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Como CJ, LeVasseur CM, Oyekan A, Padmanabhan A, Makowicz N, Chen S, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. Dynamic in vivo 3D atlantooccipital kinematics during multiplanar physiologic motions. J Biomech 2024; 173:112236. [PMID: 39084063 DOI: 10.1016/j.jbiomech.2024.112236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
Normal biomechanics of the upper cervical spine, particularly at the atlantooccipital joint, remain poorly characterized. The purpose of this study was to determine the intervertebral kinematics of the atlantooccipital joint (occiput-C1) during three-dimensional in vivo physiologic movements. Twenty healthy young adults performed dynamic flexion/extension, axial rotation, and lateral bending while biplane radiographs were collected at 30 images per second. Motion at occiput-C1 was tracked using a validated volumetric model-based tracking process that matched subject-specific CT-based bone models to the radiographs. The occiput-C1 total range of motion (ROM) and helical axis of motion (HAM) was calculated for each movement. During flexion/extension, the occiput-C1 moved almost exclusively in-plane (ROM: 17.9 ± 6.9°) with high variability in kinematic waveforms (6.3°) compared to the in-plane variability during axial rotation (1.4°) and lateral bending (0.9°) movements. During axial rotation, there was small in-plane motion (ROM: 4.2 ± 2.5°) compared to out-of-plane flexion/extension (ROM: 12.7 ± 5.4°). During lateral bending, motion occurred in-plane (ROM: 9.0 ± 3.1°) and in the plane of flexion/extension (ROM: 7.3 ± 2.7°). The average occiput-C1 axis of rotation intersected the sagittal and coronal planes 7 mm to 18 mm superior to the occipital condyles. The occiput-C1 axis of rotation pointed 60° from the sagittal plane during axial rotation but only 10° from the sagittal plane during head lateral bending. These novel results are foundational for future work on upper cervical spine kinematics.
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Affiliation(s)
- Christopher J Como
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States.
| | - Clarissa M LeVasseur
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Anthony Oyekan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Aditya Padmanabhan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Noah Makowicz
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
| | - Stephen Chen
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William F Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Joon Y Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - Jeremy D Shaw
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States; Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA, United States; Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA, United States
| | - William J Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, United States
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Gehrz JA, Hudson AS, James WF, McGuire MM. STRANGULATION-INDUCED ATLANTOAXIAL ROTATORY SUBLUXATION TREATED WITH CLOSED REDUCTION. J Emerg Med 2023; 65:e444-e448. [PMID: 37813737 DOI: 10.1016/j.jemermed.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/19/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Cervical subluxation is a broad class of injuries in which there are degrees of misalignment of vertebral bodies in relationship to adjacent vertebra. Atlantoaxial rotatory subluxation (AARS) is a subtype of cervical subluxation resulting from exaggerated rotation of the C1-C2 complex. Inflammatory, infectious, post-surgical, and traumatic etiologies are recognized and well-described. AARS is predominantly seen in children and occurs rarely in adults. CASE REPORT We submit the case of an otherwise healthy adult male patient presenting to the emergency department with strangulation-induced C1-C2 subluxation with a rotational component that was treated at the bedside by neurosurgery with closed reduction. Why Should an Emergency Physician Be Aware of This? Clinicians must consider a broad range of serious pathologies in a patient presenting with torticollis, especially in the setting of strangulation. Although extremely rare in adults, AARS must be considered in the differential diagnosis, as early identification increases the likelihood of successful nonoperative treatment.
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Affiliation(s)
- Joseph A Gehrz
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
| | | | - William F James
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Morgan M McGuire
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
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Hong WJ, Lee JK, Hong JH, Han MS, Lee SS. Iatrogenic atlantoaxial rotatory subluxation after thyroidectomy in a pediatric patient: A case report. World J Clin Cases 2023; 11:3351-3355. [PMID: 37274043 PMCID: PMC10237141 DOI: 10.12998/wjcc.v11.i14.3351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is an uncommon disease with a greater prevalence among children than adults, and it is mostly associated with trauma. Iatrogenic spinal injury accounts for a low percentage of injuries. However, in AARS, 20%-40% of cases are associated with surgery, and 48% are caused by infection. Here, we describe our experience with a case of iatrogenic AARS after general anesthesia.
CASE SUMMARY A 12-year-old girl presented with right-sided torticollis and cervical motion limit. The patient had undergone thyroidectomy 2 mo ago. Computed tomography revealed AARS with bilateral locked facets. Following the failure of repeated external reduction under general anesthesia, the patient underwent an open surgical reduction. The patient gained atlantoaxial alignment without any complications. Follow-up radiographs showed a normal appearance without instability. The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences. AARS secondary to infection and surgery is known as Grisel’s syndrome, which involves non-traumatic AARS. Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported. Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor.
CONCLUSION Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery. Moreover, clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.
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Affiliation(s)
- Woo-Joon Hong
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Jong-Hwan Hong
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju 61469, South Korea
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de Meldau Benites V, da Costa MDS, Cavalheiro S. Posterior C1-C2 fusion for atlantoaxial rotatory fixation after posterior fossa craniotomy in a 4-year old: a case report. Childs Nerv Syst 2023; 39:1647-1651. [PMID: 36705687 DOI: 10.1007/s00381-023-05862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/22/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This study aimed to highlight that atlantoaxial rotatory fixation (AARF) can be related to neurosurgery procedures in children, with an afterward demonstration of good results after halo-gravity traction and C1-C2 stabilization using the Harms technique. CASE DESCRIPTION To the best of our knowledge, this is the first case to report a 4-year-old boy who presented with AARF after a posterior fossa craniotomy to treat a cerebellar astrocytoma. At our medical facility, AARF was diagnosed using plain radiography and computed tomography imaging. The patient was treated with continuous cranial traction for 14 days. Initially, we detected that the patient had no C1 posterior arch or C2 spinous process; therefore, the best option was to perform the Harms technique. Postoperatively, the patient was placed in a cervical collar for 4 weeks. At the 4-year postoperative follow-up, the patient was doing well and had not developed any complications. CONCLUSION Herein, we report a case in which AARF can be developed after neurosurgical procedure. Surgical techniques used for atlantoaxial subluxation should be carefully selected. In our case, the Harms technique after cranial traction was an excellent option for correcting and stabilizing the abnormal neck position. However, further studies are required to determine the best technique to use in the pediatric population.
