Detailed observation of axis ring fractures using computed tomography: a retrospective analysis of 202 cases

Abstract Background: There is a dearth of research observing the precise anatomical location, pattern, and frequency of the fracture lines in axis ring fractures based on large size sample database and deducing the possible injury mechanism for such fractures. The study aimed to observe the anatomical features of axis ring fractures and evaluate the probable mechanism of injury.Methods: 202 patients with axis ring fractures were identified. According to the involvement of anatomical structures, the axis ring injuries were classified into facet joint injury and pure bony injury. The axis ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns of such fractures were observed using CT. Result: 501 anatomical structures of the axis ring were involved in 202 patients, including 288 facet joints injuries and 213 bony injuries. For facet joints injuries, the most common injuries were superior articular facet injuries, and for pure bony injuries, the most common injuries were pediculoisthmic component fractures. In regard to different element of the axis ring, the injuries of anterior element were more common than that of middle or posterior element. Most of (76.2%) axis ring fractures were asymmetrical, with different elements of the axis ring damaged on different side. Conclusion: In axis ring fractures, fracture lines could occur in any part of the ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were more common than that of middle or posterior element. The probable mechanism of such injuries might be hyperextension and axial load, with an additional rotational load.

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Localized cervical facet joint kinematics under physiological and whiplash loading

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.6.0471 ◽

2005 ◽

Vol 3 (6) ◽

pp. 471-476 ◽

Cited By ~ 46

Author(s):

Brian D. Stemper ◽

Narayan Yoganandan ◽

Thomas A. Gennarelli ◽

Frank A. Pintar

Keyword(s):

Facet Joint ◽

Human Head ◽

Facet Joints ◽

Synovial Joint ◽

Joint Injury ◽

Content Type ◽

Joint Motions ◽

Cervical Facet ◽

Cervical Facet Joint ◽

Fine Print

Object. Although facet joints have been implicated in the whiplash injury mechanism, no investigators have determined the degree to which joint motions in whiplash are nonphysiological. The purpose of this investigation was to quantify the correlation between facet joint and segmental motions under physiological and whiplash loading. Methods. Human cadaveric cervical spine specimens were exercise tested under physiological extension loading, and intact human head-neck complexes were exercise tested under whiplash loading to correlate the localized component motions of the C4–5 facet joint with segmental extension. Facet joint shear and distraction kinematics demonstrated a linear correlation with segmental extension under both loading modes. Facet joints responded differently to whiplash and physiological loading, with significantly increased kinematics for the same-segmental angulation. The limitations of this study include removal of superficial musculature and the limited sample size for physiological testing. Conclusions. The presence of increased facet joint motions indicated that synovial joint soft-tissue components (that is, synovial membrane and capsular ligament) sustain increased distortion that may subject these tissues to a greater likelihood of injury. This finding is supported by clinical investigations in which lower cervical facet joint injury resulted in similar pain patterns due to the most commonly reported whiplash symptoms.

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Intraoperative facet joint injury during anterior cervical discectomy and fusion: an experimental study

Journal of Neurosurgery Spine ◽

10.3171/spi-07/09/10/429 ◽

2007 ◽

Vol 7 (4) ◽

pp. 429-435 ◽

Cited By ~ 1

Author(s):

Parmenion Ph. Tsitsopoulos ◽

Christos Tsonidis ◽

Nikolaos Papaioannou ◽

Ioannis Venizelos ◽

Dimitra Psalla ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Surgical Intervention ◽

Facet Joint ◽

Radiological Examination ◽

Facet Joints ◽

Joint Injury ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Adjacent Structures

