scholarly journals The application of C2 transpedicular screw, C1 laminar hook fixation and bone graft in the atlantoaxial instability

2021 ◽  
Vol 38 (2) ◽  
pp. 94-98
Author(s):  
Şükrü ORAL
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Surgical Techniques ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
X Rays ◽  
Advantages And Disadvantages ◽  
Transpedicular Screw ◽  
Flexion Extension ◽  
Laminar Hooks

Traumatic atlantoaxial instability usually results from a motor vehicle accident, falls and motorcycle accidents. Atlantoaxial instability can lead to spinal cord compression and neck pain, but, spasticity and radicular symptoms as well. The purpose of surgery is to remove the compression and stabilize the joint permanently. To date, several surgical techniques have been described to remedy C1-C2 instability. In this study, the clinical and radiological outcomes of patients who operated with the C1 (Atlas bone) laminar hooks fixation and bilateral C2 (Axis bone) trans-pedicular screw technique were shown. Also, the advantages and disadvantages of this technique are discussed. From March 2010 to December 2017, 12 patients who have atlantoaxial instability were surgically treated by modified fixation technique which consists C1 laminar hooks fixation and bilateral C2 transpedicular screw. Twelve patients were operated with this procedure from March 2010 to December 2017. All the patients were checked with flexion-extension x-rays at the end of the twelfth week. The posterior bony fusion formation was observed on imaging in all patients. C2 bilateral pedicle screw combined with C1 laminar hook system is a good method for atlantoaxial instability in the conditions which is not convenient for insertion of C1 lateral mass and C2 trans-articular screw. However, this method may not be available in some cases such as traumatic, infection, neoplastic or degenerative pathologies in which the posterior arch of the atlas is damaged.

scholarly journals Unilateral C-1 posterior arch screws and C-2 laminar screws combined with a 1-side C1–2 pedicle screw system as salvage fixation for atlantoaxial instability

2016 ◽  
Vol 24 (2) ◽  
pp. 315-320 ◽  
Author(s):  
Jin Guo-Xin ◽  
Wang Huan
Keyword(s):  
Biomechanical Testing ◽  
Pedicle Screws ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Lateral Bending ◽  
Significant Difference ◽  
Flexion Extension ◽  
Intact Condition ◽  
Atlantoaxial Fixation ◽  
Group B

OBJECT Atlantoaxial instability often requires surgery, and the current methods for fixation pose some risk to vascular and neurological tissues. Thus, new effective and safer methods are needed for salvage operations. This study sought to assess unilateral C-1 posterior arch screws (PASs) and C-2 laminar screws (LSs) combined with 1-side C1–2 pedicle screws (PSs) for posterior C1–2 fixation using biomechanical testing with bilateral C1–2 PSs in a cadaveric model. METHODS Six fresh ligamentous human cervical spines were evaluated for their biomechanics. The cadaveric specimens were tested in their intact condition, stabilization after injury, and after injury at 1.5 Nm of pure moment in 6 directions. The 3 groups tested were bilateral C1–2 PSs (Group A); left side C1–2 PSs with an ipsilateral C-1 PAS + C-2 laminar screw (Group B); and left side C1–2 PSs with a contralateral C-1 PAS + C-2 LS (Group C). During the testing, angular motion was measured using a motion capture platform. Data were recorded, and statistical analyses were performed. RESULTS Biomechanical testing showed that there was no significant difference among the stabilities of these fixation systems in flexion-extension and rotation control. In left lateral bending, the bilateral C1–2 PS group decreased flexibility by 71.9% compared with the intact condition, the unilateral C1–2 PS and ipsilateral PAS+LS group decreased flexibility by 77.6%, and the unilateral C1–2 PS and contralateral PAS+LS group by 70.0%. Each method significantly decreased C1–2 movements in right lateral bending compared with the intact condition, and the bilateral C1–2 PS system was more stable than the C1–2 PS and contralateral PAS+LS system (p = 0.036). CONCLUSIONS A unilateral C-1 PAS + C-2 LS combined with 1-side C-1 PSs provided the same acute stability as the PS, and no statistically significant difference in acute stability was found between the 2 screw techniques. These methods may constitute an alternative method for posterior atlantoaxial fixation.

