scholarly journals Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

2021 ◽  
Vol 2 (15) ◽  
Author(s):  
Christopher F. Dibble ◽  
Saad Javeed ◽  
Justin K. Zhang ◽  
Brenton Pennicooke ◽  
Wilson Z. Ray ◽  
...  
Keyword(s):  
Odontoid Fracture ◽  
Atlantoaxial Subluxation ◽  
Illustrative Case ◽  
Lateral Mass ◽  
Mass Reduction ◽  
Uncommon Presentation ◽  
Cervical Traction ◽  
Spine Surgeon ◽  
Type 3 ◽  
Neurologically Intact

BACKGROUND Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact. Serial cervical traction was placed with minimal radiographic reduction. Ultimately, she underwent intraoperative reduction, instrumentation, and fusion. Freehand C1 lateral mass reduction screws were placed, then C2 translaminar screws, and finally lateral mass screws at C3 and C4. The C2–4 instrumentation was used as bilateral rod anchors to reduce the C1 lateral mass reduction screws engaged onto the subluxated atlantodental complex. As a final step, cortical allograft spacers were inserted at C1–2 under compression to facilitate long-term stability and fusion. LESSONS This is the first description of a technique using extended tulip cervical reduction screws to correct traction-irreducible atlantoaxial subluxation. This case is a demonstration of using intraoperative tools available for the spine surgeon managing complex cervical injuries requiring intraoperative reduction that is resistant to traction reduction.

scholarly journals Hemiparesis resulting from an unusual C1 fracture: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 449
Author(s):  
Sung-Joo Yuh ◽  
Zhi Wang ◽  
Ghassan Boubez ◽  
Daniel Shedid
Keyword(s):  
Cord Compression ◽  
Surgical Decompression ◽  
Neurological Deficits ◽  
Lateral Mass ◽  
Computed Tomography Scan ◽  
Instrumented Fusion ◽  
Jefferson Fracture ◽  
Type 3 ◽  
Neurologically Intact ◽  
Tomography Scan

Background: Jefferson fractures are burst fractures involving both the anterior and posterior arches of C1. They typically result from axial compression or hyperextension injuries. Most are stable, and neurological deficits are rare. They are often successfully treated with external immobilization, but require surgery (e.g., fusion/ stabilization). Case Description: An 89-year-old male presented with a left-sided hemiplegia following a trivial fall. The cervical computed tomography scan revealed a left-sided displaced comminuted C1 fracture involving the arch and lateral mass. The MR revealed posterior cord compression and focal myelomalacia. Six months following an emergent C1–C3 decompression with occiput to C4 instrumented fusion, the patient was neurologically intact and pain-free. Conclusion: An 89-year-old male presented with a left-sided hemiplegia due to a Type 3/4 C1 Jefferson fracture. Following posterior C1–C3 surgical decompression with C0–C4 instrumented fusion, the patient sustained a complete bilateral motor recovery.

Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis. Part I. Clinical, radiological, and neuropathological features

1997 ◽  
Vol 87 (6) ◽  
pp. 856-862 ◽  
Author(s):  
Adrian T. H. Casey ◽  
H. Alan Crockard ◽  
Jennian F. Geddes ◽  
John Stevens
Keyword(s):  
Cervical Myelopathy ◽  
Survival Rates ◽  
Cord Compression ◽  
Atlantoaxial Subluxation ◽  
Lateral Mass ◽  
Progressive Decrease ◽  
Content Type ◽  
Statistical Comparison ◽  
High Cervical ◽  
Fine Print

✓ This statistical comparison between patients with cervical myelopathy secondary to horizontal atlantoaxial subluxation and those with vertical translocation is designed to elucidate the mechanisms responsible for cranial settling and the effect of translocation on the development of spinal cord compression. In a 10-year study of a cohort of 256 patients, 186 suffered from myelopathy and 116 (62%) of these exhibited vertical translocation according to the Redlund-Johnell criteria. Vertical translocation occurred after a significantly longer period of disease than atlantoaxial subluxation (p < 0.001). Translocation was characterized clinically by a high cervical myelopathy with features of a cruciate paralysis present in 35% of individuals compared with 26% who exhibited horizontal atlantoaxial subluxation (p = 0.29), but there was a surprising paucity of cranial nerve problems. The patients with vertical translocation had a greater degree of neurological disability (p = 0.002) and poorer survival rates (p = 0.04). Radiologically, vertical translocation was secondary to lateral mass collapse and associated with a progressive decrease in the atlantodens interval ([ADI], r = 0.4; p < 0.001) and pannus (p = 0.003). Thirty percent of patients exhibited an ADI of less than 5 mm. This phenomenon has been termed pseudostabilization. The authors' studies emphasize that the ADI (frequently featured in the literature) is totally unreliable as an indicator of neuraxial compromise in the presence of vertical translocation.

