Multi-stage treatment of non-specific spondylodiscitis of the cervical spine

The objective is to present a clinical case of successful treatment of a patient with recurrent spondylitis at the cervical level.Clinical case. A 65-year-old patient was diagnosed with purulent spondylodiscitis at the level of C6-C7 vertebrae with the epidural and paravertebral abscesses and spinal cord compression. Emergency left colotomy, paravertebral abscess dissection, corporectomy of the C6 vertebra, abscess removal, anterior spondylodesis with bone autograft and titanium plate were performed. Massive antibacterial therapy was prescribed. After the operation, the volume of movement in the left limbs was restored, and on the 15th day after the operation, the patient was discharged. On the 36th day after discharge, she was hospitalized again with hematuria. A recurrence of suppuration in the area of the operation and phlegmon of both feet was revealed. Revision of the surgical wound and rehabilitation of the purulent focus on the neck, surgical intervention for phlegmon were performed. In purulent foci, Staphylococcus aureus was verified, which is sensitive to the main antibacterial drugs. Antibacterial therapy was continued, then, after changing the microflora in the wound, other antibiotics were prescribed. There was a pain in the area of the left spinal root C5. The connection of the fistula course with the titanium plate, the increase of pathological kyphosis at the level of the overlying vertebrae was found. The wound was examined, the titanium plate was removed, and the halo device was applied to correct the pathological kyphosis. After the operation, the radicular pain syndrome regressed, and the axis of the cervical spine was restored. After 1 month, the posterior combined fixation of the cervical spine at the C3-Th7 level was performed, and the halo device was dismantled. After 6 months, the patient was stopped wearing the Philadelphia neck collar, no recurrence of suppuration was observed, and a complete regression of neurological disorders was noted. After 1 year, a complete bone block is preserved between the C4-C7 vertebrae.Conclusion. The presented clinical case clearly illustrates the complexity of managing patients with inflammatory diseases of the cervical spine. Currently, there is no single treatment strategy for patients with spondylitis.

C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

Occipital Condyle Fractures

Occipital condyle fractures are a rare entity most commonly associated with traumatic injuries. Head CT is the most sensitive method for detecting such fractures, and follow-up MRI to identify ligamentous injury is necessary to determine if the fracture is unstable or if there is compression of neural elements. Surgical intervention with either a Halo device or internal fixation is only necessary in the setting of unstable fractures or when there is evidence of bilateral fractures or avulsed fragments causing neural compression. Most patients recover with little to no lasting symptoms, though it is important to watch for a delayed presentation of lower cranial nerve deficits.

Surgical Treatment of Stenosis of Spinal Canal and Dural Sac at the Craniovertebral Junction

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

A Technical Innovation in Midface Advancement With the External Frame Distraction Device

Background: Maxillary advancement with a rigid external distractor (RED) II is a commonly performed procedure for correcting midface hypoplasia. While there are various methods of anchoring the osteotomized maxillary segment to the halo device, the looped transpyriform wire is the simplest and most cost-effective. However, a common complication with this is the cutting through of the stainless steel traction wire across the pyriform buttress during distraction. The patient with cleft undergoing midface distraction is particularly vulnerable since the force needed for distraction is higher due to scarring from previous operations. Innovation and Design: A single-hole titanium plate is introduced as an interface between the bone of the pyriform buttress and the looped stainless steel traction wire attached to the external frame device. Evaluation: Twenty-four patients with cleft who underwent midface advancement using the external frame distractor before the introduction of the innovation were compared with 26 patients who underwent the same procedure after its introduction. The former group had 12.5% complication in the form of cut through of the traction wire, while the latter group had only 3.8% complication rate. Conclusion: Introduction of the titanium eyelet as an interface between the traction wire and the bone is a simple technical addition for a more reliable distraction using the RED II device in patients with cleft even in the presence of extensive scarring.

The use of inside-outside screws for occipitocervical fusion in pediatric patients

Object The authors describe the use of inside-outside occipital screws in 21 children with occipitocervical instability requiring occipitocervical fusion. Methods The ages of the patients were from 2 to 15 years, and patients presented with a variety of causes of occipitocervical instability, including congenital disorders, posttraumatic instability, idiopathic degeneration, and postoperative instability. Surgeries frequently included foramen magnum decompression, duraplasty, and laminectomy, but all patients required occipitocervical instrumentation and arthrodesis. Postoperative orthosis included the use of either a cervical collar or halo device. In all but one case, patients were followed postoperatively for at least 12 months. Results The mean age of patients was 9.93 years. Inside-outside screws were used in all reported cases. Rib autograft was used in all patients. In addition, demineralized bone matrix was used in 2 cases, and bone morphogenetic protein was used in 2 patients. Two patients required halo placement, and the other 19 were placed in cervical collars. The average time postoperative orthotics were used was 2.82 months. Arthrodesis was determined radiographically and was noted in all patients. No operative complications were noted; however, postoperative complications included 1 wound infection, 2 cases of hardware loosening, and the need for tracheostomy in 2 patients. Conclusions Inside-outside screws were found to be a useful component of occipitocervical instrumentation in pediatric patients ranging from 2 to 15 years of age. Arthrodesis was demonstrated in all cases.

Orthodontic and Surgical Treatment of a Patient with Apert Syndrome

ABSTRACT The aim of this case report was to present the combined orthodontic and surgical treatment of a patient with Apert syndrome in an adult stage. A 15 years old male patient with Apert syndrome was concerned about the appearance of his face and malocclusion. His profile was concave with a retruded maxilla and prominent lower lip. He had an Angle class I molar relationship with a 9.5 mm anterior open bite. The amount of crowding was 20.4 mm in the maxilla and 6 mm in the mandible. Cephalometric analysis revealed a skeletal Class III relationship due to maxillary hypoplasia with a dolichofacial growth pattern. Orthodontic treatment and orthognathic surgery were planned for the patient. After 45 months of presurgical orthodontics, the patient underwent two surgeries sequentially. The first surgery was performed to advance the maxilla and the second surgery was performed to correct the mandibular rotation and increase the overbite at the time of removing halo device. The amount of maxillary advencement was 8 mm. Mandibula was moved 1.5 mm anteriorly and rotated 1° to 1.5° (SNB and facial depth) in a counterclockwise direction. After a relatively long treatment, an esthetically pleasing and functional occlusion and correction of the skeletal problem was achieved in this adult case. How to cite this article Kaya D, Taner T, Aksu M, Keser EI, Tuncbilek G, Mavili ME. Orthodontic and Surgical Treatment of a Patient with Apert Syndrome. J Contemp Dent Pract 2012; 13(5):729-734.