Further cranial settling of the upper cervical spine following odontoidectomy

2001 ◽  
Vol 95 (2) ◽  
pp. 246-249 ◽  
Author(s):  
Sait Naderi ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Content Type ◽  
Fusion Procedure ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Additional Surgery ◽  
Upper Cervical

✓ A variety of diseases may affect the craniovertebral junction and require a decompressive and fusion procedure. Craniovertebral junction instability is expected after a fusion procedure. The authors describe two patients with basilar invagination who underwent transoral odontoidectomy and occipitocervical fixation. Despite an uneventful immediate postoperative course, further cranial settling of the C-2 vertebral body (VB) was demonstrated. One patient experienced neurological deterioration and required a second decompressive procedure, whereas the second patient was asymptomatic and required no additional surgery. It was concluded that the odontoidectomy may have led to horizontal separation of the C-1 lateral masses, resulting in further cranial settling of the C-2 VB. Preservation of one aspect of the C-1 anterior arch minimizes C-1 lateral mass offset and, in turn, further cranial settling of the C-2 VB. In addition, a more rigid fixation of C-2 may minimize the possibility of horizontal separation of the C-1 lateral masses after transoral odontoidectomy.

Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

Endoscopic Transnasal Transclival Odontoidectomy: A New Approach to Decompression: Technical Case Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONSE92-ONSE94 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Henrich Cheng ◽  
Muh-Lii Liang ◽  
Ching-Yin Ho ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
New Approach ◽  
Prolonged Intubation ◽  
Less Invasive ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Lateral Mass Screws

Abstract Objective: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression. Clinical Presentation: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention. Intervention: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted. Conclusion: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation

2007 ◽  
Vol 7 (4) ◽  
pp. 444-449 ◽  
Author(s):  
Ricardo V. Botelho ◽  
Eliseu B. Neto ◽  
Gustavo C. Patriota ◽  
Jefferson W. Daniel ◽  
Paulo A. S. Dumont ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Vertical Position ◽  
Occipitocervical Fixation ◽  
Cervical Traction ◽  
Craniocervical Instability

✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.

Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study

1999 ◽  
Vol 90 (1) ◽  
pp. 91-98 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
Robert F. Spetzler ◽  
Volker K. H. Sonntag ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Biomechanical Study ◽  
Occipital Condyle ◽  
Upper Cervical Spine ◽  
Lateral Bending ◽  
Content Type ◽  
Axial Translation ◽  
Flexion Extension ◽  
Fine Print

Object. The authors sought to determine the biomechanics of the occipitoatlantal (occiput [Oc]—C1) and atlantoaxial (C1–2) motion segments after unilateral gradient condylectomy. Methods. Six human cadaveric specimens (skull with attached upper cervical spine) underwent nondestructive biomechanical testing (physiological loads) during flexion—extension, lateral bending, and axial rotation. Axial translation from tension to compression was also studied across Oc—C2. Each specimen served as its own control and underwent baseline testing in the intact state. The specimens were then tested after progressive unilateral condylectomy (25% resection until completion), which was performed using frameless stereotactic guidance. At Oc—C1 for all motions that were tested, mobility increased significantly compared to baseline after a 50% condylectomy. Flexion—extension, lateral bending, and axial rotation increased 15.3%, 40.8%, and 28.1%, respectively. At C1–2, hypermobility during flexion—extension occurred after a 25% condylectomy, during axial rotation after 75% condylectomy, and during lateral bending after a 100% condylectomy. Conclusions. Resection of 50% or more of the occipital condyle produces statistically significant hypermobility at Oc—C1. After a 75% resection, the biomechanics of the Oc—C1 and C1–2 motion segments change considerably. Performing fusion of the craniovertebral junction should therefore be considered if half or more of one occipital condyle is resected.

Longitudinal atlantoaxial dislocation with type III odontoid fracture

1996 ◽  
Vol 84 (4) ◽  
pp. 666-670 ◽  
Author(s):  
Gregory J. Przybylski ◽  
William C. Welch
Keyword(s):  
Odontoid Fracture ◽  
Spine Injury ◽  
Upper Cervical Spine ◽  
Skeletal Traction ◽  
Radiographic Findings ◽  
Content Type ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Upper Cervical ◽  
Injury Treatment

✓ Odontoid fractures are a common traumatic upper cervical spine injury. Treatment of Type III odontoid fractures includes skeletal traction for realignment and halo vest immobilization. The authors report an unusual case of severe atlantoaxial ligamentous disruption accompanying a traumatic Type III odontoid fracture. Five pounds of skeletal traction was associated with marked neurological deterioration from unanticipated longitudinal instability. Radiographic findings were identified that were suggestive of extensive ligamentous disruption. Recommendations for individualized patient management are given in the context of related literature.

Bilateral posterolateral approach to mirror-image C-2 neurofibromas

2001 ◽  
Vol 94 (2) ◽  
pp. 292-298 ◽  
Author(s):  
Juan C. Bartolomei ◽  
H. Alan Crockard
Keyword(s):  
Nerve Root ◽  
Neurofibromatosis Type ◽  
Mirror Image ◽  
Posterolateral Approach ◽  
Time Interval ◽  
Upper Cervical Spine ◽  
Lower Extremity Weakness ◽  
Content Type ◽  
Upper Cervical ◽  
Acute Neurological Deterioration

✓ Multiple nerve root tumors are usually present in patients afflicted with neurofibromatosis Type 1. Although rare, upper cervical mirror-image neurofibromas have been reported in the medical literature, and their surgical management has been addressed in several reports; however, little has been mentioned or is known regarding upper cervical or craniocervical stability following resection of these tumors. In this report the authors describe four cases of large mirror-image C-2 neurofibromas resected in two stages via the posterolateral approach. One patient presented with acute neurological deterioration after a biopsy sample had been obtained, whereas the other three presented with gradual onset of lower-extremity weakness over several months. The time interval between the first and second decompressive surgery ranged from 10 days to 12 weeks. There were no surgery-related complications, and all patients recovered motor function in their extremities. During a follow-up period of 16 to 36 months, there was no clinical or radiological evidence of upper cervical spine instability. Although the series is too small to draw any definitive conclusions, in the authors' experience the posterolateral approach provides a direct route for the successful surgical treatment of bilateral craniocervical nerve root tumors without destabilizing the upper cervical segments.

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.

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