Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

OBJECTIVE If left untreated, occipitocervical (OC) instability may lead to serious neurological injury or death. Open internal fixation is often necessary to protect the neurovascular elements. This study reviews the etiologies for pediatric OC instability, analyzes the radiographic criteria for surgical intervention, discusses surgical fixation techniques, and evaluates long-term postoperative outcomes based on a single surgeon's experience. METHODS The charts of all patients < 18 years old who underwent internal OC fixation conducted by the senior author were retrospectively reviewed. Forty consecutive patients were identified for analysis. Patient demographic data, OC junction pathology, radiological diagnostic tools, surgical indications, and outcomes are reported. RESULTS The study population consisted of 20 boys and 20 girls, with a mean age of 7.3 years. Trauma (45% [n = 18]) was the most common cause of instability, followed by congenital etiologies (37.5% [n = 15]). The condyle-C1 interval had a diagnostic sensitivity of 100% for atlantooccipital dislocation. The median number of fixated segments was 5 (occiput–C4). Structural bone grafts were used in all patients. Postsurgical neurological improvement was seen in 88.2% (15/17) of patients with chronic myelopathy and in 25% (1/4) of patients with acute myelopathy. Preoperatively, 42.5% (17/40) of patients were neurologically intact and remained unchanged at last follow-up, 42.5% (17/40) had neurological improvement, 12.5% (5/40) remained unchanged, and 2.5% (1/40) deteriorated. All patients had successful fusion at 1-year follow-up. The complication rate was 7.5% (3/40), including 1 case of vertebral artery injury. CONCLUSIONS Occipitocervical fixation is safe in children and provides immediate immobilization, with excellent survival and arthrodesis rates. Of the radiographic tools evaluated, the condyle-C1 interval was the most predictive of atlantooccipital dislocation.

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Occipitocervical Fixation

Neurosurgery ◽

10.1227/neu.0000000000001340 ◽

2016 ◽

Vol 79 (4) ◽

pp. 549-560 ◽

Cited By ~ 16

Author(s):

Eduardo Martinez-del-Campo ◽

Jay D. Turner ◽

Samuel Kalb ◽

Leonardo Rangel-Castilla ◽

Luis Perez-Orribo ◽

...

Keyword(s):

Case Series ◽

Median Number ◽

Senior Author ◽

Neurological Deficits ◽

Neurological Injury ◽

Long Term Results ◽

Occipitocervical Fixation ◽

Surgical Fixation

Abstract BACKGROUND Occipitocervical junction instability can lead to serious neurological injury or death. Open surgical fixation is often necessary to provide definitive stabilization. However, long-term results are limited to small case series. OBJECTIVE To review the causes of occipitocervical instability, discuss the indications for surgical intervention, and evaluate long-term surgical outcomes after occipitocervical fixation. METHODS The charts of all patients undergoing posterior surgical fixation of the occipitocervical junction by the senior author were retrospectively reviewed. A total of 120 consecutive patients were identified for analysis. Patient demographic characteristics, occipitocervical junction pathology, surgical indications, and clinical and radiographic outcomes are reported. RESULTS The study population consisted of 64 male and 56 female patients with a mean age of 39.9 years (range, 7 months to 88 years). Trauma was the most common cause of instability, occurring in 56 patients (47%). Ninety patients (75%) were treated with screw/rod constructs; wiring was used in 30 patients (25%). The median number of fixated segments was 5 (O-C4). Structural bone grafts were implanted in all patients (100%). Preoperative neurological deficits were present in 83 patients (69%); 91% of those patients improved with surgery. Mean follow-up was 35.1 ± 27.4 months (range, 0-123 months). Two patients died, and 10 were lost to follow-up before the end of the 6-month follow-up period. Fusion was confirmed in 107 patients (89.1%). The overall complication rate was 10%, including 3 patients with vertebral artery injuries and 2 patients who required revision surgery. CONCLUSION Occipitocervical fixation is a durable treatment option with acceptable morbidity for patients with occipitocervical instability.

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Cement-in-cement femoral component revision

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-1953.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1215-1221

Author(s):

John W. Kennedy ◽

Nigel Y. B. Ng ◽

David Young ◽

Nicholas Kane ◽

Andrew G. Marsh ◽

...

