scholarly journals Odontoid Resorption After Posterior Occipitocervical Fusion in Rheumatoid Basilar Invagination

2021 ◽  
pp. 1-3
Author(s):  
Ben Garrido ◽  
◽  
Cristian Balcescu ◽  
Jesse Caballero ◽  
Michael McCarthy ◽  
...  
Keyword(s):  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Retrospective Case ◽  
Occipitocervical Fusion ◽  
Posterior Surgery ◽  
Increased Risk ◽  
Single Posterior Approach ◽  
Transoral Decompression

Background Context: Inflammatory arthritis of the cervical spine is common and begins early after the onset of rheumatoid arthritis. Atlantoaxial instability is the most common pattern followed by cranial settling or basilar invagination, with subaxial subluxation being least common. Vertical migration of the odontoid (basilar invagination) poses an increased risk of sudden death from compression of the brain stem. A combination of transoral decompression and posterior occipitocervical fusion has been described, although a single posterior approach stabilization may suffice and avoid the associated comorbidities with an anterior/posterior surgery in a high-risk rheumatoid patient. Purpose: To report a case of odontoid resorption and cervicomedullary angle improvement after occipitocervical fusion. Study Design: A retrospective case report. Methods: Radiographic analysis. Results: After posterior occipitocervical fusion alone for basilar invagination there was a reduction of cervicomedullary angle to 127 degrees at 3 years follow up. This was improved from an initial 115 degrees through odontoid remodeling. Conclusions: Basilar invagination treated with posterior alone occipitocervical stabilization may suffice in providing stability and long term decompression of the cervicomedullary junction through resorption and remodeling of the odontoid. This case study supports the viability of avoiding a transoral resection for an irreducible severely migrated odontoid.

Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion

2012 ◽  
Vol 10 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Robert J. Bollo ◽  
Jay Riva-Cambrin ◽  
Meghan M. Brockmeyer ◽  
Douglas L. Brockmeyer
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Basilar Invagination ◽  
Preoperative Imaging ◽  
Type I ◽  
Occipitocervical Fusion ◽  
Chiari Malformation Type I ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Brainstem Compression

Object Chiari malformation Type I (CM-I) is a congenital anomaly often treated by decompressive surgery. Patients who fail to respond to standard surgical management often have complex anomalies of the craniovertebral junction and brainstem compression, requiring reduction and occipitocervical fusion. The authors hypothesized that a subgroup of “complex” patients defined by specific radiographic risk factors may have a higher rate of requiring occipitocervical fusion. Methods A retrospective review was conducted of clinical and radiographic data in pediatric patients undergoing surgery for CM-I between 1995 and 2010. The following radiographic criteria were identified: scoliosis, syringomyelia, CM Type 1.5, medullary kinking, basilar invagination, tonsillar descent, craniocervical angulation (clivoaxial angle [CXA] < 125°), and ventral brainstem compression (pB–C2 ≥ 9 mm). A multivariate Cox regression analysis was used to determine the independent association between occipitocervical fusion and each variable. Results Of the 206 patients who underwent CM decompression with or without occipitocervical fusion during the study period, 101 had preoperative imaging available for review and formed the study population. Mean age at surgery was 9.1 years, and mean follow-up was 2.3 years. Eighty-two patients underwent suboccipital decompression alone (mean age 8.7 years). Nineteen patients underwent occipitocervical fusion (mean age 11.1 years), either as part of the initial surgical procedure or in a delayed fashion. Factors demonstrating a significantly increased risk of requiring fusion were basilar invagination (HR 9.8, 95% CI 2.2–44.2), CM 1.5 (HR 14.7, 95% CI 1.8–122.5), and CXA < 125° (HR 3.9, 95% CI 1.2–12.6). Conclusions Patients presenting with basilar invagination, CM 1.5, and CXA < 125° are at increased risk of requiring an occipitocervical fusion procedure either as an adjunct to initial surgical decompression or in a delayed fashion. Patients and their families should be counseled in regard to these findings as part of a preoperative CM evaluation.