Unilateral occipital condylar fracture presenting as neck pain and restriction of neck movements- Report of a case and review of literature

2008 ◽  
Vol 05 (02) ◽  
pp. 123-125
Author(s):  
Manoj K Tewari ◽  
KL Ratnam ◽  
Vinod K Shiv
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Young Male ◽  
Cord Compression ◽  
Head Movements ◽  
Ligament Injury ◽  
X Rays ◽  
Cervical Pain ◽  
Focal Neurological Deficit ◽  
High Cervical

AbstractOccipital condylar fractures (OCFs) once rare injuries are not so at present. A young male, victim of motor vehicle accident, presented with severe high cervical pain and restriction of neck movements without any focal neurological deficit, with normal cervical spine x-rays and computerized tomography (CT) scans brain. CT scan and magnetic resonance (MR) imaging of the craniovertebral junction (CVJ) area revealed a retro-pulsed segment in the cervical spinal canal with no cord compression or ligament injury. Patient improved with immobilization of neck. Patients with severe high cervical pain and restricted head movements OCF should be suspected and patient should be evaluated further. Majority of stable OCF improve with immobilization only.

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy

1996 ◽  
Vol 84 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Scott Shapiro
Keyword(s):  
High Speed ◽  
Iliac Crest ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Discectomy ◽  
Single Level ◽  
Flexion Extension ◽  
The Mean ◽  
Cervical Plate

✓ Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12–30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

scholarly journals Perfluorocarbon liquid-assisted intraocular foreign body removal

2021 ◽  
Vol 3 (2) ◽  
pp. 120-126
Author(s):  
Hui Wen Lim ◽  
Suyi Siow ◽  
Kiet Phang Ling
Keyword(s):  
Foreign Body ◽  
Pars Plana Vitrectomy ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Surgical Techniques ◽  
Intraocular Foreign Body ◽  
Ocular Injury ◽  
Perfluorocarbon Liquid ◽  
Open Globe ◽  
Pars Plana

Traumatic ocular injury is an uncommon yet leading cause of monocular blindness among the working-age group. Retained intraocular foreign body (IOFB) are associated with 41% of open globe injuries. Pars plana vitrectomy is often required for posterior segment IOFB removal. Advances in vitreoretinal surgical techniques and instrumentation have resulted in better treatment outcomes with reduced ocular morbidity. We report a case of modified ILM forceps with perfluorocarbon liquid-assisted non-magnetic IOFB removal in a young man after a motor vehicle accident with zone one open globe injury and a large glass IOFB in the right eye. We describe the use of perfluoro-N-octane to slide the IOFB extramacularly and reorient the IOFB plane for stable and safe retrieval by ILM end-gripping forceps. The modified design of the ILM end-gripping forceps with adjunctive use of perfluorocarbon liquid in pars plana vitrectomy reduces slippage during IOFB extraction and prevents collateral iatrogenic retinal injury.

Metastases to the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A113-A118 ◽  
Author(s):  
Hugh D. Moulding ◽  
Mark H. Bilsky
Keyword(s):  
Cervical Spine ◽  
Surgical Techniques ◽  
Spinal Metastases ◽  
Case Series ◽  
Craniovertebral Junction ◽  
External Beam Radiation ◽  
Functional Improvement ◽  
X Rays ◽  
Beam Radiation ◽  
Flexion Extension

Abstract OBJECTIVE This study reviews the relevant literature regarding the management of craniovertebral junction (CVJ) metastases. These rare tumors present significant diagnostic and treatment challenges. METHODS A PubMed search of cervical spine, cervical spine metastasis, craniovertebral junction, atlantoaxial spine, and metastasis radiation was conducted to define the epidemiology, imaging, and treatment protocols in the management of metastatic CVJ tumors. RESULTS CVJ tumors represent less than 1% of spinal metastases, and the literature is limited to small case series. CVJ tumors present with flexion, extension, and rotational pain, often associated with occipital neuralgia. Magnetic resonance imaging is the most sensitive imaging modality for the detection of spinal metastases, but plain x-rays, computed tomography, and [18F]2-fluoro-2-deoxy-D-glucose play a role in diagnosis and management. Conventional external beam radiation therapy or stereotactic radiosurgery effectively treat the majority of patients with normal spinal alignment or minimal fracture subluxations. Surgery should be considered in patients with fracture subluxations greater than 5 mm, or 3.5 mm subluxation with 11-degree angulation. The palliative goals for surgery favor posterior approaches only including laminectomy for decompression, without the need for anterior approaches with the associated morbidity. Occipitocervical instrumentation using screw-rod systems are effective for irreducible subluxations, but posterior strategies using C1–C2 or C1–C3 can be used for patients with reducible subluxations. CONCLUSION Effective management of CVJ tumors using radiation and/or surgery results in significant pain and functional improvement in properly selected patients. Advanced surgical techniques and stereotactic radiation may improve outcomes with less morbidity.