Keyword(s):

Femoral Component ◽

Short Form ◽

Demographic Data ◽

Senior Author ◽

Inclusion Criteria ◽

Reliable Technique ◽

Patient Demographic Data ◽

Oxford Hip Score ◽

Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

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Comparison of microendoscopic selective laminectomy versus conventional laminoplasty in patients with degenerative cervcical myelopathy: a minimum 2-year follow-up study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2884-6 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Yasushi Oshima ◽

So Kato ◽

Toru Doi ◽

Yoshitaka Matsubayashi ◽

Yuki Taniguchi ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Surgical Outcomes ◽

Demographic Data ◽

Invasive Procedure ◽

Detailed Comparison ◽

Cord Compression ◽

Neurological Improvement ◽

Spinal Cord Shift

Abstract Background Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years. Methods Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3–6 or C3–7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5–6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5–6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups. Results Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group. Conclusion Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM.

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SARS-CoV-2 infections in people with PCD: neither frequent, nor particularly severe

10.1101/2020.12.20.20248420 ◽

2020 ◽

Author(s):

Eva SL Pedersen ◽

Myrofora Goutaki ◽

Amanda L Harris ◽

Lucy Dixon ◽

Michele Manion ◽

...

Keyword(s):

Incidence Rate ◽

Severe Symptom ◽

Demographic Data ◽

Severe Disease ◽

Median Number ◽

Disease Course ◽

Increased Risk ◽

Using Data ◽

Ciliary Dyskinesia

AbstractPeople with pre-existing chronic health conditions are reportedly at high risk of getting the coronavirus disease (COVID-19) and of having a severe disease course but little data exist on rare diseases such as Primary Ciliary Dyskinesia (PCD). We studied risk and severity of SARS-CoV-2 infections among people with PCD using data from the COVID-PCD, a participatory study that collects data in real-time directly from people with PCD. Data was collected using online questionnaires. A baseline questionnaire collected information on demographic data, information about the PCD diagnosis and severity. A short weekly questionnaire collected information about current symptoms and incident SARS-CoV-2 infections. 578 people participated in the COVID-PCD by December 7, 2020, with a median number of follow-up weeks of 9 (interquartile range: 4-19 weeks). 256 (45%) of the participants had been tested for SARS-CoV-2 and 12 tested positive prior to study entry or during study follow up (2.1% of the total included population, 95% confidence interval (CI) 1.1-3.6%). 4 people tested positive during the study follow-up, corresponding to an incidence rate of 2.5 per 100 person-years (95% CI: 0.9-6.5). Overall, reported severity was mild with two reporting no symptoms, eight reporting mild symptoms, one reporting severe symptom without hospitalisation, and one reporting hospitalisation for 9 days. The study suggests that with careful personal protection, people with PCD do not seem to have an increased risk of infection with SARS-COV-2, nor an especially severe disease course.Take home messageIn this longitudinal study of people with PCD followed weekly via online questionnaires, the incidence rate of COVID-19 and the proportion of participants infected were low, and the observed severity mostly mild.

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Atlantooccipital transarticular screw fixation for the treatment of traumatic occipitoatlantal dislocation

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.3.0381 ◽

2005 ◽

Vol 2 (3) ◽

pp. 381-385 ◽

Cited By ~ 38

Author(s):

Iman Feiz-Erfan ◽

L. Fernando Gonzalez ◽

Curtis A. Dickman

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Screw Fixation ◽

Full Range ◽

Neurological Injury ◽

Content Type ◽

Vehicle Accident ◽

A New Technique ◽

Atlantooccipital Dislocation

✓ The authors describe a new technique of internal atlantooccipital screw fixation involving posterior wiring and fusion for the treatment of traumatic atlantooccipital dislocation, which was performed in a 17-year-old male patient involved in a motor vehicle accident and who suffered from atlantooccipital dislocation without neurological injury. At the 6-month follow-up examination, the patient was neurologically intact with a solid occipitocervical fusion and full range of motion of the neck.

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Long term follow-up of endovascular management of spinal cord arteriovenous malformations with emphasis on particle embolization

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014016 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1183-1186 ◽

Cited By ~ 4

Author(s):

Adrien Collin ◽

Marc-Antoine Labeyrie ◽

Stephanie Lenck ◽

Akli Zetchi ◽

Armand Aymard ◽

...