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Affiliation(s)
| | | | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Štulík J, Rybárová M, Barna M, Klézl Z. Atlantoaxial rotatory dislocation: Surgical treatment in a pediatric patient cohort. BRAIN & SPINE 2022; 2:101667. [PMID: 36506286 PMCID: PMC9729819 DOI: 10.1016/j.bas.2022.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/20/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
•Surgical correction of AARD is an appropriate method of treatment after failed non-operative therapy.•The technique of surgical reduction and C1-C2 fixation using Harms/Goel technique provides excellent clinical outcomes.•In case of traumatic AARD we recommend to consider temporary fixation.
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Guo Q, Xu T, Wang H, Chen F, Guo X, Lu X, Ni B. One-Stage Anterior Retropharyngeal Release Followed by Posterior Open Reduction and Intra-Articular Cage Fusion for Treating Chronic Fixed Type III Atlantoaxial Rotatory Fixation. World Neurosurg 2022; 167:e1413-e1418. [PMID: 36122856 DOI: 10.1016/j.wneu.2022.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To verify the effectiveness of anterior retropharyngeal release followed by posterior open reduction using long arm reduction screws combined with intra-articular fusion with a cage filled with the local autologous bone for treating fixed Type III atlantoaxial rotatory fixation (AARF). METHODS Data from 6 children with fixed AARF were retrospectively reviewed. All patients underwent anterior retropharyngeal release followed by posterior open reduction using long-arm reduction screws combined with intra-articular fusion with a cage filled with local autologous bone. Outcomes were measured using the atlantodental interval value, the Japanese Orthopedic Association score and visual analog scale for neck pain. Patient age, sex, operation time, blood loss, and bone fusion time were recorded. Complications related to the operation were also recorded. RESULTS All patients achieved complete reduction and solid bone fusion at follow-up. The atlantodental interval dropped to 2.1 ± 0.5 mm after the operation from a preoperative score of 15.3 ± 3.1 mm (P < 0.05). Japanese Orthopedic Association score significantly improved from a preoperative score of 15.3 ± 0.5 to 17 ± 0 at the final follow-up (P < 0.05). Visual analog scale for neck pain markedly decreased from preoperative 4.5 ± 1.0 to 0.2 ± 0.4 at the final follow-up (P < 0.05). No complication related to the surgical approach or instrumentation was observed. CONCLUSIONS One-stage anterior retropharyngeal release followed by posterior open reduction combined with intra-articular cage fusion is effective in treating chronic fixed type III AARF.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Tianming Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China; Department of Orthopedics, 905th Hospital of PLA Navy, Shanghai, People's Republic of China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xiang Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xuhua Lu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
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Xu P, Zhang Z, Zheng Y, Meng J, Qian C, Fu D, Wang D. Successful Closed Reduction of Atlantoaxial Rotatory Fixation in Children-A Retrospective Study of 30 Patients. Global Spine J 2022; 12:1655-1660. [PMID: 33530717 PMCID: PMC9609537 DOI: 10.1177/2192568220984427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To review our treatment experience and to investigate the process of this disease. METHODS Clinical data of AARF patients, who received closed reduction, was retrospectively reviewed. Patients were divided into 2 groups according to the length of delay (Group I: 1 month ≤ delayed time < 3 months), Group II (delayed time < 1 months). The correlation between the length of delayed time and clinical recovery (CR), radiological recovery (RR), and total recovery time were measured. The atlantodental interval (ADI), lateral mass-dens interval (LDI) and lateral joint space (LJS) were compared at admission and final follow-up. RESULTS 30 children (12 girls and 18 boys) with AARF had received conservative treatment. The mean age at initial treatment was 8.13-year-old, ranging from 5 to 14. The mean follow-up time was 26.93 months (range, 6-87 months). The average length of delayed time was 28.53 days (range, 2-80 days). When the LDI, LJS, and ADI differences are compared at admission and the final visit, the differences are reduced significantly on LDI and LJS. A positive correlation is observed between the length of the delay and CR time and total recovery time (r = 0.63, p = 0.00 and r = 0.47, p = 0.01) respectively. CONCLUSIONS Pediatric AARF patients who have a delay time < 3 months can be treated with closed reduction successfully. The longer the delayed time, the longer the traction time, but the cervical collar time is almost the same. The LDI and LJS on the anteroposterior of X-rays are convenient to estimate the progress of this condition during the treatment.
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Affiliation(s)
- Ping Xu
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Zhiqiang Zhang
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Yiming Zheng
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Junrong Meng
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Chuang Qian
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Dong Fu
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China
| | - Dahui Wang
- Department of Orthopedics, National Children’s Medical Center & Children’s Hospital of
Fudan University, Shanghai, China,Dahui Wang, Department of Orthopedics,
National Children’s Medical Center & Children’s Hospital of Fudan
University, 399 Wanyuan Road, Shanghai, 201102, China.
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8
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Tuan SH, Sun SF, Huang WY, Chen GB, Li MH, Liou IH. Effect of high intensity laser therapy in the treatment of acute atlantoaxial rotatory subluxation: A case report. J Back Musculoskelet Rehabil 2022; 35:963-969. [PMID: 35068439 DOI: 10.3233/bmr-210133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sudden onset of acute torticollis in children is rare and is usually diagnosed as atlantoaxial rotatory subluxation (AARS). The common treatment for acute AARS without neurological symptoms is halter traction in conjunction with muscle relaxant and sedative agents, followed by cervicothoracic orthotic immobilization. To the best of our knowledge, a case of acute AARS treatment with high-intensity laser therapy (HILT) has not yet been reported so far. OBJECTIVE We aimed to report a case of acute AARS treatment with HILT successfully and to discuss about the clinical effect of HILT in AARS. METHODS We reported a 9-year-old girl with acute onset of torticollis visiting the rehabilitation outpatient department. RESULS The physical examination revealed a typical cock robin position without neurological symptoms. A series of evaluations, including open-mouth odontoid radiograph and soft tissue sonography, confirmed the diagnosis of acute AARS. The patient received HILT over the left suboccipital and upper back muscle groups, which started on the day of the first rehabilitation clinic visit, once a week, for four weeks. Torticollis and neck pain improved gradually with each session of HILT, and the symptoms resolved completely after the fourth session. Dynamic computed tomography (CT) of the cervical spine showed no evidence of obvious AARS after the treatment. CONCLUSIONS The patient had no complaints after HILT in a case of acute AARS resulting from a mechanical factor. Due to its pain-relief and muscle-release characteristics, HILT indicates the probable benefit of relaxation of spastic muscles for patients with AARS.
