scholarly journals Surgical Treatment of Stenosis of Spinal Canal and Dural Sac at the Craniovertebral Junction

2019 ◽  
Vol 3 (6) ◽  
pp. 69-76
Author(s):  
V. E. Potapov ◽  
Z. V. Koshkareva ◽  
V. A. Sorokovikov ◽  
S. N. Larionov ◽  
O. V. Sklyarenko ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Spinal Canal ◽  
Intraoperative Complications ◽  
Odontoid Process ◽  
External Fixators ◽  
Preoperative Period ◽  
Vertebral Canal ◽  
Halo Traction ◽  
Halo Device

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

scholarly journals C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

2020 ◽  
pp. 1-3
Author(s):  
Isabel Snee ◽  
Isabel Snee ◽  
Catherine A. Mazzola
Keyword(s):  
Cervical Spine ◽  
Head Tilt ◽  
Spine Injury ◽  
Halo Traction ◽  
Cord Injury ◽  
Magnetic Resonance Imaging Mri ◽  
Cervical Spine Alignment ◽  
Atlanto Axial Joint ◽  
Spine Radiographs ◽  
Halo Device

We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

scholarly journals TREATMENT OF A PATIENT WITH MUCOPOLYSACCHARIDOSES TYPE II (HUNTER SYNDROME) COMPLICATED BY CRANIOVERTEBRAL SPINAL CANAL STENOSIS

2018 ◽  
pp. 52-56
Author(s):  
L. K. Mikhailova ◽  
A. A. Kuleshov ◽  
M. S. Vetrile ◽  
I. N. Lisyanskiy ◽  
O. A. Polyakova ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Spinal Canal ◽  
Hunter Syndrome ◽  
Craniovertebral Junction ◽  
Spinal Canal Stenosis ◽  
Type Ii ◽  
Canal Stenosis ◽  
Spine Stabilization ◽  
Different Types

Formation of spinal canal stenosis at T12-L1 level, rarely at the level of craniovertebral junction, is a typical spinal disorder in different types of mucopolysaccharidoses that is a serious complication due to tetraparesis and tetraplegia development. Clinical, roentgenologic and therapeutic aspects of the mucopolysaccharidoses type II course in a 23 months old boy as well as the results of two-step surgical treatment for the cervical spine stabilization and elimination of spinal canal stenosis at the level of craniovertebral junction are presented.

scholarly journals Biomechanics of upper cervical spine and peculiarities of treatment of patients with odontoid process fractures

1996 ◽  
Vol 3 (1) ◽  
pp. 18-21
Author(s):  
V. A. Moiseenko
Keyword(s):  
Cervical Spine ◽  
Conservative Treatment ◽  
Odontoid Process ◽  
Upper Cervical Spine ◽  
Traction Method ◽  
Cervical Muscles ◽  
Halo Traction ◽  
Upper Cervical ◽  
Extension Fracture

In transdental injuries of atlantoaxial region the indications for conservative treatment and authors bipolar Halo-traction method were worked out on the base of spine biomechanical peculiarities (anterior shifting moment and extensor conditionality of the posterior cervical muscles) as well as depending on the mechanism of the development of plane fracture of C2 odontoid process. In flexion fracture of the odontoid process without dislocation as well as in extension fracture with dislocation within the limits of 1/3 of its diameter the successful conservative treatment with plaster thoracocranial bandage was possible. In the rest of cases the authors method of bipolar Halo-traction was indicated. The experience of treatment of 32 patients was used in the work.

scholarly journals SURGICAL TREATMENT OF CERVICAL SPINE INJURIES BY PRIMARY STABLE FIXATION WITH METAL CONSTRUCTIONS

2006 ◽  
pp. 008-018
Author(s):  
Stepan Timofeyevich Vetrile ◽  
Aleksandr Ilyich Krupatkin ◽  
Sergey Viktorovich Yundin
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Vertebral Body ◽  
High Efficiency ◽  
Lower Cervical Spine ◽  
Cervical Spine Injuries ◽  
First Case ◽  
Halo Traction ◽  
Spine Injuries ◽  
Neurovascular Structures

