scholarly journals Occipitocervical fusion of traumatic atlanto-occipital dissociation in a patient with autofused cervical facet joints: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
J. Manuel Sarmiento ◽  
Daniel Chang ◽  
Peyton L. Nisson ◽  
Julie L. Chan ◽  
Tiffany G. Perry
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Ct Scans ◽  
Occipital Condyle ◽  
Upper Cervical Spine ◽  
Illustrative Case ◽  
Facet Joints ◽  
Ligamentous Injury ◽  
Occipitocervical Fusion ◽  
Fusion Construct

BACKGROUND Patients who survive traumatic atlanto-occipital dissociation (AOD) may present with normal neurological examinations and near-normal-appearing diagnostic images, such as cervical radiographs and computed tomography (CT) scans. OBSERVATIONS The authors described a neurologically intact 64-year-old female patient with a degenerative autofusion of her right C4–5 facet joints who presented to their center after a motor vehicle collision. Prevertebral soft tissue swelling and craniocervical subarachnoid hemorrhage prompted awareness and consideration for traumatic AOD. An abnormal occipital condyle–C1 interval (4.67 mm) on CT and craniocervical junction ligamentous injury on magnetic resonance imaging (MRI) confirmed the diagnosis of AOD. Her autofused right C4–5 facet joints were incorporated into the occipitocervical fusion construct. LESSONS Traumatic AOD can be easily overlooked in patients with a normal neurological examination and no associated upper cervical spine fractures. A high index of suspicion is needed when evaluating CT scans because normal values for craniocervical parameters are significantly different from the accepted ranges of normal on radiographs in the adult population. MRI of the cervical spine is helpful to evaluate for atlanto-occipital ligamentous injury and confirm the diagnosis. Occipitocervical fusion construct may need to be extended to incorporate spinal levels with degenerative autofusion to prevent adjacent level degeneration.

Investigation of Upper Cervical Spine Injury due to Frontal and Rear Impact Loading Using Finite Element Analysis

2014 ◽  
Author(s):  
Tanvir Mustafy ◽  
Kodjo Moglo ◽  
Samer Adeeb ◽  
Marwan El-Rich
Keyword(s):  
Finite Element ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Spine Injury ◽  
Upper Cervical Spine ◽  
Fe Model ◽  
Facet Joints ◽  
Element Analysis ◽  
Effective Prevention ◽  
Upper Cervical

Predicting neck response and injury resulting from motor vehicle crashes is essential for improving occupant protection, effective prevention, and in the evaluation and treatment of spinal injuries. Injury mechanism of upper cervical spine due to frontal/rear-end impacts was studied using Finite Element (FE) analyses. A FE model of ligamentous (devoid of muscles) occipito-C3 cervical spine was developed. Time and rate-dependent material laws were used for assessing bone and ligament failure. Frontal and rear-end impact loads at two rates of 5G and 10G accelerations were applied to analyze the model response in terms of stress distribution, intradiscal pressure change, and contact pressure in facet joints. Failure occurrence and initiation instants were investigated. Frontal and rear-end impacts increased stresses significantly producing failure in most components for both rates. However, transverse ligament and C2-vertebral endplate only failed under rear-end impact. No failure occurred in cortical bone, dens, disc, anterior or posterior longitudinal ligaments. The spine is more prone to injury under rear-end impact as most of the spinal components failed and failure started earlier. Ligaments and facet joints are the most vulnerable components of the upper cervical spine when subjected to frontal/rear end impacts and injury may occur at small ranges of displacement/rotation.

scholarly journals STABILIZATION OF OCCIPITOATLANTOAXIAL COMPLEX THROUGH POSTERIOR APPROACH

2005 ◽  
pp. 008-015
Author(s):  
Nikolay Alekseyevich Korzh ◽  
Aleksandr Evgenyevich Barysh
Keyword(s):  
Cervical Spine ◽  
Posterior Approach ◽  
Clinical Effectiveness ◽  
Upper Cervical Spine ◽  
Fixation Device ◽  
Occipitocervical Fusion ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Upper Cervical

A posterior occipitocervical fusion with a novel fixation device developed at Sytenko Institute for Spine and Joints Pathology and a technology of its application have been biomechanically substantiated. The analysis of surgeries in 6 patients with upper cervical spine injuries and disorders was performed. The results were assessed as excellent in 3 patients and good in 3 ones. Some criteria for comprehensive estimation of clinical effectiveness of surgeries performed were proposed.

scholarly journals Tumoral Calcinosis of the Cervical Spine Associated with a Pathologic Odontoid Fracture

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Andy Y. Wang ◽  
Joseph N. Tingen ◽  
Eric J. Mahoney ◽  
Ron I. Riesenburger
Keyword(s):  
Cervical Spine ◽  
Soft Tissues ◽  
Odontoid Fracture ◽  
Tumoral Calcinosis ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
First Case ◽  
Pathologic Fractures ◽  
Upper Cervical ◽  
Calcium Deposits

