Fixation with C-2 laminar screws in occipitocervical or C1–2 constructs in children 5 years of age or younger: a series of 18 patients

2014 ◽  
Vol 14 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Jennifer G. Savage ◽  
Daniel H. Fulkerson ◽  
Anish N. Sen ◽  
Jonathan G. Thomas ◽  
Andrew Jea
Keyword(s):  
Cervical Spine ◽  
Screw Placement ◽  
Upper Cervical Spine ◽  
Children's Hospital ◽  
Translaminar Screw ◽  
Upper Cervical ◽  
Children’S Hospital ◽  
The Mean ◽  
Translaminar Screws

Object There are rare indications for upper cervical spine fusion in young children. Compared with nonrigid constructs, rigid instrumentation with screw fixation increases the fusion rate and reduces the need for halo fixation. Instrumentation may be technically challenging in younger children. A number of screw placement techniques have been described. Use of C-2 translaminar screws has been shown to be anatomically feasible, even in the youngest of children. However, there are few data detailing the clinical outcome. In this study, the authors describe the clinical and radiographic follow-up of 18 children 5 years of age or younger who had at least one C-2 translaminar screw as part of an occipitocervical or C1–2 fusion construct. Methods A retrospective review of all children treated with instrumented occipitocervical or C1–2 fusion between July 1, 2007, and June 30, 2013, at Riley Children's Hospital and Texas Children's Hospital was performed. All children 5 years of age or younger with incorporation of at least one C-2 translaminar screw were identified. Results Eighteen children were studied (7 boys and 11 girls). The mean age at surgery was 38.1 months (range 10–68 months). Indications for surgery included traumatic instability (6), os odontoideum (3), destructive processes (2), and congenital instability (7). A total of 24 C-2 translaminar screws were placed; 23 (95.8%) of 24 were satisfactorily placed (completely contained within the cortical walls). There was one medial cortex breach without neurological impingement. There were no complications with screw placement. Three patients required wound revisions. Two patients died as a result of their original condition (trauma, malignant tumor). The mean follow-up duration for the surviving patients was 17.5 months (range 3–60 months). Eleven (91.7%) of the 12 patients followed for 6 months or longer showed radiographic stability or completed fusion. Conclusions Use of C-2 translaminar screws provides an effective anchor for internal fixation of the upper cervical spine. In this study of children 5 years of age or younger, the authors found a high rate of radiographic fusion with a low rate of complications.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

2021 ◽  
pp. 219256822110391
Author(s):  
Yakubu Ibrahim ◽  
Hao Li ◽  
Geng Zhao ◽  
Suomao Yuan ◽  
Yiwei Zhao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Neck Disability Index ◽  
Pedicle Screws ◽  
Rotary Motion ◽  
Upper Cervical Spine ◽  
Complex Fractures ◽  
Upper Cervical ◽  
Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

Atlantal fracture with transverse ligament disruption in a child

2009 ◽  
Vol 4 (3) ◽  
pp. 196-198 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Eric C. Peterson
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Upper Cervical Spine ◽  
Transverse Ligament ◽  
Jefferson Fracture ◽  
Fractures In Children ◽  
Upper Cervical ◽  
Almost All ◽  
Ligament Disruption

Even though fractures in children with immature spines occur predominantly in the upper cervical spine, isolated C-1 fractures are relatively rare. The fractures in almost all cases reported to date were considered stable due to the presence of the intact transverse ligament. The authors report the case of a young child who sustained a Jefferson fracture and in whom MR imaging revealed disruption of the transverse ligament. Although surgical treatment has been suggested as the treatment of choice for children with unstable atlantoaxial injuries, external immobilization alone allowed a full recovery in the patient with no evidence of instability at follow-up.

scholarly journals Upper Cervical Spine Fracture-Dislocation in Patients With Ankylosing Spondylitis: Application of Halo Vest Before and During Posterior Surgery