Objective. To study efficiency of primary stable metal constructions and halo-vest for lower cervical spine injuries. Material and Methods. Experience in surgical treatment of 62 patients with various injuries of lower cervical spine has been analyzed and summarized. The patients were grouped according to two main factors causing the injured spine dysfunction: dislocation damages (dislocations, fracture-dislocations), in which compression of neurovascular structures and disturbance of spine support ability are caused by vertebra dislocation; and vertebral body fractures (compression, compression-splintered) in which the compression and disturbance are arising from vertebral body destruction. In the first case a reduction of dislocated vertebra by various methods depending on the duration and rigidity of the injury was performed. In the second case a destroyed vertebral body was resected with subsequent stabilization. Results. The choice of surgical tactics with use of modern metal fixation devices was substantiated for treatment of lower cervical spine injuries. Indications for the application of anterior and posterior stabilizing constructions were determined considering a compression direction of neurovascular structures and a degree of destruction of the spine support columns. An algorithm of surgical treatment was suggested basing on a principle of damage reposition irrespective of injury duration. High efficiency of Halo-traction for treatment of lower cervical spine injuries was proved and its most effective application (combination with various methods of internal fixation) was determined. Conclusion. The application of primary stable metal devices in combination with halo fixation is a method of choice for treatment of lower cervical spine injuries.

scholarly journals Surgical treatment of multilevel lumbar vertebral canal stenosis using dynamic stabilization. Multicenter study

2017 ◽  
Vol 24 (4) ◽  
pp. 11-17
Author(s):  
A. O Gushcha ◽  
S. V Kolesov ◽  
Ekaterina N. Poltorako ◽  
D. A Kolbovskiy ◽  
A. I Kaz’min
Keyword(s):  
Surgical Treatment ◽  
Multicenter Study ◽  
Spinal Canal ◽  
Adjacent Segment ◽  
Spinal Motion ◽  
Vertebral Canal ◽  
Transpedicular Fixation ◽  
Canal Stenosis ◽  
Sf 36 ◽  
Spine Pathology

Purpose: to compare the results of surgical treatment of patients with multilevel lumbar vertebral canal stenosis. Patients and methods. Prospective randomized multicenter study included 71 patients aged 41 - 79 years. In the 1st group of patients (n=38) a standard wide decompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant spinal motion segment using rigid stabilization and interbody fusion was performed. In the 2nd group (n=33) microdecompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant segment using the rods of nitinol transpedicular device. The results were assessed by the pain VAS, ODI and SF-36 questionnaires, roentgenologic, CT and MRI data. Results. Mean follow up made up 1.5 years, the maximum one - 3.0 years. Significant pain relief and im- provement in the quality of life as compared with the preoperative level was reported for both groups. No sig- nificant difference between the groups was observed. Functional roentgenograms showed within 5° (4.2 - 6.5°) preservation of motion in the stabilized segment only in patients from the 2nd group. Adjacent segment pathology in 12 months after operation was diagnosed only in 1 patient from the 1st group. Conclusion. Preliminary results allow considering the dynamic transpedicular fixation using nitinol rods as an effective surgical technique for the treatment of degenerative lumbar spine pathology.

Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI

2018 ◽  
Vol 15 (4) ◽  
pp. 32-40
Author(s):  
S. P. Mironov ◽  
S. V. Kolesov ◽  
V. S. Pereverzev ◽  
D. A. Kolbovsky ◽  
A. A. Kuleshov ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Spinal Canal ◽  
Soft Tissues ◽  
Upper Cervical Spine ◽  
Type I ◽  
Timely Initiation ◽  
Enzyme Replacement ◽  
Emergency Tracheostomy