scholarly journals Painful torticollis due to tubercular atlantoaxial rotatory fixation: A case report

2020 ◽  
Vol 11 ◽  
pp. 440
Author(s):  
Abolfazl Rahimizadeh ◽  
Walter Williamson ◽  
Shaghayegh Rahimizadeh ◽  
Mahan Amirzadeh
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Laboratory Tests ◽  
Rare Event ◽  
Lateral Mass ◽  
Case Description ◽  
Mass Reduction ◽  
Iliac Bone Graft ◽  
Atlantoaxial Rotatory Fixation ◽  
Rotatory Fixation

Background: Tubercular atlantoaxial, rotary dislocation warranting fixation (AARF) is an extremely rare event. Case Description: AARF was suspected in a 23-year-old female with painful torticollis. When diagnostic studies documented unilateral destruction of the left lateral mass of the atlas, she underwent removal of the lateral mass, reduction of the deformity, and C1-C2 fusion/reconstruction utilizing an iliac bone graft. Laboratory tests and the pathologic surveys were all consistent with the diagnosis of underlying tuberculosis. Conclusion: We present a case of tubercular atlantoaxial, rotary dislocation (AARF) in a patient who warranted C1-C2 decompression, reduction, and fusion.

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

Odontoid Fracture

Neurosurgery ◽  
1981 ◽  
Vol 9 (6) ◽  
pp. 631-637 ◽  
Author(s):  
Chris E. U. Ekong ◽  
Michael L. Schwartz ◽  
Charles H. Tator ◽  
David W. Rowed ◽  
Virginia E. Edmonds
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Halo Vest ◽  
Cord Injury ◽  
Type 3 ◽  
Halo Device

Abstract Twenty-two patients with C-2 fractures involving the odontoid process were treated by immobilization in a halo device. Six had associated spinal cord injury (1 complete and 5 incomplete), and 16 had no spinal cord injury. The age of the patients ranged from 20 to 86 years, with a mean age of 53. There were 15 cases in which the fracture line went through the base of the odontoid process only (Type 2), 1 case with a Type 2 odontoid fracture associated with a Jefferson fracture, 4 in which the fracture line involved the body of C-2 (Type 3), and 2 cases with a Type 3 odontoid fracture associated with a Jefferson fracture. Eighteen of the patients were followed for at least 6 months (the mean follow-up period was approximately 2/12; years) to determine the results of bony fusion and neurological improvement. Three patients died early: 1 had no spinal cord injury and died of an associated head injury; 2 had spinal cord injuries and died of respiratory failure. One was lost to follow-up. Successful bony healing and stability at the fracture site as indicated by flexion and extension roentgenograms of the cervical spine were achieved in 10 (59%) of 17 patients treated with the halo ring and vest only. Early fusion was required in 1 patient, and late fusion was required in 5 patients. The remaining 2 patients refused operation. Improvement in neurological status was noted in all four surviving patients with spinal cord injury. and none of the patients without spinal cord injury developed a neurological deficit during the course of the halo treatment. The average duration of hospitalization was 27 days for those without spinal cord injury and 70 days for those with spinal cord injury. Complications related directly to the halo devices were few and minor and included scalp infection, pressure sores, loosening of the halo pins, and 1 case of osteomyelitis of the skull. We found that the halo device is useful for immobilizing the cervical spine even in the presence of diminished sensation over the trunk. Except for the presence of certain types of coexisting head injury, an absolute contraindication to its use has not been encountered. The major advantage of the halo vest is that it allows external maneuvering of bony injuries in all three planes followed by fixation when acceptable reduction is attained without the need for early operation in patients who may already be very ill. The halo vest also allows early mobilization of patients and early discharge from the hospital.

scholarly journals Posterior Temporary Fixation of C1-2 Screw-rod System for Unstable C1 Burst Fracture

2020 ◽  
Author(s):  
Yun-lin Chen ◽  
Xu-dong Hu ◽  
Yang Wang ◽  
Wei-yu Jiang ◽  
Wei-hu Ma
Keyword(s):  
Burst Fracture ◽  
Implant Removal ◽  
Alternative Technique ◽  
Lateral Mass ◽  
Age At Surgery ◽  
Rod System ◽  
C2 Fixation ◽  
Type 3 ◽  
Rotation Function