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Affiliation(s)
- Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan
| | - Shu-Fen Sun
- School of Medicine, National Yang-Ming Ciao-Tung University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wan-Yun Huang
- Institute of Allied Health Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Du J, Gao X, Huang Y, Yang X, Zheng B, Liu Z, Hui H, Gao L, Wu J, Zhao Z, He B, Yan L, Hao D. Posterior Surgery in the Treatment of Craniovertebral Junction Deformity with Torticollis. Orthop Surg 2022; 14:2418-2426. [PMID: 35912975 PMCID: PMC9531064 DOI: 10.1111/os.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the clinical effect of posterior surgery in the treatment of craniovertebral junction (CVJ) deformities with torticollis and methods for preventing and treating complications in order to obtain a reasonable treatment strategy. METHODS From January 2007 to December 2017, 78 patients who suffered from CVJ deformities with torticollis treated by posterior surgery were analyzed. The surgical techniques were all posterior correction and fusion to restore the anatomical alignment of the craniovertebral junction. The visual analog score (VAS) and Short Form-36 (SF-36) health survey questionnaire were utilized to evaluate preoperative and postoperative neck pain, and changes in the torticollis angle and atlas-dens interval (ADI) were evaluated through anteroposterior X-ray and computed tomography. Intra- and postoperative complications were all recorded. One-way ANOVA, LSD-t test, and χ2 test were performed to evaluate the difference between the preoperative and postoperative data. RESULTS The mean follow-up time was 37.4 ± 15.7 months, the average operation time was 115.6 ± 12.8 min, and the average blood loss was 170.8 ± 26.3 mL. According to the deformity site, the range of posterior correction and fusion was as follows: 38 cases of C1 -C2 , 33 cases of C0 -C2 , and seven cases of C0 -C3 . The preoperative SF-36, VAS, torticollis angle, and ADI were 42.6 ± 8.8, 4.8 ± 1.1, 37.2 ± 11.2°, and 4.9 ± 2.3 mm, respectively. The difference was significant at 3 months post operation (p < 0.05), and there was no significant difference at the final follow-up compared with 3 months post operation (p > 0.05). CONCLUSION It can objectively achieve favorable correction and satisfactory clinical effects under posterior correction and fixation for CVJ deformities with torticollis. Intra- and postoperative complications can be settled by proper management.
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Affiliation(s)
- Jinpeng Du
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Xiangcheng Gao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina,Yan'an UniversityYan'an CityChina
| | - Yunfei Huang
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Xiaobin Yang
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Bolong Zheng
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Zhongkai Liu
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Hua Hui
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Lin Gao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Jiayuan Wu
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Zhigang Zhao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Baorong He
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Liang Yan
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Dingjun Hao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
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Shimizu H, Endo T, Takahata M, Yasui K, Sodeyama Y, Iwasaki N. Occipitoatlantoaxial rotatory fixation caused by minor traumatic occipitoatlantal rotatory fixation with compensatory counter-rotation in atlantoaxial joint: A case report. J Orthop Sci 2022; 27:956-959. [PMID: 31607518 DOI: 10.1016/j.jos.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/17/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Hirokazu Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsutomu Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Keigo Yasui
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Yohei Sodeyama
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Spirollari E, Beaudreault C, Ng C, Vazquez S, Chapman E, Clare K, Wang R, Naftchi A, Das A, Lui A, Sacknovitz A, Dominguez JF, Gandhi CD, Tyagi R, Houten JK, Kinon MD. Cervical fusion for adult patients with atlantoaxial rotatory subluxation. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:224-233. [PMID: 35875625 PMCID: PMC9263735 DOI: 10.21037/jss-22-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is a rare injury of the C1/C2 junction. It is often associated with trauma in adults. Treatment may depend on the duration of symptoms and clinical presentation, but there is no consensus regarding the ideal management of these injuries. Our objective is to ascertain the prevalence of neurological deficit, complications, and outcomes of patients diagnosed with AARS undergoing cervical fusion (CF) versus those treated without CF. METHODS The 2016-2019 National Inpatient Sample (NIS) was queried using International Classification of Diseases, 10th revision (ICD-10) for adult patients with C1/C2 subluxation. Patients undergoing CF were defined through ICD-10 procedure codes. Baseline health and acute illness severity was calculated using the 11-point modified frailty index (mFI-11). Presenting characteristics, treatment complications, and outcomes were evaluated of CF vs. non-CF patients. RESULTS Of 990 adult patients with AARS, 720 were treated without CF and 270 were treated with CF. CF patients were more often myelopathic. Patients that had undergone CF treatment were negatively associated with having had extensive trauma. Patients undergoing CF experienced significantly longer length of stay (LOS), increased healthcare resource utilization, and decreased inpatient mortality. Sepsis had a negative association with patients that underwent CF treatment while pneumonia had a positive association. CONCLUSIONS Adult patients undergoing CF for AARS demonstrated an increase in healthcare resource utilization but also a significant decrease in mortality. Extent of acute injury appears to have a strong influence on decision making for CF. Further study of decision making for treatment of this rare injury in adults is warranted.
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Affiliation(s)
| | | | | | | | - Emily Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Ankita Das
- New York Medical College, Valhalla, NY, USA
| | - Aiden Lui
- New York Medical College, Valhalla, NY, USA
| | | | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Chirag D. Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rachana Tyagi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - John K. Houten
- Department of Neurosurgery, Maimonides Medical Center, Zucker School of Medicine at Hofstra-Northwell, Brooklyn, NY, USA
| | - Merritt D. Kinon
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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12
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Osman N, Kia C. Traumatic atlantoaxial rotatory subluxation in adults: is cervical fusion the answer? JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:193-195. [PMID: 35875622 PMCID: PMC9263734 DOI: 10.21037/jss-22-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Nebiyu Osman
- Department of Orthopedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopedic Surgery, University of Connecticut, Farmington, CT, USA
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13
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An S, Hyun SJ. Pediatric Spine Trauma. J Korean Neurosurg Soc 2022; 65:361-369. [PMID: 35462522 PMCID: PMC9082124 DOI: 10.3340/jkns.2021.0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022] Open
Abstract
Pediatric spine has growth potential with incomplete ossification, and also unique biomechanics which have important implications for trauma patients. This article intends to review various aspects of pediatric spine trauma including epidemiology, anatomy and biomechanics, and clinically relevant details of each type of injury based on the location and mechanism of injury. With the appropriate but not superfluous treatment, pediatric spine trauma patients can have better chance of recovery. Therefore, as a spine surgeon, understanding the general concept for each injury subtype together with the debate and progress in the field is inevitable.