scholarly journals Ossification of the Posterior Atlantoaxial Membrane Associated with an Os Odontoideum: A Case Report

2011 ◽  
Vol 19 (3) ◽  
pp. 392-394 ◽  
Author(s):  
Junichi Ohya ◽  
Hirotaka Chikuda ◽  
Shurei Sugita ◽  
Takashi Ono ◽  
Yasushi Oshima ◽  
...  
Keyword(s):  
Case Report ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Ectopic Ossification ◽  
Vehicle Accident ◽  
A Minor ◽  
Atlantoaxial Arthrodesis

We report a case of ossification of the posterior atlantoaxial membrane associated with an os odontoideum in a 46-year-old woman. She developed myelopathy following a minor motor vehicle accident. The patient underwent posterior atlantoaxial arthrodesis and resection of the ossified lesion and recovered uneventfully. Long-standing atlantoaxial instability might have played a role in ectopic ossification of the posterior atlantoaxial membrane.

scholarly journals Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion

2021 ◽  
pp. 095441192110324
Author(s):  
Timothy L Lasswell ◽  
John B Medley ◽  
Jack P Callaghan ◽  
Duane S Cronin ◽  
Colin D McKinnon ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Bending ◽  
Intact State ◽  
Significant Difference ◽  
Flexion Extension ◽  
Translaminar Screw ◽  
Fresh Frozen

The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL). Each specimen was tested in a spinal loading simulator that separately applied axial rotation, flexion-extension and lateral bending. In each test condition, displacement controlled angular motion was applied in both directions at a speed of 2 deg/s until a resulting moment of 1.5 Nm was achieved. The measured ranges of motion (ROM) of the C1-C2 segments were compared for each test condition using nonparametric Friedman tests. The destabilized state had significantly more C1-C2 motion ( p < 0.05) than the intact state in all cases, and all constructs greatly reduced this motion. C2 pedicle screw constructs that used the C1PA clamp had significantly less C1-C2 motion ( p < 0.05) than those with C1LM screws in flexion-extension as well as axial rotation and no statistically significant difference was detected in lateral bending. C2 translaminar screw constructs that used the C1PA clamp had significantly less C1-C2 motion ( p < 0.05) than those with C1LM screws in flexion-extension and no statistically significant difference was detected in axial rotation or in lateral bending. Data from the current study suggested that constructs using the novel C1PA clamp would provide as good, or improved, biomechanical stability to the C1-C2 segment compared with constructs using C1LM screws.

Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases

2015 ◽  
Vol 22 (4) ◽  
pp. 387-393 ◽  
Author(s):  
Zhonghai Li ◽  
Fengning Li ◽  
Shuxun Hou ◽  
Yantao Zhao ◽  
Ningfang Mao ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Iliac Crest ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Donor Site ◽  
Japanese Orthopaedic Association ◽  
Neurological Deficits ◽  
Anterior Discectomy ◽  
Flexion Extension