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Median Number ◽

Injection Technique ◽

Imaging Data ◽

Independent Observer ◽

Neurological Improvement

ObjectiveTo determine long term safety and efficacy of endovascular treatment of spinal cord arteriovenous malformations (AVMs), with calibrated particle embolization as a firstline approach.MethodsWe reviewed clinical and imaging data of consecutive patients who underwent endovascular treatment for both nidal and fistulous type spinal cord AVMs in our center, from 1990 to 2015. Outcome at the last follow-up was assessed by an independent observer.ResultsEmbolization of spinal cord AVMs was performed in 61 patients, including 46 (75%) with particles (exclusively in 29 patients), 30 (49%) with cyanoacrylate, and 6 (10%) with combined surgical treatments. Particle embolizations were iterative in 33 patients (median number of sessions 5 (range 3–6)). Neurological deterioration after treatment occurred in 5 patients (cyanoacrylate=4, surgery=1, particles=0; P<0.001). At a median follow-up of 6 years (range 3–13 years), angiographic cure was obtained in 11/61 (18%) patients (nidal type=6/53 (11%), fistulous type=5/8 (63%)). In progressive forms, neurological improvement occurred in 16/28 (57%) patients, stabilized in 9/28 (31%), and worsened in 3/28 (12%). In hemorrhagic forms, the rebleeding rate was 4/14 patient years without standard treatment, 0/322 patient years in partial iterative treatment, and 0/15 patient years in angiographically cured lesions (P=0.001).ConclusionOur study suggests that particle embolization as a firstline therapy to treat spinal cord AVMs is safe and offers long term efficacy, especially for those with small, distal, and multiple shunts. Partial occlusion of the AVM may be sufficient to prevent rebleeding, without the potential risks of complete occlusion. Particle calibration and injection technique, ‘one by one’, are critical to safety. Cyanoacrylate embolization or surgery remains necessary if particle embolization fails to occlude large shunts.

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Contralateral Interhemispheric Approach to Deep-Seated Cavernous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000339 ◽

2014 ◽

Vol 75 (1) ◽

pp. 80-86 ◽

Cited By ~ 18

Author(s):

Hasan A. Zaidi ◽

Shakeel A. Chowdhry ◽

Peter Nakaji ◽

Adib A. Abla ◽

Robert F. Spetzler

Keyword(s):

Clinical Outcomes ◽

Chart Review ◽

Short Term Memory ◽

Demographic Data ◽

Retrospective Chart Review ◽

Senior Author ◽

Cavernous Malformations ◽

Memory Problems ◽

Interhemispheric Approach

Abstract BACKGROUND: Deep-seated periventricular cavernous malformations of the basal ganglia or thalamus can be approached via an interhemispheric craniotomy. OBJECTIVE: To determine surgical efficacy and clinical outcomes of the contralateral interhemispheric approach. METHODS: Retrospective chart review was performed on patients undergoing an interhemispheric approach for the resection of deep-seated cavernous malformation by the senior author (R.F.S.) between 2005 and 2013. Demographic data and clinical outcomes were reviewed. Pre- and postoperative imaging were analyzed for lesion location, size, associated venous anomaly, proximity to ventricle, and presence of residual. RESULTS: Twenty-one patients underwent a contralateral interhemispheric-transventricular approach, 7 patients had a contralateral interhemispheric-transcingulate approach and 3 patients had a contralateral interhemispheric-transchoroidal approach. Mean age was 40.1 years, and the majority were female (58.1%). Mean maximum cavernoma diameter was 1.97 cm, and 43.8% reached the surface of the ventricle. Average follow-up was 8.9 months, with complete resection achieved in 96.8% of patients. At last follow-up, 61.3% of patients remained stable and 29.0% had improved. Of the patients, 6.5% experienced transient weakness that resolved at last follow-up, and 1 patient (3.2%) had short-term memory problems. There were no surgical mortalities. CONCLUSION: The contralateral interhemispheric approach is a safe, clinically well tolerated, and surgically efficacious approach to deep-seated cavernomas.

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A 10-year experience of radiosurgical treatment for cerebral arteriovenous malformations: a perspective from a series with large malformations

Journal of Neurosurgery ◽

10.3171/2011.3.jns10814 ◽

2011 ◽

Vol 115 (2) ◽

pp. 337-346 ◽

Cited By ~ 11

Author(s):

Gisela Murray ◽

Ricardo H. Brau

Keyword(s):