Tumoral calcinosis involves focal calcium deposits in the soft tissues surrounding a joint and most commonly occurs in the hips and elbows, rarely in the cervical spine. Furthermore, it has not been known to be associated with pathologic fractures. To the best of our knowledge, our case report highlights the first case of a pathologic type II odontoid fracture associated with adjacent tumoral calcinosis, resulting in pain, dysphagia, and severe spinal stenosis. The patient underwent a posterior occipitocervical fusion and C1 laminectomy, along with planned tracheostomy and gastrostomy to avoid expected difficulty with postoperative extubation and dysphagia. Additionally, we present a review of existing literature on tumoral calcinosis in the upper cervical spine.

Numerical investigation on the stability of human upper cervical spine (C1–C3)

2021 ◽  
pp. 1-13
Author(s):  
Waseem Ur Rahman ◽  
Wei Jiang ◽  
Guohua Wang ◽  
Zhijun Li
Keyword(s):  
Finite Element ◽  
Cervical Spine ◽  
Axial Rotation ◽  
Upper Cervical Spine ◽  
Fe Model ◽  
Facet Joints ◽  
Flexion Extension ◽  
Upper Cervical ◽  
The Stability

BACKGROUND: The finite element method (FEM) is an efficient and powerful tool for studying human spine biomechanics. OBJECTIVE: In this study, a detailed asymmetric three-dimensional (3D) finite element (FE) model of the upper cervical spine was developed from the computed tomography (CT) scan data to analyze the effect of ligaments and facet joints on the stability of the upper cervical spine. METHODS: A 3D FE model was validated against data obtained from previously published works, which were performed in vitro and FE analysis of vertebrae under three types of loads, i.e. flexion/extension, axial rotation, and lateral bending. RESULTS: The results show that the range of motion of segment C1–C2 is more flexible than that of segment C2–C3. Moreover, the results from the FE model were used to compute stresses on the ligaments and facet joints of the upper cervical spine during physiological moments. CONCLUSION: The anterior longitudinal ligaments (ALL) and interspinous ligaments (ISL) are found to be the most active ligaments, and the maximum stress distribution is appear on the vertebra C3 superior facet surface under both extension and flexion moments.

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 Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor

BMC Surgery ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Jun Zou ◽  
Chenxi Yuan ◽  
Ruofu Zhu ◽  
Zhiming Zhang ◽  
Weimin Jiang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Upper Cervical Spine ◽  
Spine Tumor ◽  
Occipitocervical Fusion ◽  
Rod System ◽  
Upper Cervical ◽  
Cervical Spine Tumor

scholarly journals Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

2021 ◽  
Vol 12 ◽  
pp. 524
Author(s):  
Enyinna Nwachuku ◽  
Confidence Njoku-Austin ◽  
Kevin P. Patel ◽  
Austin W. Anthony ◽  
Aditya Mittal ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Collar ◽  
Occipital Condyle ◽  
Type I ◽  
Occipitocervical Fusion ◽  
Orthopedic Injury ◽  
Trauma Population ◽  
Cervical Orthosis ◽  
Cervical Spine Fractures ◽  
Occipital Condyle Fractures

Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

Navigated Anterior Approach to the Upper Cervical Spine After Occipitocervical Fusion

Spine ◽  
2009 ◽  
Vol 34 (22) ◽  
pp. E800-E805 ◽  
Author(s):  
Masashi Neo ◽  
Ryo Asato ◽  
Shunsuke Fujibayashi ◽  
Hiromu Ito ◽  
Mitsuru Takemoto ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Anterior Approach ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Upper Cervical

scholarly journals Incidence and Variants of Posterior Arch Defects of the Atlas Vertebra

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Sebastian Guenkel ◽  
Sladjana Schlaepfer ◽  
Sonja Gordic ◽  
Guido A. Wanner ◽  
Hans-Peter Simmen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Congenital Anomalies ◽  
Caucasian Population ◽  
Ct Scans ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Anterior Arch ◽  
Predominant Type ◽  
Upper Cervical ◽  
Posterior Arch Defects

In order to describe the incidence and existing variants of congenital anomalies of the atlas vertebrae in a Caucasian population, we examined 1069 CT scans of the upper cervical spine. We found 41 cases with altered atlas vertebrae, representing 3.8% of all analyzed patients. With 83% of all found anomalies, the predominant type is characterized by a small dorsal cleft (3.2% of all patients). Rare varieties feature unilateral or bilateral dorsal arch defects, combined anterior and posterior clefts (0.2% of all patients) or total erratic atlas vertebra malformation (0.1% of all patients). Atlas arch defects are found nearly 4% at the time. Most anomalies affect the posterior arch, whereas the anterior arch or both are rarely affected. Totally irregular C1 vertebrae are extremely infrequent.

Sign in / Sign up

Export Citation Format

Share Document