Object Disorders of the cervical spine can be successfully addressed by surgical intervention when the choice of such intervention takes into account the possible complications in the treated and adjacent structures. The aim of this study was to investigate the potential for intraoperative trauma in cervical zygapophysial joints and to describe possible pathological changes that may occur during cervical spine surgery. Methods Fifteen sheep underwent surgical intervention via an anterior cervical approach; discectomy at the C5–6 level was performed. In 10 animals, the discectomy was accompanied by titanium cage fusion. The sheep were killed immediately after completion of the operation. Radiological examination of the isolated cervical spines followed. Furthermore, the cervical spines were submitted to decalcification and incised using a microtome, and tissue sections were then studied using light microscopy. Results Radiological examination was used to assess vertebral alignment, vertebral body (VB) morphology, implant position, and endplate and facet joint gross morphology. Histological examination of the endplate and VB demonstrated degenerative lesions as well as cellular necrosis. The study of the facet joints at the treated as well as at adjacent segments (both above and below) revealed in some cases edema between the collagen fibers of the joint capsules, congestion, and microhemorrhages. Injuries were evident in animals in which the Caspar device was used. Conclusions Histopathologically confirmed lesions occurred in facet joints while anterior cervical spine surgery was being performed in sheep. The findings were indicative of trauma and, in the case of human spine surgery, could possibly account for several postoperative complications and patient complaints.

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Effect of CT-based attenuation correction on uptake ratios in skeletal SPECT

Nuklearmedizin ◽

10.1055/s-0037-1616624 ◽

2007 ◽

Vol 46 (01) ◽

pp. 38-42 ◽

Cited By ~ 12

Author(s):

V. Schulz ◽

I. Nickel ◽

A. Nömayr ◽

A. H. Vija ◽

C. Hocke ◽

...

Keyword(s):

Vertebral Body ◽

Facet Joint ◽

One Dimension ◽

Patient Specific ◽

Data Sets ◽

Facet Joints ◽

Lumbar Vertebral Body ◽

Ct System ◽

Ct Data ◽

Attenuation Corrected

SummaryThe aim of this study was to determine the clinical relevance of compensating SPECT data for patient specific attenuation by the use of CT data simultaneously acquired with SPECT/CT when analyzing the skeletal uptake of polyphosphonates (DPD). Furthermore, the influence of misregistration between SPECT and CT data on uptake ratios was investigated. Methods: Thirty-six data sets from bone SPECTs performed on a hybrid SPECT/CT system were retrospectively analyzed. Using regions of interest (ROIs), raw counts were determined in the fifth lumbar vertebral body, its facet joints, both anterior iliacal spinae, and of the whole transversal slice. ROI measurements were performed in uncorrected (NAC) and attenuation-corrected (AC) images. Furthermore, the ROI measurements were also performed in AC scans in which SPECT and CT images had been misaligned by 1 cm in one dimension beforehand (ACX, ACY, ACZ). Results: After AC, DPD uptake ratios differed significantly from the NAC values in all regions studied ranging from 32% for the left facet joint to 39% for the vertebral body. AC using misaligned pairs of patient data sets led to a significant change of whole-slice uptake ratios whose differences ranged from 3,5 to 25%. For ACX, the average left-to-right ratio of the facet joints was by 8% and for the superior iliacal spines by 31% lower than the values determined for the matched images (p <0.05). Conclusions: AC significantly affects DPD uptake ratios. Furthermore, misalignment between SPECT and CT may introduce significant errors in quantification, potentially also affecting leftto- right ratios. Therefore, at clinical evaluation of attenuation- corrected scans special attention should be given to possible misalignments between SPECT and CT.

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CyberKnife rhizotomy for facetogenic back pain: a pilot study

Neurosurgical FOCUS ◽

10.3171/foc-07/12/e2 ◽

2007 ◽

Vol 23 (6) ◽

pp. E1 ◽

Cited By ~ 3

Author(s):

Gordon Li ◽

Chirag Patil ◽

John R. Adler ◽

Shivanand P. Lad ◽

Scott G. Soltys ◽

...

Keyword(s):