Puerto Rico ◽

Arteriovenous Malformations ◽

Demographic Data ◽

Latency Period ◽

Senior Author ◽

Neurological Deficits ◽

Bivariate Analysis ◽

Median Volume ◽

Lost To Follow Up

Object The purpose of this study was to describe a 10-year experience in the use of radiosurgery (RS) for patients with arteriovenous malformations (AVMs) in Puerto Rico. Methods This retrospective analysis was performed for all patients with AVMs treated with RS by the senior author (R.H.B.) in Puerto Rico. Between February 1999 and December 2009, a total of 83 patients underwent the procedure. All charts were reviewed for recollection of demographic data, and AVM and treatment characteristics. Clinical and radiographic follow-up information was collected retrospectively. Results Eighty-three patients were treated and 86 RS procedures for AVMs were performed during a 10-year period. Eight patients were lost to follow-up. The remaining 75 patients included 36 males and 39 females, whose median age was 34.5 years. Hemorrhage was the initial presentation in 40% of patients. Fifty-seven AVMs (73%) were treated previously with endovascular neurosurgery, without success. The median volume of the malformation was 17.7 ml. Nearly 65% of the malformations were considered large (≥ 10 ml) in volume. Forty patients had AVMs with largest diameter ≥ 3.5 cm. The overall obliteration rate was 56.4%, and the median time for obliteration was 29 months. The AVMs ≥ 3.5 cm in diameter had a greater latency period than those < 3.5 cm (31 months vs 46 months, respectively; p = 0.01). In addition, AVM obliteration was inversely associated with its volume, especially in large lesions (p = 0.037). In bivariate analysis, patients achieving obliteration had lower Spetzler-Martin scores compared with patients in whom obliteration was not achieved (p = 0.009). Postradiosurgery hemorrhages were seen in 9 cases. Eleven patients underwent surgery after RS. Major neurological deficits developed in 9 patients, whereas 17 had only minor deficits. The occurrence of neurological deficits was significantly associated with lesions with volume ≥ 10 ml. Conclusions Radiosurgery is a reasonable treatment option for AVMs in the majority of cases, in spite of the large, difficult-to-treat malformations.

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Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19293 ◽

2019 ◽

Vol 1 (2) ◽

pp. V7

Author(s):

Ken Matsushima ◽

Michihiro Kohno ◽

Helmut Bertalanffy

Keyword(s):

Cavernous Malformation ◽

Cleavage Plane ◽

Foramen Magnum ◽

Senior Author ◽

Neurological Deficits ◽

Lateral Part ◽

Sitting Position ◽

Brainstem Cavernoma ◽

Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

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Adenosine-induced Asystole during AVM Embolization

Clinical Neuroradiology ◽

10.1007/s00062-021-01035-z ◽

2021 ◽

Author(s):

V. Hellstern ◽

P. Bhogal ◽

M. Aguilar Pérez ◽

M. Alfter ◽

A. Kemmling ◽

...

Keyword(s):

Demographic Data ◽

Clinical Results ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Residual Shunt ◽

Grade 5 ◽

Martin Grade ◽

Grade 3 ◽

Brain Avms

Abstract Background Adenosine induced cardiac standstill has been used intraoperatively for both aneurysm and arteriovenous malformation (AVM) surgery and embolization. We sought to report the results of adenosine induced cardiac standstill as an adjunct to endovascular embolization of brain AVMs. Material and Methods We retrospectively identified patients in our prospectively maintained database to identify all patients since January 2007 in whom adenosine was used to induce cardiac standstill during the embolization of a brain AVM. We recorded demographic data, clinical presentation, Spetzler Martin grade, rupture status, therapeutic intervention and number of embolization sessions, angiographic and clinical results, clinical and radiological outcomes and follow-up information. Results We identified 47 patients (22 female, 47%) with average age 42 ± 17 years (range 6–77 years) who had undergone AVM embolization procedures using adjunctive circulatory standstill with adenosine. In total there were 4 Spetzler Martin grade 1 (9%), 9 grade 2 (18%), 15 grade 3 (32%), 8 grade 4 (18%), and 11 grade 5 (23%) lesions. Of the AVMs six were ruptured or had previously ruptured. The average number of embolization procedures per patient was 5.7 ± 7.6 (range 1–37) with an average of 2.6 ± 2.2 (range 1–14) embolization procedures using adenosine. Overall morbidity was 17% (n = 8/47) and mortality 2.1% (n = 1/47), with permanent morbidity seen in 10.6% (n = 5/47) postembolization. Angiographic follow-up was available for 32 patients with no residual shunt seen in 26 (81%) and residual shunts seen in 6 patients (19%). The angiographic follow-up is still pending in 14 patients. At last follow-up 93.5% of patients were mRS ≤2 (n = 43/46). Conclusion Adenosine induced cardiac standstill represents a viable treatment strategy in high flow AVMs or AV shunts that carries a low risk of mortality and permanent neurological deficits.

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