Traumatic atlantooccipital dislocation

1977 ◽  
Vol 46 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Alan H. Fruin ◽  
Thomas P. Pirotte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Upper Cervical Spine ◽  
Nerve Injuries ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Upper Cervical ◽  
Cranial Nerve Injuries ◽  
Atlantooccipital Dislocation ◽  
Fine Print

✓ A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.

Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival

1980 ◽  
Vol 52 (4) ◽  
pp. 541-546 ◽  
Author(s):  
Arthur B. Dublin ◽  
William M. Marks ◽  
David Weinstock ◽  
Thomas H. Newton
Keyword(s):  
Systemic Hypertension ◽  
Nerve Injuries ◽  
Short Term ◽  
Term Survival ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Cranial Nerve Injuries ◽  
Angiographic Evidence ◽  
Fine Print ◽  
Short Term Survival

✓ Three patients with traumatic atlanto-occipital articulation (AOA) dislocation are presented, and an additional 10 well documented cases are reviewed from the literature. Medulla oblongata and/or spinal cord deficits, and evidence of cranial nerve injuries were noted in eight patients. Angiographic evidence of vertebral occlusion or narrowing was demonstrated in four patients. One patient had systemic hypertension, presumably from bilateral traumatic ninth nerve injuries. Five patients ultimately died. A new method for measuring the AOA is introduced.

Therapeutic trial of hypercarbia and hypocarbia in acute experimental spinal cord injury

1984 ◽  
Vol 61 (5) ◽  
pp. 925-930 ◽  
Author(s):  
Ronald W. J. Ford ◽  
David N. Malm
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Mortality Rates ◽  
Therapeutic Trial ◽  
Tissue Preservation ◽  
Content Type ◽  
Experimental Spinal Cord Injury ◽  
Cord Injury ◽  
Fine Print

✓ Hypocarbia, normocarbia, or hypercarbia was maintained for an 8-hour period beginning 30 minutes after acute threshold spinal cord injuries in cats. No statistically significant differences in neurological recovery or histologically assessed tissue preservation were found among the three groups of animals 6 weeks after injury. No animal recovered the ability to walk. It is concluded that maintenance of hypercarbia or hypocarbia during the early postinjury period is no more therapeutic than maintenance of normocarbia. Mortality rates and tissue preservation data suggest, however, that postinjury hypocarbia may be less damaging than hypercarbia.

Late neurological changes following traumatic spinal cord injury

1988 ◽  
Vol 69 (3) ◽  
pp. 399-402 ◽  
Author(s):  
Joseph M. Piepmeier ◽  
N. Ross Jenkins
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Neurological Status ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.

Fractures of the C-2 vertebral body

1994 ◽  
Vol 81 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Body Fracture ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Type 3 ◽  
Fine Print

✓ Vertical C-2 body fractures are presented in 15 patients with clinical and imaging correlations that suggest the existence of a variety of mechanisms of injury. In these patients, clinical and imaging correlations were derived by: 1) defining the point of impact by clinical examination; 2) defining the point of impact by soft-tissue changes on cranial magnetic resonance (MR) imaging or computerized tomography (CT); 3) obtaining an accurate history of the mechanism of injury; and 4) spine imaging (x-ray studies, CT, and MR imaging) of the C-2 body fracture and surrounding bone and soft tissue. The cases presented involve the region located between the dens and the pars interarticularis of the axis. Although these fractures are rarely reported, they are not uncommon. An elucidation of their pathological anatomy helps to further the understanding of the mechanistic etiology of upper cervical spine trauma. A spectrum of mechanisms of injury causing upper cervical spine fractures was observed. The type of injury incurred is determined predominantly by the force vector applied during impact and the intrinsic strength and anatomy of C-2 and its surrounding spinal elements. From this clinical experience, two types of vertical C-2 body fractures are defined and presented: coronally oriented (Type 1) and sagittally oriented (Type 2). A third type of C-2 body fracture, the horizontal rostral C-2 fracture (Type 3), is added for completeness; this Type 3 fracture is the previously described Type III odontoid process fracture described by Anderson and D'Alonzo.

The pathophysiological response to spinal cord injury

1974 ◽  
Vol 40 (1) ◽  
pp. 3-33 ◽  
Author(s):  
Jewell L. Osterholm
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Controversial Issues ◽  
Content Type ◽  
Cord Injury ◽  
Injury Research ◽  
Fine Print

✓ In this review of spinal cord injury research, the author has selected contributions which in his opinion best represent modern experimental concepts regarding the mechanism and management of spinal cord injuries. He has placed special emphasis on the controversial issues appropriate to a new, stimulating, and competitive area of research.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Risk of persistent cranial nerve injury after carotid endarterectomy

2004 ◽  
Vol 101 (3) ◽  
pp. 445-448 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Rick Bond ◽  
Marc R. Mayberg ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Content Type ◽  
Before And After ◽  
Cranial Nerve Injury ◽  
Cranial Nerve Injuries ◽  
Fine Print

Object. Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist. Methods. The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1–6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9–4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Horner syndrome. In only nine patients (0.5%; 95% CI 0.24–0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001). Conclusions. The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.