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14
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Spontaneous Osseous Fusion after Remodeling Therapy for Chronic Atlantoaxial Rotatory Fixation and Recovery Mechanism of Rotatory Range of Motion of the Cervical Spine. J Clin Med 2022; 11:jcm11061504. [PMID: 35329830 PMCID: PMC8949716 DOI: 10.3390/jcm11061504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to investigate the risk factors of spontaneous osseous fusion (SOF) of the atlantoaxial joint after closed reduction under general anesthesia followed by halo fixation (remodeling therapy) for chronic atlantoaxial rotatory fixation, and to elucidate the recovery mechanism of the rotatory range of motion (ROM) after halo removal. Twelve patients who underwent remodeling therapy were retrospectively reviewed. Five patients with SOF were categorized as the fusion group and seven patients without SOF as the non-fusion group. Three dimensional CT was used to detect direct osseous contact (DOC) of facet joints before and during halo fixation, while dynamic CT at neutral and maximally rotated head positions was performed to measure rotatory ROM after halo removal. The duration from onset to initial visit was significantly longer (3.2 vs. 5.7 months, p = 0.04), incidence of DOC during halo fixation was higher (0/7 [0%] vs. 4/5 [80%], p = 0.004), and segmental rotatory ROM of Occiput/C1 (Oc/C1) at final follow-up was larger (9.8 vs. 20.1 degrees, p = 0.003) in the fusion group. Long duration from the onset to the initial visit might induce irreversible damage to the articular surface of the affected facet, which was confirmed as DOC during halo fixation and resulted in SOF. Long duration from the onset to the initial visit and DOC during halo fixation could be used to suggest the risk for SOF. Nonetheless, rotatory ROM of Oc/C1 increased to compensate for SOF.
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15
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Abstract
BACKGROUND Atlantoaxial rotatory fixation (AARF) comprises a spectrum of abnormal rotational relationships between C1 (atlas) and C2 (axis). We aimed to evaluate the efficacy and long-term clinical outcomes of halter traction in treating patients diagnosed with primary AARF. METHODS We included patients <18 years of age who presented with new-onset painful torticollis, neck pain, and sternocleidomastoid muscle spasm, had an AARF diagnosis confirmed by use of 3-dimensional dynamic computed tomography, received in-hospital cervical halter traction under our treatment protocol, and were followed for ≥12 months. Radiographic and long-term clinical outcomes were analyzed. RESULTS A total of 43 patients (31 male and 12 female; average age of 7.9 years) satisfied the inclusion criteria. There were 5 acute, 6 subacute, and 32 chronic cases. The mean duration of initial symptoms prior to treatment was 12.1 weeks. Thirty-seven (86.0%) of the patients experienced previous minor trauma, and 6 (14.0%) had a recent history of upper-respiratory infection (Grisel syndrome). The mean duration of in-hospital traction was 17.6 days. The mean follow-up period was 8.5 years. Forty-two (97.7%) of the patients achieved normal cervical alignment after treatment. One patient (2.3%) had recurrence and received a second course of halter traction, with cervical alignment restored without any surgical intervention. No neurological deficits were noted during or after the treatment. No major complications were observed. CONCLUSIONS Normal anatomy and restoration of cervical alignment can be achieved by cervical halter traction in most cases of AARF. LEVELS OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chi-Yung Yeung
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Kuang Feng
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
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16
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Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review. Eur J Trauma Emerg Surg 2021; 48:3505-3511. [PMID: 34881392 PMCID: PMC9532283 DOI: 10.1007/s00068-021-01849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications. METHODS We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated. RESULTS The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections. CONCLUSION The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications.
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17
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Koljonen PA, Cheung KM. Concomitant atlantoaxial and atlanto-occipital rotatory dislocation in children: Radiological features, diagnostic pitfalls, and long-term outcome. J Orthop Surg (Hong Kong) 2021; 29:23094990211015502. [PMID: 33998343 DOI: 10.1177/23094990211015502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial and atlanto-occipital joints, or OAARD - short for occipital-atlantoaxial rotatory dislocation - is a condition which has been poorly elucidated and probably underdiagnosed. We believe that the pathogenesis of combined atlantoaxial and atlanto-occipital dislocation is most likely a result of untreated atlantoaxial rotatory dislocation leading to chronic secondary compensation measures occurring at the occiput-C1 joints. Unique clinical and radiological features lead to difficulty in diagnosis, and conventional treatment algorithms may not apply. This paper describes a combination of clinical and radiological features which can help clinicians correctly diagnose and treat OAARD.
