Syringomyelia From Extramedullary Compression: Resolution After Microsurgical Resection of a High-Cervical Spine Schwannoma: 2-Dimensional Operative Video

We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR). Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

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The Application of Endoscopic Technique in High Cervical Anterior Approach to the Craniovertebral Junction

10.21203/rs.3.rs-133410/v1 ◽

2020 ◽

Author(s):

Jiangtao Liu ◽

Hongming Ji ◽

Gangli Zhang ◽

Shengli Chen ◽

Shiyuan Zhang ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Anterior Approach ◽

Craniovertebral Junction ◽

Close Proximity ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Surgical Corridor ◽

High Cervical ◽

Neurovascular Structures

Abstract Objectives: Surgery on the craniovertebral junction (CVJ) presents particular challenges owing to the close proximity of critical neurovascular structures and the brainstem. It is difficult for classic approaches to obtain the extra exposure of neurovascular structures of the CVJ in practice.The surgical approach to the craniovertebral junction (CVJ) offers specific challenges. We explored the feasibility of an endoscope-assisted high anterior cervical approach to the CVJ. Methods: We quantitatively assessed the surgical corridor to, and extent of exposure of, the CVJ in six cadaveric specimens, using 0° and 30° endoscopes. Results: The endoscope provided sufficient exposure of neurovascular structures and the brainstem in the CVJ. Resection of the anterior arch of C1 was avoided in minimal anterior clivectomy. After removing the odontoid, greater exposure of the CVJ was obtained. Conclusion: An endoscope-assisted high anterior cervical approach to the CVJ preserves cervical spine stability while minimizing the risk of neurovascular injury within the surgical corridor.

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Accuracy and Safety in Screw Placement in the High Cervical Spine

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000813 ◽

2019 ◽

Vol 32 (4) ◽

pp. E193-E199 ◽

Cited By ~ 3

Author(s):

Jung-Woo Hur ◽

Jin-Sung Kim ◽

Kyeong-Sik Ryu ◽

Myeong-Hoon Shin

Keyword(s):

Cervical Spine ◽

Screw Placement ◽

High Cervical

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The C2 Cortical Screw, an Alternative Fixation Technique for the C2 Segment During High Cervical Spine Surgery: Technical Note

World Neurosurgery ◽

10.1016/j.wneu.2020.06.160 ◽

2020 ◽

Vol 142 ◽

pp. 24-28

Author(s):

Gang-Un Kim ◽

Gun Woo Lee

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Technical Note ◽

Fixation Technique ◽

Cervical Spine Surgery ◽

Cortical Screw ◽

Alternative Fixation ◽

High Cervical

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Assessment and Diagnosis of Trauma in the High Cervical Spine Using Dissection, Radiography, Computed Tomography and Magnetic Resonance Imaging

Academic Forensic Pathology ◽

10.23907/2014.069 ◽

2014 ◽

Vol 4 (4) ◽

pp. 532-544

Author(s):

Vivian S. Snyder ◽

Evan W. Matshes

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Resonance Imaging ◽

High Cervical ◽

Assessment And Diagnosis

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Atlanto-axial rotational limitation secondary to osteoid osteoma of the axis

Journal of Neurosurgery ◽

10.3171/jns.1989.70.1.0129 ◽

1989 ◽

Vol 70 (1) ◽

pp. 129-131 ◽

Cited By ~ 6

Author(s):

Michael N. Bucci ◽

John A. Feldenzer ◽

William A. Phillips ◽

Stephen S. Gebarski ◽

Robert C. Dauser

Keyword(s):

Cervical Spine ◽

Physical Therapy ◽

Osteoid Osteoma ◽

Unusual Case ◽

Clinical Symptoms ◽

Transoral Approach ◽

Content Type ◽

Microsurgical Resection ◽

Fine Print

✓ An unusual case of atlanto-axial rotational limitation secondary to an osteoid osteoma of the axis is presented. Transoral microsurgical resection followed by physical therapy improved the clinical symptoms. This case illustrates several unique problems within the cervical spine as well as the efficacy of the transoral approach to the axis.

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Influence of Axial Load and a 45-Degree Flexion Head Position on Cervical Spinal Stiffness in Healthy Young Adults

Frontiers in Physiology ◽

10.3389/fphys.2021.786625 ◽

2021 ◽

Vol 12 ◽

Author(s):

Léonie Hofstetter ◽

Melanie Häusler ◽

Petra Schweinhardt ◽

Ursula Heggli ◽

Denis Bron ◽

...