Abstract Background Whether an unstable C1 burst fracture should be treated surgically or conservatively is controversial. The purpose of this study is to evaluate the effectiveness and motion-preserving function of temporary fixation of C1-2 screw-rod system for the reduction and fixation of unstable C1 burst fracture (type 3 and 4 according to the Gehweiler classification).Patients and Methods We retrospectively reviewed 10 patients who were treated with posterior temporary C1-C2 fixation. We assessed age at surgery, gender, pre- and post-operative VAS, NDI, atlanto-dens interval, lateral mass distance and rotation function of C1-C2 complex.Results 6 males and 4 females were included in our study. The average follow-up duration was 14.1± 1.37 months. The left-to-right ROMs of C1-C2 rotation was 9.6±1.42°. The pre-operative cervical VAS was 8.30±0.48; the post-operative cervical VAS of C1-C2 fusion was 2.90±0.57. The pre-operative VAS for removal was 2.0±0.00, the post-operative VAS for removal was 2.3±0.48; The pre-operative cervical NDI was 81.40%±2.07%, the post-operative cervical NDI of C1-C2 fusion was 18.10%±1.52%. The preoperative NDI for removal was 15.9%±1.20%, The post-operative NDI for removal was 14.5%±1.08%. The pre-operative ADI was 4.43±0.34mm, post-operative ADI was 1.94±0.72mm. The pre-operative LMD was 6.36±0.58mm, post-operative LMD was 1.64±0.31mm.Conclusion Posterior temporary C1-2 fixation can achieve a good fusion, satisfied reduction of C1 burst fracture, relieve the pain, improve the cervical function outcome, but may reduce the rotational ROM of C1-2. Temporary C1- C2 fixation is an alternative technique to manage the C1 burst fracture, but the need for implant removal needs to be questioned. For patients with CT scan before implant removal showing spontaneous fusion, they may potentially not profit from implant removal.

Delayed Neurological Deficit after Traumatic Odontoid Fracture

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Yesaya Yunus ◽  
Julius July ◽  
Lutfi Hendriansyah
Keyword(s):  
Neurological Deficit ◽  
Significant Risk ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Odontoid Fractures ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Cervical Traction

Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly.  If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy.We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation.Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients.All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture.

Delayed Neurological Deficit after Traumatic Odontoid Fracture

2018 ◽  
Vol 1 (2) ◽  
pp. 22
Author(s):  
Yesaya Yunus ◽  
Julius July
Keyword(s):  
Neurological Deficit ◽  
Significant Risk ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Odontoid Fractures ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Cervical Traction

Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly.  If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy.We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation.Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients.All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture. 

Traumatic Posterolateral C1-C2 Dislocation Complicated with Locked Lateral Mass and Type II Odontoid Fracture—5-Year Follow-up

2018 ◽  
Vol 114 ◽  
pp. 330-334 ◽  
Author(s):  
Zhu Minyu ◽  
Wu Shiyang ◽  
Chandoo Suraj ◽  
Huang Kelun ◽  
Lin Chaowei ◽  
...  
Keyword(s):  
Odontoid Fracture ◽  
Type Ii ◽  
Lateral Mass

scholarly journals Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note

2019 ◽  
Vol 10 ◽  
pp. 218
Author(s):  
Robert Sinurat
Keyword(s):  
Magnetic Resonance Image ◽  
Clinical Symptoms ◽  
Technical Note ◽  
Odontoid Fracture ◽  
Atlantoaxial Subluxation ◽  
Occipitocervical Fusion ◽  
Odontoid Fractures ◽  
Occipitocervical Fixation ◽  
Surgical Expertise

Background: To relieve the onset of new clinical symptoms, it is important to recognize and treat previously neglected odontoid fractures. However, many hospitals in developing countries do not have the equipment or surgical expertise to adequately manage these lesions. Case Description: A 31-year-old male presented with paresthesias/quadriparesis attributed to an accident sustained 6 months earlier. The cervical magnetic resonance image revealed atlantoaxial subluxation type 2. Following a laminectomy and occipitocervical fusion with a Ransford loop, the patient’s symptoms significantly improved. Conclusion: Straight forward laminectomy and occipitocervical fusion with a Ransford loop may adequately treat selected cases of neglected atlantoaxial subluxation in a developing country.

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