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Affiliation(s)
- Paul A Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong
| | - Kenneth Mc Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong
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18
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Alexiades NG, Shao B, Braga BP, Bonfield CM, Brockmeyer DL, Browd SR, DiLuna M, Groves ML, Hankinson TC, Jea A, Leonard JR, Lew SM, Limbrick DD, Mangano FT, Martin J, Pahys J, Powers A, Proctor MR, Rodriguez L, Rozzelle C, Storm PB, Anderson RCE. Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified Delphi study. J Neurosurg Pediatr 2021; 27:649-660. [PMID: 33799292 DOI: 10.3171/2020.10.peds20778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy. METHODS A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS After the initial round, consensus was achieved with 40 statements regarding the following topics: goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice. CONCLUSIONS In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
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Affiliation(s)
- Nikita G Alexiades
- 1Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Belinda Shao
- 1Department of Neurological Surgery, Columbia University Medical Center, New York, New York
- 2Rutgers New Jersey Medical School, Newark, New Jersey
| | - Bruno P Braga
- 3Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher M Bonfield
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas L Brockmeyer
- 5Department of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Samuel R Browd
- 6Department of Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Michael DiLuna
- 7Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Mari L Groves
- 8Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Hankinson
- 9Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Andrew Jea
- 10Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jeffrey R Leonard
- 11Department of Neurosurgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sean M Lew
- 12Department of Pediatric Neurosurgery, Children's Wisconsin, Milwaukee, Wisconsin
| | - David D Limbrick
- 13Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Francesco T Mangano
- 14Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jonathan Martin
- 15Division of Pediatric Neurosurgery, Connecticut Children's Hospital, Hartford, Connecticut
| | - Joshua Pahys
- 16Department of Pediatric Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Alexander Powers
- 17Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark R Proctor
- 18Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luis Rodriguez
- 19Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Curtis Rozzelle
- 20Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama, Birmingham; and
| | - Phillip B Storm
- 21Department of Neurosurgery, University of Pennsylvania/Children's Hospital of Philadelphia, Pennsylvania
| | - Richard C E Anderson
- 1Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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19
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Natural History, Neuroradiological Workup, and Management Options of Chronic Atlantoaxial Rotatory Fixation Caused by Drug-Induced Cervical Dystonia. Case Rep Orthop 2021; 2021:6683268. [PMID: 33763273 PMCID: PMC7946456 DOI: 10.1155/2021/6683268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
Atlantoaxial rotatory fixation (AARF) resulting from drug-induced cervical dystonia (DICD) represents an extremely rare complication of antipsychotic treatment, requiring a comprehensive assessment of pharmacologic therapy and timely radiologic workup. We report a chronic case of Fielding type I, Pang type I AARF secondary to schizophrenia treatment in a 16-year-old girl, along with a review of the literature on the management challenges posed in this condition. In this scenario, torticollis may just represent the tip of the iceberg, and only an effective multidisciplinary approach increases the chances of satisfactory correction with closed reduction, hence avoiding the burden of more invasive treatment options.
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20
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Shimazaki T, Yamada K, Sato K, Jimbo K, Nakamura H, Goto M, Matsubara T, Mizokami K, Iwahashi S, Sasaki T, Shiba N. Primary treatment of atlantoaxial rotatory fixation in children: a multicenter, retrospective series of 125 cases. J Neurosurg Spine 2021; 34:498-505. [PMID: 33276329 DOI: 10.3171/2020.7.spine20183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary treatment for atlantoaxial rotatory fixation (AARF) remains controversial. The aim of this study was to investigate the primary treatment for AARF and create an algorithm for primary treatment. METHODS The authors analyzed the data of 125 pediatric patients at four medical institutions from April 1989 to December 2018. The patients were reported to have neck pain, torticollis, and restricted neck range of motion and were diagnosed according to the Fielding classification as type I or II. As a primary treatment, 88 patients received neck collar fixation, and 28 of these patients did not show symptom relief and required Glisson traction. Thirty-seven patients were primarily treated with Glisson traction. In total, 65 patients, including neck collar treatment failure patients, underwent Glisson traction in hospitals. RESULTS The success rate of treatment was significantly higher in the Glisson traction group (97.3%) than in the neck collar fixation group (68.2%) (p = 0.0001, Wilcoxon test). In the neck collar effective group, Fielding type I was more predominant (p = 0.0002, Wilcoxon test) and the duration from onset to the first visit was shorter (p = 0.02, Wilcoxon test) than that in the neck collar ineffective group. Using multivariate logistic regression analysis with the above items, the authors generalized from the estimated formula: logit [p(success group by neck collar fixation group)|duration from onset to the first visit (x1), Fielding type (x2)] = 0.4(intercept) - 0.15x1 + 1.06x2, where x1 is the number of days and x2 = 1 (for Fielding type I) or -1 (for Fielding type II). In cases for which the score is a positive value, the neck collar should be chosen. Conversely, in cases for which the score is a negative value, Glisson traction should be the first choice. CONCLUSIONS According to this formula, in patients with Fielding type I AARF, neck collar fixation should be allowed only if the duration from onset is ≤ 10 days. In patients with Fielding type II, because the score would be a negative value, Glisson traction should be performed as the primary treatment.
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21
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Isogai N, Matsui I, Sasao Y, Nishiyama M, Funao H, Ishii K. A Rare Case of Nontraumatic Atlantoaxial Rotatory Fixation in an Adult Patient Treated by a Closed Reduction: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00024. [PMID: 33599465 DOI: 10.2106/jbjs.cc.20.00675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 42-year-old woman presented with a severe neck pain and torticollis due to uncertain etiology. Because her radiographs and computed tomography revealed atlantoaxial rotatory fixation (AARF) that is an extremely rare condition in the adult population, a nonsurgical treatment was initially applied. Because 3 weeks of indirect traction failed, closed reduction was performed under general anesthesia at 2 months after onset, and her symptoms markedly improved without any complications and recurrence. CONCLUSION Closed reduction under general anesthesia for nontraumatic AARF in adult patients might be an effective treatment option, even for chronic cases or intractable cases by traction treatment.
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Affiliation(s)
- Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Izumi Matsui
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Makoto Nishiyama
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
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Sae-Huang M, Borg A, Hill CS. Systematic review of the nonsurgical management of atlantoaxial rotatory fixation in childhood. J Neurosurg Pediatr 2021; 27:108-119. [PMID: 33036001 DOI: 10.3171/2020.6.peds20396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atlantoaxial rotatory fixation (AARF) is an acquired fixed abnormality of C1-2 joint rotation associated with torticollis in childhood. If the condition is left uncorrected, patients are at risk for developing C1-2 fusion with permanent limitation in the cervical range of movement, cosmetic deformity, and impact on quality of life. The management of AARF and the modality of nonsurgical treatment are poorly defined in both primary care and specialized care settings, and the optimal strategy is not clear. This systematic review aims to examine the available evidence to answer key questions relating to the nonsurgical management of AARF. METHODS A systematic review was performed using the following databases: PubMed, MEDLINE, Healthcare Management Information Consortium (HMIC), EMCare, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), and Allied and Complementary Medicine Database (AMED). Search criteria were created and checked independently among the authors. All articles with a radiological diagnosis of AARF and primary outcome data that met the study inclusion criteria were included and analyzed by the authors. RESULTS Search results did not yield any level I evidence such as a meta-analysis or randomized controlled trial. The initial search yielded 724 articles, 228 of which were screened following application of the core exclusion criteria. A total of 37 studies met the full criteria for inclusion in this review, consisting of 4 prospective studies and 33 retrospective case reviews. No articles directly compared outcomes between modalities of nonsurgical management. Six studies compared the outcome of AARF based on duration of symptoms before initiation of treatment. Comparative analysis of studies was hindered by the wide variety of treatment modalities described and the heterogeneity of outcome data. CONCLUSIONS The authors did not identify any level I evidence comparing different nonsurgical management approaches for AARF. There were few prospective studies, and most studies were uncontrolled, nonrandomized case series. Favorable outcomes were often reported regardless of treatment methods, with early treatment of AARF tending to yield better outcomes independent of the treatment modality. There is a lack of high-quality data, and further research is required to determine the optimal nonsurgical treatment strategy.