Prediction of mobility gains in patients with cervical spinal cord injuries

1976 ◽  
Vol 45 (6) ◽  
pp. 677-682 ◽  
Author(s):  
Robert L. Mason ◽  
Richard F. Gunst
Keyword(s):  
Spinal Cord ◽  
Motor Skills ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Neurological Status ◽  
Prediction Equation ◽  
Predictor Variables ◽  
Content Type ◽  
Mobility Score ◽  
Fine Print

✓ A measure of mobility for patients with spinal cord injuries is introduced that is very useful in determining patient recovery. The index is used to obtain a prediction equation for motor skills 1 year after injury. Important predictor variables identified include the patient's sex, rectal status, total reflexes, two treatment combinations, motor and sensory neurological history since injury, neurological status, and initial mobility score. Interpretations are made to explain the meaning of the contributions of these variables and show the usefulness of the prediction equation.

Spontaneous and electrically-evoked activity in the anterolateral column of the spinal cord in dogs

1974 ◽  
Vol 40 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Robin D. Illingworth ◽  
Pedro Molina-Negro
Keyword(s):  
Spinal Cord ◽  
Body Image ◽  
Content Type ◽  
Percutaneous Cordotomy ◽  
Upper Cervical ◽  
Anesthetized Dogs ◽  
Different Depths ◽  
Evoked Activity ◽  
Electrical Skin ◽  
Fine Print

✓ Recordings have been made from the upper cervical spinal cords of 14 intact anesthetized dogs. Small bipolar concentric electrodes were passed from posterior to anterior and the spontaneous electrical activity at different depths recorded. It has been shown that there is a difference between the activity recorded in the gray and white matter and between different regions in the gray matter. Responses evoked by contralateral electrical skin stimulation have also been recorded in the anterolateral columns. The results obtained suggest that the fibers may be arranged in the tract as a model of body image rather than segmentally. All the trajectories used in this study have been verified histologically. Possible application of this technique to the procedure of percutaneous cordotomy is discussed.

Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients

1999 ◽  
Vol 90 (1) ◽  
pp. 206-219 ◽  
Author(s):  
Eduardo Salas ◽  
Laligam N. Sekhar ◽  
Ibrahim M. Ziyal ◽  
Anthony J. Caputy ◽  
Donald C. Wright
Keyword(s):  
Cervical Spine ◽  
Medulla Oblongata ◽  
Sigmoid Sinus ◽  
Vascular Lesions ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Bypass Procedure ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Fine Print

Object. The aim of this study was to describe six variations of the extreme-lateral craniocervical approach, their application, and treatment results. Methods. During a 4-year period 69 patients underwent surgery in which six variations of the extreme-lateral craniocervical approach were performed. The variations included: the transfacetal approach (TFA), performed to treat four lesions in the upper cervical spine anterior or anterolateral to the spinal cord; the retrocondylar approach, to treat five intradural lesions located anterolateral to the medulla oblongata and six vascular lesions to expose the extradural segment of the vertebral artery (VA); the partial transcondylar approach (PTCA), to treat 18 intradural lesions located anterior to the medulla oblongata; the complete transcondylar approach (CTCA), to treat 13 extradural lesions that involved the lower clivus and anterior upper cervical spine; the extreme-lateral transjugular approach, to treat 14 jugular foramen tumors; and the transtubercular approach with or without division of the sigmoid sinus, to treat complex VA and vertebrobasilar junction aneurysms. An anatomical prosection was performed to study the surgical exposure of each of the six variations of the extreme-lateral craniocervical approach. Total removal was achieved in 35 (69%) of the patients with tumor; subtotal resection was achieved in 16 (31%) of those patients. In the 12 patients with VA aneurysms, seven underwent clipping, three underwent trapping and a vein graft bypass procedure, and two underwent trapping without the use of a bypass procedure. In five other patients, different cystic, inflammatory, and other vascular lesions were successfully treated. Fifty percent of the patients who underwent surgery via the TFA, 83% via the of the CTCA, and 11% via the PTCA required an occipitocervical fusion procedure. The mean Karnofsky Performance Scale score was 74.7 preoperatively and 76.4 postoperatively. Major complications were hydrocephalus (nine patients), cerebrospinal fluid leakage (seven patients), worsened cranial nerve function (seven patients), vertebrobasilar vasospasm (one patient), and sigmoid sinus thrombosis (one patient). Conclusions. To treat lesions in the region of the foramen magnum and surrounding areas, the approach should be tailored to each specific lesion to provide the needed exposure without unnecessary operative steps.

Sign in / Sign up

Export Citation Format

Share Document