 patients; eventually it was attained in all but one. Four patients exhibited persistent spinal instability after an initial procedure. This was caused by erosion of a multistranded cable through the intact arch of C-2 in two cases, by pin site infection necessitating early halo removal in one case, and by slippage in a halo following a Gallie procedure, which was revised with a Brooks fusion in one case. This series, the largest yet published, shows that with appropriate surgical management, posterior upper cervical fusion in the pediatric population is highly successful. Careful attention to halo pin site care and caution in using multistranded cable in young patients may improve results.

scholarly journals Occipitalization of Atlas: A Case Report with its Ontogenic Basis and Review of Literature

2017 ◽  
Vol 1 (1) ◽  
pp. 34-37
Author(s):  
Sanjay Piplani ◽  
JS Kullar
Keyword(s):  
Case Report ◽  
Cervical Vertebrae ◽  
Clinical Importance ◽  
Signs And Symptoms ◽  
Craniocervical Junction ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Review Of Literature ◽  
Flexion Extension ◽  
Upper Cervical

ABSTRACT Introduction Anatomy of the cervical vertebrae allows free flexion, extension, and rotation, which take place almost entirely in the first two cervical vertebrae. Variation in the articulation of upper cervical spine-like congenital fusion of the atlas to the base of the occiput, i.e., occipitalization of the atlas, is one of the common skeletal abnormalities. Such variations will produce irregular motion and at times a definite instability of the joint involved. Conclusion Considering the nature and functional importance of the joints in relation to these bones, the resulting disability is one of the rare occurrences and deserves special attention. Such patients exhibit neurological signs and symptoms usually no sooner than the second decade. Thus, anatomy, variations, and anomalies of the craniocervical junction are of high clinical importance to many specialties like anatomists, neurosurgeons, radiologists, and manipulative therapists, as they markedly influence mobility and stability of the cervical region. How to cite this article Lalit M, Piplani S, Mahajan A, Kullar JS. Occipitalization of Atlas: A Case Report with its Ontogenic Basis and Review of Literature. Curr Trends Diagn Treat 2017;1(1):34-37.

Tension and Combined Tension-Extension Structural Response and Tolerance Properties of the Human Male Ligamentous Cervical Spine

2009 ◽  
Vol 131 (8) ◽  
Author(s):  
Alan T. Dibb ◽  
Roger W. Nightingale ◽  
Jason F. Luck ◽  
V. Carol Chancey ◽  
Lucy E. Fronheiser ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Sagittal Plane ◽  
Model Development ◽  
Structural Response ◽  
Tensile Load ◽  
Beam Theory ◽  
Head Rotation ◽  
Tensile Loading ◽  
Upper Cervical Spine ◽  
Upper Cervical

Tensile loading of the human cervical spine results from noncontact inertial loading of the head as well as mandibular and craniofacial impacts. Current vehicle safety standards include a neck injury criterion based on beam theory that uses a linear combination of the normalized upper cervical axial force and sagittal plane moment. This study examines this criterion by imposing combined axial tension and bending to postmortem human subject (PMHS) ligamentous cervical spines. Tests were conducted on 20 unembalmed PMHSs. Nondestructive whole cervical spine tensile tests with varying cranial end condition and anteroposterior loading location were used to generate response corridors for computational model development and validation. The cervical spines were sectioned into three functional spinal segments (Occiput-C2, C4-C5, and C6-C7) for measurement of tensile structural response and failure testing. The upper cervical spine (Occiput-C2) was found to be significantly less stiff, absorb less strain energy, and fail at higher loads than the lower cervical spine (C4-C5 and C6-C7). Increasing the moment arm of the applied tensile load resulted in larger head rotations, larger moments, and significantly higher tensile ultimate strengths in the upper cervical spine. The strength of the upper cervical spine when loaded through the head center of gravity (2417±215 N) was greater than when loaded over the occipital condyles (2032±250 N), which is not predicted by beam theory. Beam theory predicts that increased tensile loading eccentricity results in decreased axial failure loads. Analyses of the force-deflection histories suggest that ligament loading in the upper cervical spine depends on the amount of head rotation orientation, which may explain why the neck is stronger in combined tension and extension.

Optimal Fusion Configuration Following C2 Corpectomy

2009 ◽  
Author(s):  
Justin K. Scheer ◽  
John Equizabal ◽  
Jovauna M. Currey ◽  
Jenni M. Buckley ◽  
R. T. McClellan ◽  
...  
Keyword(s):  
Structural Integrity ◽  
Surgical Intervention ◽  
Cervical Vertebrae ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Mechanical Instability ◽  
Common Location ◽  
Upper Cervical ◽  
Optimal Fusion ◽  
Base Of The Skull

The upper cervical spine is a common location for metastatic tumors, which often necessitate surgical intervention to prevent neurological compromise [1]. Removal of the tumor often requires partial or complete resection of cervical vertebrae and therefore causes substantial mechanical instability in the cervical region [2]. Structural integrity is restored by fusion of the base of the skull to C5 using various spinal hardware, including cages and posterior screw-rod constructs. Due to the proximity of the spinal cord and vertebral arteries, these procedures have high associated morbidity and mortality, and the biomechanical necessity of more risky procedures, e.g., additional cages replacing the lateral masses of C2, in order to achieve sufficient rigidity has not been evaluated. Thus, the goal of this study is to determine the optimal fusion configuration following C2 corpectomy that maximized segmental rigidity while minimizing risk to the patient.