2021 ◽  
Author(s):  
Haisong Yang ◽  
Yuling Sun ◽  
Liang Wang ◽  
Chunyan Gao ◽  
Fengbin Yu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Spine Fracture ◽  
Fracture Dislocation ◽  
Cervical Spine Fracture ◽  
Upper Cervical Spine ◽  
Halo Vest ◽  
Posterior Surgery ◽  
Upper Cervical

Abstract Background It is a challenge to reduce and immobilize the broken “bamboo spine”, especially for the upper cervical spine, in patients with ankylosing spondylitis (AS) before and during posterior surgery. Methods We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 17 patients with AS and upper cervical spine fracture-dislocation who underwent surgical treatment in three clinical spine center from 2010 to 2019. A halo vest was used to reduce and immobilize fractured spinal column ends. The neurological injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score and Japanese Orthopaedic Association (JOA) score before and after operation. Complications and time of bone fusion were recorded. Results Fourteen patients achieved closed anatomical reduction after halo vest application. No displacement in fracture ends and loss of reduction occurred after prone position. No patient presented with secondary neurological deterioration. All patients was performed posterior surgery. The surgery improved the ASIA grade in all patients (P < 0.001). The mean JOA score also increased significantly at last follow-up compared to preoperation (14.5 ± 2.3 vs. 9.2 ± 2.4, P < 0.01). No severe complication and death occurred. All patients reached solid bony fusion at 12-month follow-up. Conclusions Use of a halo vest before and during the operation is safe and effective in patients with AS who develop upper cervical spine fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration. .

Ventral C1 Fracture Combined with Congenital Posterior Cleft: What to Do?

2017 ◽  
Vol 79 (01) ◽  
pp. 066-072
Author(s):  
Philipp Dammann ◽  
Tobias Schoemberg ◽  
Yahya Ahmadipour ◽  
Michael Payer ◽  
Ulrich Sure ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Full Range ◽  
Rare Condition ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Spine Mobility ◽  
Upper Cervical ◽  
Congenital Cleft ◽  
Transverse Atlantal Ligament

Background and Objective We present a treatment approach for a rare condition of patients with a ventral C1 fracture and a congenital cleft in the posterior arch (half-ring Jefferson fracture) with an intact transverse atlantal ligament. Our technique aims to achieve stability of the atlanto-occipital and atlantoaxial joints while preserving mobility of the upper cervical spine. Patients and Methods Two male patients, 43 years and 29 years of age, respectively, were admitted to our hospital due to a fracture of the ventral arch of the atlas with no damage of the transverse atlantal ligament. Both men also presented a congenital cleft of the posterior arch. Initial conservative management with a halo-thoracic vest was performed in one case and failed. As a result, surgical treatment was performed in both cases using bilateral C1 mass screws and a transverse connector. Results The patients showed no neurologic deficits on follow-up examination 4 weeks after surgery with a full range of head and neck motion. Computed tomography (CT) showed no dislocation of the implanted material with good dorsal alignment and a stable ventral fracture distance. Follow-up CT showed osseous stability in both cases with the beginning of bony ossification of the bone graft. Conclusion Isolated instable fractures of the ventral arch of the atlas with a congenital cleft of the posterior arch with no damage of the transverse atlantal ligament can be stabilized using bilateral C1 mass screws and a transverse connector preserving upper cervical spine mobility.

scholarly journals Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Katharina E. Wenning ◽  
Martin F. Hoffmann
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Range Of Motion ◽  
Rating Scale ◽  
Neck Disability Index ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Atlantoaxial Fusion ◽  
Upper Cervical

Abstract Background The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods Over a 5-year period (2010–2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Conclusion Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

scholarly journals Posterior Resection via Atlantoaxial Lamina Space Without Internal Fixation for C1-C2 Intraspinal Tumors: A Novel Approach

2020 ◽  
Author(s):  
Beiping Ouyang ◽  
Xiaobao Zou ◽  
Ling Ni ◽  
Su Ge ◽  
Yuyue Chen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Statistical Significance ◽  
Tumor Resection ◽  
Neck Disability Index ◽  
Upper Cervical Spine ◽  
One Stage ◽  
Flexion Extension ◽  
Upper Cervical

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation.Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up.Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

scholarly journals Effects of upper cervical joints manipulation on the signs and symptoms of subjects with headache: a blind clinical trial.