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Axial Load ◽

Head Position ◽

Good Reliability ◽

Head Posture ◽

Work Related ◽

Spinal Stiffness ◽

Proxy Measure ◽

High Cervical

Background: Neck pain is a major cause of disability worldwide. Poor neck posture such as using a smartphone or work-related additional cervical axial load, such headgear of aviators, can cause neck pain. This study aimed at investigating the role of head posture or additional axial load on spinal stiffness, a proxy measure to assess cervical motor control.Methods: The posterior-to-anterior cervical spinal stiffness of 49 young healthy male military employees [mean (SD) age 20 ± 1 years] was measured in two head positions: neutral and 45-degree flexed head position and two loading conditions: with and without additional 3 kg axial load. Each test condition comprised three trials. Measurements were taken at three cervical locations, i.e., spinous processes C2 and C7 and mid-cervical (MC).Results: Cervical spinal stiffness measurements showed good reliability in all test conditions. There was a significant three-way interaction between location × head position × load [F(2, 576) = 9.305, p < 0.001]. Significant two-way interactions were found between measurement locations × loading [F(2, 576) = 15.688, p < 0.001] and measurement locations × head position [F(2, 576) = 9.263, p < 0.001]. There was no significant interaction between loading × head position [F(1, 576) = 0.692, p = 0.406]. Post hoc analysis showed reduction of stiffness in all three measurement locations in flexion position. There was a decrease in stiffness in C2 with loading, increase in stiffness in C7 and no change in MC.Discussion: A flexed head posture leading to decreased stiffness of the cervical spine might contribute to neck pain, especially if the posture is prolonged and static, such as is the case with smartphone users. Regarding the additional load, stiffness decreased high cervical and increased low cervical. There was no change mid cervical. The lower spinal stiffness at the high cervical spine might be caused by capsular ligament laxity due to the buckling effect. At the lower cervical spine, the buckling effect seems to be less dominant, because the proximity to the ribs and sternum provide additional stiffness.

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Intracranial Hypotension Headache Caused by a Massive Cerebrospinal Fluid Leak Successfully Treated with a Targeted C2 Epidural Blood Patch: A Case Report

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/399 ◽

2013 ◽

Vol 4;16 (4;7) ◽

pp. 399-404

Author(s):

Xiaobin Yi

Keyword(s):

Cerebrospinal Fluid ◽

Cervical Spine ◽

Intracranial Hypotension ◽

Epidural Blood Patch ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Csf Leak ◽

Blood Patch ◽

High Cervical ◽

Epidural Steroid

Cervical epidural steroid injections, administered either intralaminarly or transforaminally, are common injection therapies used in many interventional pain management practices to treat cervicalgia or cervicobrachial pain secondary to spondylosis or intervertebral disc displacement of the cervical spine. Among the risks associated with these procedures are the risk for inadvertent dural puncture and the development of positional headache from intracranial hypotension. We report the case of a 31-year-old woman with a history of migraine and cervicalgia from cervical spine spondylosis and cervical disc degenerative disease that developed an intractable orthostatic headache accompanied by nausea and vomiting after a therapeutic high cervical intralaminar epidural steroid injection was administered directly to the C1-C2 spinal level. Although the initial magnetic resonance imaging of the brain was unremarkable, a computed tomography myelogram study revealed a massive cerebrospinal fluid (CSF) leak from the cervical spine. Repeated cervical epidural blood patches using a catheter targeted to the high cervical spine (C2) to inject 15 mL of autologous blood was required to totally alleviate her symptoms after she failed conservative therapy. Determining the optimal location or approach to administer an epidural blood patch can be a challenge depending on the location of the CSF leak. Our case demonstrates that targeted cervical epidural blood patch placement using an easily manipulated catheter under fluoroscopic guidance is a safe and effective approach to treat a massive CSF leak in the high cervical spine region caused by prior therapeutic cervical spine epidural steroid injection. Key words: Cervical epidural blood patch, intracranial hypotension, intracranial hypotension headache, spinal headache, orthostatic headache, epidural steroid injection, cerebrospinal fluid leak, post dural headache

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High cervical spine spondylodiscitis management and literature review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.01.18 ◽

2017 ◽

Vol 63 (1) ◽

pp. 18-20 ◽

Cited By ~ 5

Author(s):

André Luis Sebben ◽

◽

Xavier Soler Graells ◽

Marcel Luiz Benato ◽

Pedro Grein Del Santoro ◽

...

Keyword(s):

Cervical Spine ◽

Unusual Case ◽

Epidural Abscess ◽

Cord Compression ◽

Neurological Deficits ◽

Osteolytic Lesions ◽

Double Approach ◽

The Subject ◽

High Cervical ◽

Unusual Type

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

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