OBJECT The object of this study was to describe the authors' method of anterior discectomy/corpectomy and fusion combined with internal fixation for the treatment of unstable hangman's fractures and to evaluate the clinical and radiological outcomes. METHODS This study included 38 consecutive patients who underwent surgery for unstable hangman's fractures between July 2002 and October 2011 and were followed up for more than 2 years. The patients were 18 women and 20 men with a mean age of 42.8 years (range 20–69 years). The fracture resulted from a fall in 9 patients, a motor vehicle accident in 21 patients, and a motorcycle accident in 8 patients. The Levine-Edwards classification was Type II in 13 patients, Type IIA in 20 patients, and Type III in 5 patients. All patients underwent anterior C2–3 intervertebral disc excision or C-3 corpectomy, decompression and reduction, interbody implantation of an autologous iliac bone graft, and internal fixation with a titanium plate. Pain was assessed before and after surgery using a visual analog scale (VAS). Myelopathy was graded using the Japanese Orthopaedic Association (JOA) score. Patient satisfaction with the surgery was assessed using Odom's grading system. Anteroposterior, lateral, and dynamic (flexion/extension) radiographs were obtained during the follow-up period. Two-dimensional CT studies with sagittal and coronal reconstructions were routinely performed. RESULTS The mean follow-up period was 49.2 months (range 24–132 months). There was a significant decrease between the preoperative and final follow-up VAS scores (mean [SD] 7.56 ± 1.52 vs 2.36 ± 1.25, p < 0.05) and a significant increase between the preoperative and final follow-up JOA scores (12.58 ± 1.34 vs 16.13 ± 1.17, p < 0.05). Postoperative radiographs showed satisfactory reduction of the fracture in all cases. Postoperative complications included transient neurological deficits (3 cases), hematoma (2 cases), temporary dysphagia (5 cases), temporary hoarseness (2 cases), prolonged pain at the iliac crest donor site (4 cases), and wound infection at the iliac crest donor site (2 cases). Solid fusion was achieved in 94.7% of patients at the final follow-up. CONCLUSIONS Anterior discectomy/corpectomy and fusion combined with internal fixation is a safe and effective procedure for the treatment of unstable hangman's fractures.

Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

2017 ◽  
Vol 79 (01) ◽  
pp. 045-051 ◽  
Author(s):  
Shailendra Ratre ◽  
Nishtha Yadav ◽  
Vijay Parihar ◽  
Jitin Bajaj ◽  
Yatin Kher ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Surgical Techniques ◽  
Atlantoaxial Instability ◽  
Endoscopic Management ◽  
Posterior Arch ◽  
Type I ◽  
Karnofsky Performance Score ◽  
Arnold Chiari Malformation ◽  
Number Of Patients

Introduction Several different surgical techniques have been used in the treatment of patients with symptomatic Arnold-Chiari malformation type 1 (ACM-1) with or without syrinx. Endoscope-assisted decompression of the posterior fossa has been found to be safe and effective. We report our initial experience of endoscopic management of ACM-I. Material and Methods This was a prospective study of 15 symptomatic patients. Pre- and postoperative clinical status and computed tomography and magnetic resonance imaging findings were recorded. Suboccipital bone of ∼ 3 cm distance from the foramen of magnum and posterior arch of atlas was removed. Partial splitting of the dura mater with preservation of the inner portion and the arachnoid membrane was performed. Any change in axial and sagittal length of the syrinx, tonsillar ascension, shape of the tonsil tip, appearance of cerebrospinal fluid posterior to the tonsil, and formation of the cisterna magna were recorded. Patients with atlantoaxial instability, tethered cord, associated myelomeningocele, hydrocephalus, or elevated intracranial pressure were excluded. Results Age of patients ranged from 26 to 48 years. There were nine female patients. There were six patients with ACM-I without and nine with ACM-I with syrinx. Average pre- and postoperative Karnofsky performance score was 78 and 93, respectively. Average operative time was 130 minutes (110–190 minutes), and blood loss was 30 mL (20–180 mL). Follow-up ranged from 9 to 21 months. Conclusion Although the study is limited by the small number of patients with a short follow-up, endoscopic decompression in selected patients of ACM-I with or without syrinx with dural splitting was a safe and effective alternative to microsurgical treatment.

scholarly journals Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures

2020 ◽  
Vol 72 (4) ◽  
pp. 1221-1230
Author(s):  
G.A.C. Diamante ◽  
P.V.T. Marinho ◽  
C.C. Zani ◽  
M.V. Bahr Arias
Keyword(s):  
Range Of Motion ◽  
Spinal Cord Injuries ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Ex Vivo ◽  
Testing Machine ◽  
Thoracolumbar Spine ◽  
Biomechanical Study ◽  
Flexion Extension ◽  
Induced Fractures

ABSTRACT Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.

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