2020 ◽  
Vol 18 ◽  
pp. 1-8
Author(s):  
Fabiana Forti Sakabe ◽  
Daniel Iwai Sakabe ◽  
Gustavo Luiz Bortolazzo
Keyword(s):  
Cervical Spine ◽  
Neck Disability Index ◽  
Signs And Symptoms ◽  
Upper Cervical Spine ◽  
Pain Diary ◽  
Upper Cervical ◽  
The Subject ◽  
Midas Questionnaire ◽  
Student’S T

There is a relationship between headaches and dysfunctions in the upper cervical spine, so joint manipulation in this region can be a useful tool for recovering tissue mobility and improving the related symptoms. Objectives: to evaluate the effect of 3 sessions of manipulation of the upper cervical spine on pain, cervical mobility, neck disability index (NDI) and the MIDAS questionnaire of subjects with headache. Methods: 13 subjects (28.1 ± 6.7 years) with headache participated. Initially, they filled in a pain diary for 4 weeks. After this period, NDI and MIDAS questionnaire were applied. Then, the cervical spine movements were measured with a tape measure, with the subject in the seated position. Subsequently, the intervention was performed (3 sessions with an interval of 7 days between them), with the subject positioned in the supine position and the global manipulation for the upper cervical spine was applied bilaterally. At the end of the intervention, subjects were re-evaluated for cervical mobility and for the NDI and MIDAS questionnaire. After that period, subjects answered the pain diary for another 4 weeks (follow up). The statistical analysis consisted of the KS normality test, followed by ANOVA test (and Tukey post hoc test) or paired Student's t test, with the level of significance set at 5%. Results: MIDAS questionnaire and NDI showed a significant improvement after the cervical mobility intervention. The pain parameters, assessed by the pain diary, were significantly reduced during the intervention and remained so in the follow up evaluation. Conclusion: the intervention was effective in reducing the signs and symptoms of subjects with headache.

Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

2014 ◽  
Vol 14 (4) ◽  
pp. 425-433 ◽  
Author(s):  
Shobhan Vachhrajani ◽  
Anish N. Sen ◽  
Krishna Satyan ◽  
Abhaya V. Kulkarni ◽  
Sherri B. Birchansky ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ct Scans ◽  
Upper Cervical Spine ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Upper Cervical ◽  
Prevertebral Soft Tissue ◽  
The Mean ◽  
Atlantodental Interval

Object Upper cervical spine injuries in the pediatric age group have been recognized as extremely unstable from ligamentous disruption and as potentially lethal. Few measurement norms have been published for the pediatric upper cervical spine to help diagnose this pathological state. Instead, adult measurement techniques and results are usually applied inappropriately to children. The authors propose using high-resolution reconstructed CT scans to define a range of normal for a collection of selected upper cervical spine measurements in the pediatric age group. Methods Sagittal and coronal reformatted images were obtained from thin axial CT scans obtained in 42 children (< 18 years) in a 2-month period. There were 25 boys and 17 girls. The mean age was 100.9 months (range 1–214 months). Six CT scans were obtained for nontrauma indications, and 36 were obtained as part of a trauma protocol and later cleared for cervical spine injury. Six straightforward and direct linear distances—basion-dental interval (BDI); atlantodental interval (ADI); posterior atlantodental interval (PADI); right and left lateral mass interval (LMI); right and left craniocervical interval (CCI); and prevertebral soft-tissue thickness at C-2—that minimized logistical and technical distortions were measured and recorded. Statistical analysis including interobserver agreement, age stratification, and sex differences was performed for each of the 6 measurements. Results The mean ADI was 2.25 ± 0.24 mm (± SD), the mean PADI was 18.3 ± 0.07 mm, the mean BDI was 7.28 ± 0.10 mm, and the mean prevertebral soft tissue width at C-2 was 4.45 ± 0.43 mm. The overall mean CCI was 2.38 ± 0.44 mm, and the overall mean LMI was 2.91 ± 0.49 mm. Linear regression analysis demonstrated statistically significant age effects for PADI (increased 0.02 mm/month), BDI (decreased 0.02 mm/month), and CCI (decreased 0.01 mm/month). Similarly significant effects were found for sex; females demonstrated on average a smaller CCI by 0.26 mm and a smaller PADI by 2.12 mm. Moderate to high interrater reliability was demonstrated across all parameters. Conclusions Age-dependent and age-independent normal CT measurements of the upper cervical spine will help to differentiate physiological and pathological states in children. The BDI appears to change significantly with age but not sex; on the other hand, the LMI and ADI appear to be age-independent measures. This preliminary study suggests acceptable levels of interrater reliability, and further expanded study will aim to validate these measurements to produce a profile of normal upper cervical spine measurements in children.