To analyze surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis. Material and Methods. A total of 9 patients (4 men, 5 women) with mucopolysaccharidosis were operated on for craniovertebral stenosis in 2012–2017. All patients underwent clinical examination, standard radiography of the cervical spine with functional tests to assess atlantooccipital stability according to Rothman, and MRI to determine the degree of the spinal cord compression, stenosis of the spinal canal, and changes in soft tissues surrounding the spinal canal due to fibrosis and accumulation of glycosaminoglycans. Maximum stenosis at the C0–C2 level was noted in 5 patients, at C1–C2 in 2, at C2–C4 in 1, and at C0–C1 in 1. Myelopathy in the upper cervical spine was detected in five cases. The overall somatic and functional statuses, as well as neurological parameters were assessed. Follow-up examination and X-ray examination were performed at 3, 6 and 12 months after surgery, and further every 6 months. Results. The average follow-up period was 2.5 years. The age of the patients varied from 1.8 to 34 years. After 3, 6, and 12 months after surgery, instrumentation was radiologically stable in all cases, there were no bone resorption signs around the elements of instrumentation. Seven patients showed a regression of neurologic symptoms and positive dynamics in the somatic status according to the assessment scales. In one patient, the neurological status remained unchanged. In one case, a temporary deterioration in the condition was noted after a failed intubation attempt, which required emergency tracheostomy, and operation was postponed to a later date to stabilize the condition. Complications after surgical treatment were observed in five patients. In one case, pseudoarthrosis, rod fracture, and instrumentation instability developed 1.5 years after the intervention, and revision surgery was required. Wound healing problems were observed in three patients and a liquorrhea in the early postoperative period, which was stopped without revision intervention – in one case. Conclusion. Decompression and stabilization in patients with mucopolysaccharidosis should be performed in advance, before any neurological disorder development. Fixation is required to prevent the development of instability, post-laminectomy deformities, and progression of cicatricial stenosis. Timely initiation of enzyme-replacement therapy improves the results of mucopolysaccharidosis treatment.

scholarly journals Treatment of a patient with mucopolysaccharidoses type II (Hunter syndrome) complicated by craniovertebral spinal canal stenosis

2018 ◽  
Vol 25 (1) ◽  
pp. 52-56
Author(s):  
Luydmila K. Mikhailova ◽  
A. A Kuleshov ◽  
M. S Vetrile ◽  
I. N Lisyanskiy ◽  
O. A Polyakova ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Spinal Canal ◽  
Hunter Syndrome ◽  
Craniovertebral Junction ◽  
Spinal Canal Stenosis ◽  
Type Ii ◽  
Canal Stenosis ◽  
Spine Stabilization ◽  
Different Types

Formation of spinal canal stenosis at T12-L1 level, rarely at the level of craniovertebral junction, is a typical spinal disorder in different types of mucopolysaccharidoses that is a serious complication due to tetraparesis and tetraplegia development. Clinical, roentgenologic and therapeutic aspects of the mucopolysaccharidoses type II course in a 23 months old boy as well as the results of two-step surgical treatment for the cervical spine stabilization and elimination of spinal canal stenosis at the level of craniovertebral junction are presented.

MODIFIED LAMINOPLASTY AFTER EXCISION OF CERVICAL SCHWANNOMA WITH LARGE EXTRAVERTEBRAL EXTENSION

2018 ◽  
Vol 1 (1) ◽  
pp. 9
Author(s):  
Muhammad Faris ◽  
Abdul Hafid Bajamal ◽  
Zaky Bajamal ◽  
Krisna Tsaniadi Prihastomo
Keyword(s):  
Surgical Treatment ◽  
Spinal Canal ◽  
Conventional Technique ◽  
Modified Technique ◽  
Younger Patients ◽  
Knowing That ◽  
Anteroposterior Diameter ◽  
Intradural Extramedullary ◽  
Intradural Extramedullary Tumour

Tumour excision and laminoplasty are commonly performed as surgical treatment of extra vertebral extension of cervical schwannoma. It is worth knowing that the conventional technique of multilevel laminectomy may hinder younger patients in the long-term. This article reports a 30-year old man with an intradural-extramedullary tumour which extended from C4 to T1 that underwent modified laminoplasty.  This modified technique is preferable in maintaining the anteroposterior diameter of spinal canal as well as reducing the displacement of guttered laminae

A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

2021 ◽  
pp. 1-7
Author(s):  
Marko Jug
Keyword(s):  
Cervical Spine ◽  
3D Model ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Upper Cervical Spine ◽  
Spine Instrumentation ◽  
Cord Injury ◽  
Spinal Navigation ◽  
Upper Cervical ◽  
3D Printed

<b><i>Introduction:</i></b> In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. <b><i>Case Presentation:</i></b> We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. <b><i>Discussion/Conclusion:</i></b> Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

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