scholarly journals Upper Cervical Compression Myelopathy Caused by the Retro-Odontoid Pseudotumor With Degenerative Osteoarthritis and Calcium Pyrophosphate Dihydrate Disease: A Case Report and Literature Review

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 903-913
Author(s):  
Takashi Yurube ◽  
Tetsuhiro Iguchi ◽  
Keisuke Kinoshita ◽  
Takashi Sadamitsu ◽  
Kenichiro Kakutani
Keyword(s):  
Case Report ◽  
Dynamic Instability ◽  
Calcium Pyrophosphate ◽  
Atlantoaxial Instability ◽  
Upper Cervical Spine ◽  
Calcium Pyrophosphate Dihydrate ◽  
Crystal Deposition ◽  
Upper Cervical ◽  
Pyrophosphate Dihydrate ◽  
Compression Myelopathy

The retro-odontoid pseudotumor is often concurrent with atlantoaxial subluxation (AAS). Therefore, the pseudotumor is relatively common in rheumatoid arthritis (RA) but rare in primary osteoarthritis (OA). This is a case report of an elderly male patient suffering from neck pain and compression myelopathy caused by the craniocervical pseudotumor with OA but without atlantoaxial instability. He had long-lasting peripheral and spinal pain treated by nonsteroidal anti-inflammatory drugs. Imaging found upper cervical spondylosis without AAS or dynamic instability but with periodontoid calcifications and ossifications, suggesting calcium pyrophosphate dihydrate (CPPD) crystal deposition. Based on a comprehensive literature search and review, CPPD disease around the atlantodental joint is a possible contributor to secondary OA development and retro-odontoid pannus formation through chronic inflammation, which can be enough severe to induce compression myelopathy in non-RA patients without AAS. The global increase in the aged population advises caution regarding more prevalent upper cervical spine disorders associated with OA and CPPD.

scholarly journals Anatomy and clinical relevance of sub occipital soft tissue connections with the dura mater in the upper cervical spine

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9716
Author(s):  
Rob Sillevis ◽  
Russell Hogg
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cadaver Study ◽  
Cervicogenic Headache ◽  
Passive Movement ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Posterior Aspect ◽  
Upper Cervical ◽  
Nuchal Ligament

Background The upper cervical region is a complex anatomical structure. Myodural bridges between posterior suboccipital muscles and the dura might be important explaining conditions associated with the upper cervical spine dysfunction such as cervicogenic headache. This cadaver study explored the upper cervical spine and evaluated the myodural bridges along with position of spinal cord in response to passive motion of upper cervical spine. Methods A total of seven adult cadavers were used in this exploratory study. The suboccipital muscles and nuchal ligament were exposed. Connections between the Rectus Capitis Posterior major/minor and the Obliquus Capitis minor, the nuchal ligament, posterior aspect of the cervical spine, flavum ligament and the dura were explored and confirmed with histology. The position of the spinal cord was evaluated with passive motions of the upper cervical spine. Outcomes In all cadavers connective tissues attaching the Rectus Capitis Posterior Major to the posterior atlanto-occipital membrane were identified. In the sagittal dissection we observed connection between the nuchal ligament and the dura. Histology revealed that the connection is collagenous in nature. The spinal cord moves within the spinal canal during passive movement. Discussion The presence of tissue connections between ligament, bone and muscles in the suboccipital region was confirmed. The nuchal ligament was continuous with the menigiovertebral ligament and the dura. Passive upper cervical motion results in spinal cord motion within the canal and possible tensioning of nerve and ligamentous connections.

scholarly journals Orofacial myofunctional disorders in children with asymmetry of the posture and locomotion apparatus

2005 ◽  
Vol 31 (1) ◽  
pp. 26-38
Author(s):  
Heike Korbmacher ◽  
◽  
Lutz Koch ◽  
Bärbel Kahl-Nieke
Keyword(s):  
Cervical Spine ◽  
Vertebral Column ◽  
Head Position ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Adequate Treatment ◽  
Upper Cervical ◽  
Tongue Dysfunction ◽  
Orofacial Region ◽  
Articulation Disorders

352 children radiologically identified with asymmetry in the occipito-cervical region were assessed on a number of myofunctional measures. In all children an orthopedic examination was conducted including a functional test of the upper cervical spine and the iliac joint, the postural test by Matthiass, as well as gait analysis. During a second examination the orofacial myofunctional status was recorded. In general, about 70% of the children revealed orofacial myofunctional disorders. Correlational analysis was conducted in order to determine whether specific myofunctional variables were associated with postural and orthopedic alterations. A weak body posture correlated statistically significantly with all assessed myofunctional variables. On the other hand, all orthopedic items correlated significantly with a reclined head position. A blockade of the iliac spine correlated significantly with persistent habits, articulation disorders and tongue dysfunction, whereas functional asymmetry of the upper cervical spine correlated significantly with incompetent lips. A finding of at least five statistically significant correlations within each orofacial variable underlined the complex symptomatology of myofunctional disorders, so that consideration needs to be given to adequate treatment approaches. The data generated by the present study stress the importance of early interdisciplinary screening in children to ensure a physiological development of the orofacial region and the still growing vertebral column. To help understand the complexity of symptoms influencing orofacial development, an explanatory model of the “interactive functional box system” is given.

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