Back Pain ◽

Radiofrequency Ablation ◽

Facet Joint ◽

Late Onset ◽

Target Volume ◽

Facet Joints ◽

Positron Emission ◽

Cyberknife Radiosurgery ◽

Joint Injections

Object By targeting the medial branches of the dorsal rami, radiofrequency ablation and facet joint injections can provide temporary amelioration of facet joint–producing (or facetogenic) back pain. The authors used CyberKnife radiosurgery to denervate affected facet joints with the goal of obtaining a less invasive yet more thorough and durable antinociceptive rhizotomy. Methods Patients with refractory low-back pain, in whom symptoms are temporarily resolved by facet joint injections, were eligible. The patients were required to exhibit positron emission tomography–positive findings at the affected levels. Radiosurgical rhizotomy, targeting the facet joint, was performed in a single session with a marginal prescription dose of 40 Gy and a maximal dose of 60 Gy. Results Seven facet joints in 5 patients with presumptive facetogenic back pain underwent CyberKnife lesioning. The median follow-up was 9.8 months (range 3–16 months). The mean planning target volume was 1.7 cm3 (range 0.9–2.7 cm3). A dose of 40 Gy was prescribed to a mean isodose line of 79% (range 75–80%). Within 1 month of radiosurgery, improvement in pain was observed in 3 of the 5 patients with durable responses at 16, 12, and 6 months, respectively, of follow-up. Two patients, after 12 and 3 months of follow-up, have neither improved nor worsened. No patient has experienced acute or late-onset toxicity. Conclusions These preliminary results suggest that CyberKnife radiosurgery could be a safe, effective, and non-invasive alternative to radiofrequency ablation for managing facetogenic back pain. No patient suffered recurrent symptoms after radiosurgery. It is not yet known whether pain relief due to such lesions will be more durable than that produced by alternative procedures. A larger series of patients with long-term follow-up is ongoing.

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Posterior Epidural Migration of Sequestrated Lumbar Disc Fragments Into the Bilateral Facet Joints

Neurosurgery ◽

10.1227/neu.0b013e3182245b21 ◽

2011 ◽

Vol 69 (5) ◽

pp. E1148-E1151 ◽

Cited By ~ 5

Author(s):

Tzuu-Yuan Huang ◽

Kung-Shing Lee ◽

Tai-Hsin Tsai ◽

Yu-Feng Su ◽

Shiuh-Lin Hwang

Keyword(s):

Differential Diagnosis ◽

Facet Joint ◽

Lumbar Disc ◽

Synovial Cyst ◽

Leg Pain ◽

Hybrid Technique ◽

Facet Joints ◽

Disc Disease ◽

First Case ◽

Rod System

Abstract BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints. CONCLUSION A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.

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Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160078 ◽

2016 ◽

Vol 74 (9) ◽

pp. 745-749 ◽

Cited By ~ 11

Author(s):

Catarina C. Lins ◽

Diego T. Prado ◽

Andrei F. Joaquim

Keyword(s):

Surgical Treatment ◽

Facet Joint ◽

Direct Reduction ◽

Point Of View ◽

Facet Joints ◽

Spine Trauma ◽

Joint Dislocations ◽

Cervical Facet ◽

Cervical Facet Joint ◽

Anterior Posterior

ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

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Spinal neuronal plasticity is evident within 1 day after a painful cervical facet joint injury

Neuroscience Letters ◽

10.1016/j.neulet.2013.03.019 ◽

2013 ◽

Vol 542 ◽

pp. 102-106 ◽

Cited By ~ 24

Author(s):

Nathan D. Crosby ◽

Christine L. Weisshaar ◽

Beth A. Winkelstein

Keyword(s):

Neuronal Plasticity ◽

Facet Joint ◽

Joint Injury ◽

Cervical Facet ◽

Cervical Facet Joint

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Severe Facet Joint Arthrosis Caused C7/T1 Myelopathy: A Case Report

Case Reports in Medicine ◽

10.1155/2009/481459 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Toshimi Aizawa ◽

Hiroshi Ozawa ◽

Takeshi Hoshikawa ◽

Takashi Kusakabe ◽

Eiji Itoi

Keyword(s):

Cervical Myelopathy ◽

Rare Case ◽

Facet Joint ◽

Spinous Process ◽

Intervertebral Disc Herniation ◽

Facet Joints ◽

Single Level ◽

Neurological Improvement ◽

Bony Spur ◽

Radiological Examinations

Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait clumsiness. The radiological examinations revealed severe C7/T1 facet joint arthrosis with bony spur extending into the spinal canal, which compressed the spinal cord laterally. The T1 spinous process indicated nonunion of a “clay-shoveler's” fracture, which suggested that his cervico-thoracic spine had been frequently moved, and thus severe arthrosis had occurred in the facet joints. A right hemilaminectomy of C7 and C7/T1 facetectomy with single level spinal fusion led to complete neurological improvement.

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