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Affiliation(s)
- Morrakot Sae-Huang
- 1Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
| | - Anouk Borg
- 2Department of Neurosurgery, John Radcliffe Hospital, Oxford; and
| | - Ciaran Scott Hill
- 1Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
- 3University College London Cancer Institute, London, United Kingdom
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Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under anaesthesia. Childs Nerv Syst 2021; 37:167-175. [PMID: 32661645 PMCID: PMC7790795 DOI: 10.1007/s00381-020-04727-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 01/06/2023]
Abstract
AIMS The aims were to evaluate the safety of manipulation under anaesthesia (MUA) for atlantoaxial rotatory fixation (AARF) and the relative efficacy of rigid collar vs halo-body orthosis (HBO) in avoiding relapse and the need for open surgery. METHODS Cases of CT-verified AARF treated by MUA were identified from a neurosurgical operative database. Demographic details, time to presentation and aetiology of AARF were ascertained through case note review. Cases were divided according to method of immobilisation after successful reduction, either rigid collar (group 1) or HBO (group 2). The primary outcome measure was relapse requiring open surgical arthrodesis. RESULTS Thirty-three patients (2.2-12.7 years) satisfied inclusion criteria. Time to presentation varied from 1 day to 18 months. There were 19 patients in group 1 and 14 in group 2. There were no adverse events associated with MUA. 9/19 (47%) patients in group 1 resolved without need for further treatment compared with 10/14 (71%) in group 2 (p = 0.15). Of the 10 patients who failed group 1 treatment, four resolved after HBO. A total of ten patients (30%) failed treatment and required open surgery. CONCLUSIONS MUA is a safe procedure for AARF where initial conservative measures have failed. MUA followed by immobilisation avoids the need for open surgery in over two thirds of cases. Immobilisation by cervical collar appears equally effective to HBO as an initial management, and so a step-wise approach may be reasonable. Delayed presentation may be a risk factor for relapse and need for open surgery.
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24
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Singla R, Manjunath N, Sharma R, Mishra S. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult: A Case Report. Int J Spine Surg 2020; 14:46-52. [PMID: 32128302 DOI: 10.14444/7006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARDs) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed and C1-2 fixation with the Harms technique was performed after intraoperative reduction resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Niveditha Manjunath
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
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25
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Raghav S, Niveditha M, Ravi S, Shashwat M. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult. Int J Spine Surg 2020; 13:531-535. [PMID: 31970048 DOI: 10.14444/6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARD) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed, and C1-2 fixation with the Harms technique was performed after intraoperative reduction, resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Singla Raghav
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjunath Niveditha
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sharma Ravi
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mishra Shashwat
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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26
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Benmelouka A, Shamseldin LS, Nourelden AZ, Negida A. A Review on the Etiology and Management of Pediatric Traumatic Spinal Cord Injuries. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 4:e28. [PMID: 32322796 PMCID: PMC7163256 DOI: 10.22114/ajem.v0i0.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Pediatric traumatic spinal cord injury (SCI) is an uncommon presentation in the emergency department. Severe injuries are associated with devastating outcomes and complications, resulting in high costs to both the society and the economic system. EVIDENCE ACQUISITION The data on pediatric traumatic spinal cord injuries has been narratively reviewed. RESULTS Pediatric SCI is a life-threatening emergency leading to serious outcomes and high mortality in children if not managed promptly. Pediatric SCI can impose many challenges to neurosurgeons and caregivers because of the lack of large studies with high evidence level and specific guidelines in terms of diagnosis, initial management and of in-hospital treatment options. Several novel potential treatment options for SCI have been developed and are currently under investigation. However, research studies into this field have been limited by the ethical and methodological challenges. CONCLUSION Future research is needed to investigate the safety and efficacy of the recent uprising neurodegenerative techniques in SCI population. Owing to the current limitations, there is a need to develop novel trial methodologies that can overcome the current methodological and ethical limitations.
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Affiliation(s)
| | | | | | - Ahmed Negida
- Medical Research Group of Egypt, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Neurosurgery Department, Bahçeşehir University, Istanbul, Turkey
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Copley PC, Tilliridou V, Kirby A, Jones J, Kandasamy J. Management of cervical spine trauma in children. Eur J Trauma Emerg Surg 2019; 45:777-789. [PMID: 30167742 PMCID: PMC6791958 DOI: 10.1007/s00068-018-0992-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/16/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation. METHODS We set out to review cervical spine injuries in children and advise on current best practice with regards to management. RESULTS Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed. CONCLUSIONS Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.
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Affiliation(s)
- Phillip Correia Copley
- Department of Neurosurgery, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU UK
| | - Vicky Tilliridou
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew Kirby
- Department of Radiology, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Jeremy Jones
- Department of Radiology, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Jothy Kandasamy
- Department of Neurosurgery, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU UK
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Hannonen J, Perhomaa M, Salokorpi N, Serlo W, Sequeiros RB, Sinikumpu J. Interventional magnetic resonance imaging as a diagnostic and therapeutic method in treating acute pediatric atlantoaxial rotatory subluxation. Exp Ther Med 2019; 18:18-24. [PMID: 31258633 DOI: 10.3892/etm.2019.7565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/21/2019] [Indexed: 11/05/2022] Open
Abstract
Atlantoaxial rotatory subluxation or fixation (AARF) is a rare condition, usually occurring in pediatric patients. It mimics benign torticollis but may result in permanent disability or death. The condition requires prompt diagnosis by thorough examination to avoid any treatment delays. Spiral computed tomography (CT) with three-dimensional reconstruction CT is recommended for identifying incongruence between C1 and C2 vertebrae, and magnetic resonance imaging (MRI) may be performed to exclude ligamentous injuries. In addition to static imaging, dynamic CT involves the reduction between C1 and C2 being confirmed using CT with the head turned maximally to the left and right. The present report (level of evidence, III) provides a method for treating AARF that has similar advantages as dynamic CT but avoids ionizing radiation by replacing CT with interventional MRI. The new method comprised simultaneous axial traction and manual closed reduction, performed under general anesthesia, and the use of interventional MRI to ensure that reduction was achieved and held. The head is turned maximally to the right and left during the manual reduction. A rigid cervical collar was used following reduction. Dynamic CT was not required but prior diagnostic static CT was performed in preparation. No further CT was required. There appears to be no previous studies on interventional MRI in AARF care. Being superior in its diagnostic soft-tissue visualization performance and lacking ionizing radiation, interventional MRI is a potential option for investigating and treating acute AARF in non-syndromic patients with no trauma history.
