New Simple 3-Dimensional Computed Tomogram Classification Leading to Successful Conservative Treatment in 51 Atlanto-Axial Rotatory Fixation Children

<b><i>Objective:</i></b> to present a new and easy classification of atlanto-axial rotatory fixation (AARF) and to investigate the efficiency of conservative treatment of AARF. <b><i>Background:</i></b> Although there is a precise definition and diagnostic classification of AARF, there is still significant difficulty in measuring the atlas and axis angles because all of the atlas or axis cannot be seen in a certain 2-dimensional computed tomogram image. In addition, some recent case reports showed that long-term conservative treatment can reduce pediatric AARFs, even that are severe or chronic. <b><i>Methods:</i></b> Fifty-one children with AARF were analyzed retrospectively with new 3-dimensional computed tomogram (3DCT)-based AARF classification; the mean age was 72.7 ± 35.2 months (19–139 months). In the new AARF classification, type 1 was defined as that when the C1C2 angle is not 0° on midline and type 2 as that when the C1C2 angle is 0° on the midline. <b><i>Results:</i></b> All 7 children with AARF type 1 were treated successfully only with Halter tractions. Twenty among 44 children with type 2 did not show any difference in improvement compared with not-treated 24 children with type 2. <b><i>Conclusion:</i></b> The first new AARF classification based on 3DCT appears to be easy to use and even the most severe children with AARF may be managed only with conservative treatment such as long-term Halter traction.

Managing the Anomalous Vertebral Artery in C1–C2 Stabilization for Congenital Atlantoaxial Instability

Objectives This study aimed to demonstrate the technique of handling the anomalous vertebral artery in congenital atlantoaxial instability. The vertebral artery course can be variable in congenital atlantoaxial instability, especially if there is assimilation of atlas. The surgical technique to stabilize the atlantoaxial joint should ensure the patency and safety of the vertebral artery and prevents devastating stroke. Computed tomography (CT) angiography of the vertebral artery is mandatory in planning the surgical strategies. The vertebral artery can be injured during dissection of soft tissues between atlas and axis and can be compromised during distraction and instrumentation. The vertebral artery needs to be mobilized based on the tortuosity in the course during instrumentation and prevents compression of the artery against bony structures or screw heads. The vertebral artery has to be identified earlier in the course of dissection and should protect it. It is also imperative to choose the surgical approach that can be performed under vision using operative microscope rather than adapting blind procedures like transarticular screw. Here, in our present case, we demonstrate the technique of mobilizing the vertebral artery which was coursing medially preventing the access for the instrumentation and perform stabilization of atlantoaxial joint using Goel–Harms technique, and prevent its compression after placement of screw by deroofing the bony ridges of axis (Figs. 1 and 2). We also emphasize the various technical nuances during the stabilization with distraction of joint space of atlas and axis.The link to the video can be found at: https://youtu.be/pgURpF_jACc.

Acute Spinal Cord Contusion in a Patient with Multiple Upper Cervical Fractures, Parkinson’s Disease, and Torticollis: Surgical Management

Case Report. Spine surgery in patients with Parkinson’s disease (PD) involves increased risk. We describe a case of cervical myelopathy in a patient with PD, multiple fractures involving the atlas and axis vertebrae, and spasmodic torticollis. The patient was successfully treated with an upper cervical decompression and occipital-cervical (OC) fusion surgery. Strategies for torticollis reduction and successful surgical outcome are discussed. Risks and benefits must be carefully weighed when considering occipital cervical fusion in PD patients. Conclusion. Intraoperative manual reduction of laterocollis is possible after general endotracheal anesthesia, and continuous neuromonitoring is established. Use of optimizing strategies such as perioperative botulinum injections and intraoperative O-arm navigation should be considered.

Imaging findings for Atlanto-occipital assimilation with multiple cervical vertebral anomalies in a Beagle dog: A 2 year follow-up

A 3-year-old male Beagle dog was presented for a physical examination, which revealed a mild stiff neck that was affecting movement. The imaging modalities led to our diagnosis of an asymmetric fusion of the occipital condyle and atlas wing consistent with Atlanto-occipital assimilation (AOA). An incomplete ossification of the atlas and axis, dysplastic dens, and a blocked vertebra were also noted. During a two-year follow-up, the dog showed no other clinical signs or disease progression. To our knowledge, this is the first imaging description of AOA in veterinary medicine. We recommend a careful CT (computed tomography) and an MRI (magnetic resonance imaging) evaluation in cases of neck pain and cervical myelopathy, and inclusion of AOA among the differential diagnoses, with the awareness that its clinical signs resemble those of other canine diseases.

Cervical arthritis, C3-C7, from an identified osteological collection

Osteoarthritis on the cervical vertebrae, C3-C7, accumulates as a function of age, life style, diet and severity of long-term skeletomuscular stress. However, the degree to which age (older adult and elderly) and sex differences impact on the manifestation of osteoarthritis remains difficult to assess because of the variability of biological aging and the lack of discrete post-reproductive age categories. The aim of this investigation was to score the degree of osteophytic marginal lipping, porosity and eburnation on the cervical vertebrae of identified individuals from the William M. Bass Donated Skeletal Collection of the Forensic Anthropology Center of the University of Tennessee, Knoxville, USA, to address whether the expression of osteoarthritic features differs (1) between older adults, 50-55 years, and elderly adults, 70-76 years, within each sex; (2) between both sexes of the same age category; and (3) between the sexes regardless of age. Osteological remains included were accessioned between 2000 and 2010 to reflect contemporary variation, and only C3 to C7 were scored given the distinctions in morphology and function of the atlas and axis. The vertebrae were separated by number and analyzed using Mann-Whitney U tests. Osteoarthritic features are generally more severe in males compared to females although eburnation is elevated in older females (50-55 years) compared to their elderly counterparts (70-76 years). Both sexes show an accumulation of osteoarthritic features as a consequence of advancing age. However, sex differences between elderly adults (70-76 years) are less extreme compared to when all females and males are considered regardless of age.