Cochlear implantation in children with Jervell, Lange-Nielsen syndrome

2007 ◽  
Vol 122 (3) ◽  
pp. 314-317 ◽  
Author(s):  
A Daneshi ◽  
M M Ghassemi ◽  
M Talee ◽  
S Hassanzadeh
Keyword(s):  
Cochlear Implantation ◽  
Deaf Children ◽  
Retrospective Case ◽  
Profound Hearing Loss ◽  
Long Term Performance ◽  
Retrospective Case Study ◽  
Term Performance

AbstractJervell, Lange-Nielsen syndrome is a condition that causes profound hearing loss and disruption of the normal cardiac rhythm. This disorder is a form of long QT syndrome, a cardiac disorder that causes the cardiac muscle to take longer than usual to recharge between beats. A retrospective case study was performed to document cochlear implantation in three profoundly deaf children (two of them siblings) with Jervell, Lange-Nielsen syndrome. We discuss diagnosis and management of this syndrome and also the long-term performance of cochlear implantation in these Iranian patients, referring especially to the role of the ENT specialist in diagnosis and treatment. The collected data show that cochlear implantation can be relatively safely performed in patients with Jervell, Lange-Nielsen syndrome and that these children received significant benefit from cochlear implantation.

Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery

2002 ◽  
Vol 97 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Moses Joseph Arunkumar ◽  
Vedantam Rajshekhar
Keyword(s):  
Craniovertebral Junction ◽  
Neurological Deficits ◽  
Retropharyngeal Abscess ◽  
Occipitocervical Fusion ◽  
Limb Weakness ◽  
Long Term Outcome ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

Object. The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical fusion, and antituberculous therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. Methods. In this retrospective study, the authors reviewed the management and outcome in nine consecutive patients in whom features of spinal cord compression were observed and CVJ tuberculosis was diagnosed between 1993 and 1999. They ranged in age from 9 to 55 years. Onset of symptoms was acute or subacute and rapidly progressive (median 4 months, range 1–12 months). Patients presented with neck pain (89%), progressive limb weakness (89%), sensory symptoms (22%), and urinary dysfunction (33%). The mean preoperative functional grade based on the Nurick Scale was 3.4 (range 1–5). The disease caused reducible atlantoaxial dislocation (AAD) in three patients (33%), irreducible AAD in two (22%), basilar impression (BI) in one (11%), AAD with BI in one (11%), and C-2 vertebral body (VB) destruction without dislocation in two (22%). Surgery was performed in all cases. Five patients (56%) underwent transoral odontoidectomy, two (22%) transoral decompression of retropharyngeal abscess and granulation tissue, and two (22%) transoral decompression of abscess and diseased parts of the C-2 VB. All patients then underwent occipitocervical (occiput—C3) fusion in which a contoured Steinmann pin and iliac bone grafts were used. Postoperatively, ATT was prescribed for 18 months. In the immediate postoperative period, function in these patients improved from a mean Nurick grade of 3.4 to 2.3 (p < 0.01). At long-term follow-up examination (median 18.8 months, range 7–46 months) function improved from a mean Nurick grade of 3.4 to 0.3 (range 0–2) (p < 0.001). Conclusions. Patients with CVJ tuberculosis with features of cervical myelopathy are ideally managed with transoral decompressive procedures followed by occipitocervical fusion because this therapy provides immediate neurological improvement, stability, and allows early mobilization. The long-term prognosis in patients with this disease is excellent provided it is treated with appropriate surgical intervention(s) and with adequate duration of ATT.

scholarly journals Long-term outcome of autistic spectrum disorder: a retrospective case study in a southern italian region

2017 ◽  
Vol 43 (1) ◽  
Author(s):  
Francesca Felicia Operto ◽  
Federica Martino ◽  
Annalisa Rinaldi ◽  
Angelo Cerracchio ◽  
Giovanni Salvati ◽  
...  
Keyword(s):  
Autistic Spectrum Disorder ◽  
Spectrum Disorder ◽  
Italian Region ◽  
Retrospective Case ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Autistic Spectrum ◽  
Retrospective Case Study

Inflammatory bowel disease and the craniocervical junction

1999 ◽  
Vol 6 (6) ◽  
pp. E12 ◽  
Author(s):  
Timothy Ryken ◽  
Arnold Menezes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fusion ◽  
Long Term Follow Up ◽  
History Of ◽  
Inflammatory Bowel