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Affiliation(s)
- Juuli Hannonen
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland
| | - Marja Perhomaa
- Department of Radiology, Pediatric Imaging, Oulu University Hospital, Oulu 90220, Finland
| | - Niina Salokorpi
- Department of Neurosurgery, Pediatric Neurosurgery, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
| | | | - Jaakko Sinikumpu
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
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Fernandes R, Fitzpatrick N, Rusbridge C, Rose J, Driver CJ. Cervical vertebral malformations in 9 dogs: radiological findings, treatment options and outcomes. Ir Vet J 2019; 72:2. [PMID: 31044069 PMCID: PMC6480486 DOI: 10.1186/s13620-019-0141-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Disregarding atlantoaxial instability in toy breed dogs associated with dens malformation and cervical spondylomyelopathy; cervical vertebral malformations are rare and poorly characterised in veterinary medicine and consequently treatment strategies and clinical outcome are sparsely documented. RESULTS Electronic clinical records at our veterinary referral hospital between April 2009 and November 2018 were searched for patients presented with cervical myelopathy secondary to an underlying suspected vertebral malformation/instability. Nine dogs met the inclusion criteria. Two dogs were diagnosed with atlantoaxial pseudoarthrosis, two dogs with a syndrome similar to Klippel-Feil in humans, two dogs with congenital cervical fusion, two dogs with congenital C2-C3 canal stenosis and deficiencies of the dorsal arch of the atlas and laminae of the axis and one with axial rotatory displacement. Tetraparesis, proprioceptive deficits, cervical hyperesthesia and cervical scoliosis were the most common clinical signs. The axis was the most commonly affected vertebrae (8/9 patients). Patients diagnosed with Klippel-Feil-like Syndrome were the younger (average of 262.5 days) and patients diagnosed with fused vertebrae the oldest (average of 2896 days) in our studied population (average of 1580.8 days). CONCLUSION Cervical vertebral malformations are rare, or alternatively, being underdiagnosed in veterinary medicine. Patients diagnosed with Klippel-Feil-like Syndrome had a successful medium and long-term outcome with conservative management. Surgical treatment was often indicated for the other conditions presented in this study due to spinal instability and/or myelopathy. Stabilisations via ventral approaches were revealed to be safe. Multicentre and prospective studies are necessary in veterinary medicine to better characterise clinical outcomes in cervical vertebral malformations.
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Affiliation(s)
| | - Noel Fitzpatrick
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ UK
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, Vet School Main Building (VSM), Daphne Jackson Road, Guildford, Surrey GU2 7AL UK
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ UK
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, Vet School Main Building (VSM), Daphne Jackson Road, Guildford, Surrey GU2 7AL UK
| | - Jeremy Rose
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ UK
| | - Colin J. Driver
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ UK
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Zattra C, Schiariti MP, La Corte E, Broggi M, Acerbi F, Ferroli P. Atlanto-axial rotatory fixation complicating ventriculo-peritoneal shunt surgery: a case report and literature review. Childs Nerv Syst 2019; 35:713-717. [PMID: 30276650 DOI: 10.1007/s00381-018-3983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atlanto-axial rotatory fixation (AARF) is a rare complication of ventriculo-peritoneal shunt (VPS) surgery. CASE PRESENTATION The authors present a unique case of AARF developing early after VP shunting, with persistent torticollis, a "cock-robin" head position, and a thick fibrous band along the catheter path. Due to refractoriness to conservative treatments, AARF, which can be an early-onset complication of VPS surgery, was resolved by removing the distal catheter along with the fibrous band encasing it. CONCLUSION Surgical removal of the fibrous band might be enough to solve such complication with no need of further surgical fusion procedures.
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Affiliation(s)
- Costanza Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
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31
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Mahr D, Freigang V, Bhayana H, Kerschbaum M, Frankewycz B, Loibl M, Nerlich M, Baumann F. Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children. Eur J Trauma Emerg Surg 2019; 47:713-718. [PMID: 30783696 DOI: 10.1007/s00068-019-01096-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atlanto-axial rotatory fixation (AARF) is an uncommon condition in children presenting with torticollis. Many studies have elaborated on the diagnostic sequence of AARF. However, there is no consensus for the algorithm of management of AARF. METHODS This study proposes to provide a comprehensive step-by-step guideline which aims to achieve and retain anatomic reduction of the atlanto-axial joint (AAJ). We recommend a 'therapeutic crescendo': closed reduction and immobilization in a rigid cervical collar (step I). In cases of re-dislocation, a second attempt of closed reduction and immobilization in a Halo-jacket (step II). Cases of recurrent dislocations due to persistent instability require open reduction and internal fixation. We present a new surgical technique of transverse suture transfixation (TSF) of C1/C2 (step III). Alternatively, a dorsal stabilization of C1/C2 is indicated after open reduction (step IV). 13 patients with radiologically confirmed AARF were included in this study. These patients were treated as per the above mentioned algorithm. All these patients were serially evaluated with a minimum follow-up of 1 year. RESULTS Clinical data of 10/13 patients were available for follow-up evaluation at mean 4.6 years after the onset of symptoms. Two patients were managed surgically. We recorded good clinical results in all patients treated according to the algorithm. CONCLUSIONS AARF is a subacute pediatric emergency. Reduction and maintenance of joint congruency of the AAJ are the treatment goals. The comprehensive therapeutic algorithm presented in this study is applicable in patients with AARF to achieve excellent long-term results. LEVEL OF EVIDENCE IV, Retrospective cohort study. TRIAL REGISTRATION NUMBER Clinical Trial Registry University of RegensburgZ-2014-0453-4. Registered 01 December 2014.