scholarly journals Pediatric occipitocervical fusion: long-term radiographic changes in curvature, growth, and alignment

2016 ◽  
Vol 18 (5) ◽  
pp. 644-652 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Jay D. Turner ◽  
Hector Soriano-Baron ◽  
Anna G. U. S. Newcomb ◽  
Samuel Kalb ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Clinical Status ◽  
Body Height ◽  
Upper Cervical Spine ◽  
Normal Children ◽  
Sagittal Vertical Axis ◽  
Vertical Growth ◽  
The Mean

OBJECTIVE The authors assessed the rate of vertebral growth, curvature, and alignment for multilevel constructs in the cervical spine after occipitocervical fixation (OCF) in pediatric patients and compared these results with those in published reports of growth in normal children. METHODS The authors assessed cervical spine radiographs and CT images of 18 patients who underwent occipitocervical arthrodesis. Measurements were made using postoperative and follow-up images available for 16 patients to determine cervical alignment (cervical spine alignment [CSA], C1–7 sagittal vertical axis [SVA], and C2–7 SVA) and curvature (cervical spine curvature [CSC] and C2–7 lordosis angle). Seventeen patients had postoperative and follow-up images available with which to measure vertebral body height (VBH), vertebral body width (VBW), and vertical growth percentage (VG%—that is, percentage change from postoperative to follow-up). Results for cervical spine growth were compared with normal parameters of 456 patients previously reported on in 2 studies. RESULTS Ten patients were girls and 8 were boys; their mean age was 6.7 ± 3.2 years. Constructs spanned occiput (Oc)–C2 (n = 2), Oc–C3 (n = 7), and Oc–C4 (n = 9). The mean duration of follow-up was 44.4 months (range 24–101 months). Comparison of postoperative to follow-up measures showed that the mean CSA increased by 1.8 ± 2.9 mm (p < 0.01); the mean C2–7 SVA and C1–7 SVA increased by 2.3 mm and 2.7 mm, respectively (p = 0.3); the mean CSC changed by −8.7° (p < 0.01) and the mean C2–7 lordosis angle changed by 2.6° (p = 0.5); and the cumulative mean VG% of the instrumented levels (C2–4) provided 51.5% of the total cervical growth (C2–7). The annual vertical growth rate was 4.4 mm/year. The VBW growth from C2–4 ranged from 13.9% to 16.6% (p < 0.001). The VBW of C-2 in instrumented patients appeared to be of a smaller diameter than that of normal patients, especially among those aged 5 to < 10 years and 10–15 years, with an increased diameter at the immediately inferior vertebral bodies compensating for the decreased width. No cervical deformation, malalignment, or detrimental clinical status was evident in any patient. CONCLUSIONS The craniovertebral junction and the upper cervical spine continue to present normal growth, curvature, and alignment parameters in children with OCF constructs spanning a distance as long as Oc–C4.

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