Rheumatological complications have been described in up to 30% of patients being followed for inflammatory bowel disease. The majority of these complications occur as spondylitic changes in the lumbar spine. Erosive arthritic disease associated with inflammatory bowel disease occurs less frequently, but it can result in ligamentous laxity and joint instability. To highlight the potential significance of the process at the craniocervical junction, the authors describe the long-term follow-up care of a complicated case. A 56-year-old woman, with a long history of ulcerative colitis, presented with atlantoaxial instability and underwent a C1-3 fusion; however, the presence of significant occipitoatlantal instability was not recognized. This resulted in high cervicomedullary quadriplegia, requiring traction reduction and a combined anterior transoral decompressive-posterior occipitocervical fusion. The patient's neurological deficit completely resolved postoperatively.

Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients

2007 ◽  
Vol 7 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Russ P. Nockels ◽  
Christopher I. Shaffrey ◽  
Adam S. Kanter ◽  
Syed Azeem ◽  
Julie E. York
Keyword(s):  
Internal Fixation ◽  
Posterior Instrumentation ◽  
Basilar Invagination ◽  
Long Term Results ◽  
Occipitocervical Fusion ◽  
Rigid Internal Fixation ◽  
Flexion Extension ◽  
Diverse Patient Population

Object. Instability of the occipitocervical junction may result from degenerative disease, infection, tumor, and trauma. Surgical stabilization involving screw fixation and rigid implants has been found to be biomechanically superior to wire-based implants. To evaluate the long-term results in a large and diverse patient population, the authors prospectively studied a consecutive group of 69 patients. Methods. All patients underwent occipitocervical fusion in which rigid posterior instrumentation included either plates or rods and screws. Patients ranged in age from 11 to 90 years (mean 51.4 years); there were 34 female and 35 male patients. The mean follow-up duration was 37 months (range 6–66 months). Fifty-seven (83%) of the 69 patients had long-standing occipitocervical anomalies, whereas the remainder presented with acute instability. Basilar invagination was present in 20 patients. Results. Correction of a severe cervical kyphotic deformity was accomplished in six patients. There were no fatalities or medical complications associated with the procedures. During the follow-up period, 87% of the patients exhibited improvement in their myelopathic symptoms; in 13% the symptoms were unchanged. Complications were minimal. Stability was demonstrated on flexion/extension studies in all cases. There were no treatment-related deaths, although four patients died within the follow-up period, all due to progression of metastatic disease. Conclusions. The authors found that rigid internal fixation of the occipitocervical complex was safe, effective, and technically possible for spine surgeons familiar with occipital bone anatomy and lateral mass fixation.

Caregivers' Perceptions of Speech-Language Pathologist Talk About Child Language and Literacy Disorders

2020 ◽  
Vol 29 (4) ◽  
pp. 2049-2067
Author(s):  
Karmen L. Porter ◽  
Janna B. Oetting ◽  
Loretta Pecchioni
Keyword(s):  
Language And Literacy ◽  
Collective Case Study ◽  
Study Approach ◽  
School Aged Children ◽  
Speech Language Pathologist ◽  
Therapy Goals ◽  
Semistructured Interviews ◽  
Types Of Information

Purpose This study examined caregiver perceptions of their child's language and literacy disorder as influenced by communications with their speech-language pathologist. Method The participants were 12 caregivers of 10 school-aged children with language and literacy disorders. Employing qualitative methods, a collective case study approach was utilized in which the caregiver(s) of each child represented one case. The data came from semistructured interviews, codes emerged directly from the caregivers' responses during the interviews, and multiple coding passes using ATLAS.ti software were made until themes were evident. These themes were then further validated by conducting clinical file reviews and follow-up interviews with the caregivers. Results Caregivers' comments focused on the types of information received or not received, as well as the clarity of the information. This included information regarding their child's diagnosis, the long-term consequences of their child's disorder, and the connection between language and reading. Although caregivers were adept at describing their child's difficulties and therapy goals/objectives, their comments indicated that they struggled to understand their child's disorder in a way that was meaningful to them and their child. Conclusions The findings showed the value caregivers place on receiving clear and timely diagnostic information, as well as the complexity associated with caregivers' understanding of language and literacy disorders. The findings are discussed in terms of changes that could be made in clinical practice to better support children with language and literacy disorders and their families.

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