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Affiliation(s)
- Daniel Mahr
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Himanshu Bhayana
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, Delhi, 110095, India
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Borys Frankewycz
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Markus Loibl
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
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Abnormalities of the craniovertebral junction in the paediatric population: a novel biomechanical approach. Clin Radiol 2018; 73:839-854. [DOI: 10.1016/j.crad.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
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Pavlova OM, Ryabykh SO, Burcev AV, Gubin AV. Anomaly-Related Pathologic Atlantoaxial Displacement in Pediatric Patients. World Neurosurg 2018; 114:e532-e545. [DOI: 10.1016/j.wneu.2018.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
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34
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Kashii M, Masuhara K, Kaito T, Iwasaki M. Rotatory Subluxation and Facet Deformity in the Atlanto-occipital Joint in Patients with Chronic Atlantoaxial Rotatory Fixation: Two Case Reports. J Orthop Case Rep 2018; 7:59-63. [PMID: 29600213 PMCID: PMC5868886 DOI: 10.13107/jocr.2250-0685.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The relationship between the morphometry of atlantoaxial joint and chronic atlantoaxial rotatory fixation (AARF) is well known, but disorders in the atlanto-occipital joint in chronic AARF are not fully elucidated. The authors report two rare cases of secondary deformities in the atlanto-occipital joint in chronic AARF. Case Reports: Two patients with chronic AARF were treated with closed manipulation, skull traction and halo-vest immobilization. Clinical outcomes and radiographs were reviewed retrospectively, focusing on pathological changes in the atlanto-occipital joint using multiplanar reconstruction computed tomography and three-dimensional computed tomography images. Case 1 (12-year-old girl) had rotatory subluxation with a superior facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. After a series of conservative treatments, both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced, and both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed. She was monitored without surgery because the disorder progressed to the spontaneous fusion of the occipital bone to the axis. Case 2 (13-year-old boy) had rotatory subluxation without facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. However, both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed over time, and both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced after a series of conservative treatments. He still had severe neck pain and severely restricted neck mobility and underwent spinal fusion. Conclusion: Atlanto-occipital rotatory subluxation and facet deformity in the atlanto-occipital joint may occur after prolonged AARF. It is necessary to pay attention to pathological changes not only in the atlantoaxial joint but also in the atlanto-occipital joint, when orthopedic surgeons treat patients with AARF.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, Japan.,Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kenta Masuhara
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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35
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Craniovertebral Junction Abnormalities in Surgical Patients With Congenital Muscular Torticollis. J Craniofac Surg 2018; 29:e327-e331. [PMID: 29485567 DOI: 10.1097/scs.0000000000004403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our clinical experience led us to realize that craniovertebral junction (CVJ) abnormalities were common in surgical patients with congenital muscular torticollis (CMT). This study aimed to report the concurrence rate of CVJ abnormalities in surgical patients with CMT, along with comprehensive evaluation of type of concurrent CVJ abnormalities. This was a retrospective cohort study in a tertiary hospital, including 41 subjects who underwent surgical release for CMT at the mean age of 8.38 years. The presence of CVJ abnormalities was analyzed, using craniofacial 3-dimensional computed tomography images. The concurrence rate of CVJ abnormalities was 70% in surgical patients with CMT. Subjects with CVJ abnormalities had, on average, 1.48 abnormalities. The CVJ abnormalities were rotation and lateral shift of the atlanto-axial joint along with rotation of atlanto-occipital joint, where rotation of the atlanto-axial joint was most common (82.76%). There is no patient with anterior shift of the atlanto-axial joint. Chronic mechanical tension by the contracted unilateral sternocleidomastoid muscle of CMT could be responsible for concurrent CVJ abnormalities. The CVJ abnormalities are more common in the atlanto-axial joint than in the atlanto-occipital joint. In conclusions, CVJ abnormality seems to be a common concurrent skeletal complication of CMT, at least, in surgical patients. The CVJ abnormality might be included in the list of skeletal complications of CMT. If CVJ abnormalities are significantly more common in surgical patients with CMT, CVJ abnormalities might be one of predictors of surgical patients with CMT.
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Sonoo T, Sato T, Den S, Inokuchi R, Matsubara T, Nakajima S, Yahagi N. Child With Acute Neck Pain. Ann Emerg Med 2017; 68:e5-6. [PMID: 27343677 DOI: 10.1016/j.annemergmed.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Tomohiro Sonoo
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Sato
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Shota Den
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan; Department of Orthopedic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Takehiro Matsubara
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan; Department of Orthopedic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Susumu Nakajima
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Yahagi
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
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Miyao Y, Sasaki M, Umegaki M, Yonenobu K. Adult Case of Atlantoaxial Rotatory Fixation Treated with In Situ Fixation Using an Unusual Posterior Instrumentation Construct. NMC Case Rep J 2017; 4:63-66. [PMID: 28840080 PMCID: PMC5566685 DOI: 10.2176/nmccrj.cr.2016-0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/02/2016] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory fixation (AARF) occurs commonly in children who have undergone trauma. It is usually corrected with conservative therapy. In this report, however, the patient was an adult with AARF who was treated surgically. A 64-year-old woman presented with a 1-year history of spastic gait and hand clumsiness. Imaging studies revealed the presence of AARF, os odontoideum, and severe spinal cord compression at that spinal level. As the AARF had not been responded to head traction with a halo device, we decided to treat the patient with in situ posterior fixation. Because the rigid dislocation was present between the atlas and the axis, we were forced to make an unusual instrumentation construct. Neurological symptoms other than hand numbness diminished after the surgery, and arthrodesis was obtained between the occiput and the axis. It should be noted that surgical planning for posterior instrumentation construct is required when rigid AARF is treated surgically.
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Affiliation(s)
- Yasuyoshi Miyao
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Manabu Sasaki
- Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan
| | - Masao Umegaki
- Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan
| | - Kazuo Yonenobu
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Osaka, Japan
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Anderst W, Rynearson B, West T, Donaldson W, Lee J. Dynamic in vivo 3D atlantoaxial spine kinematics during upright rotation. J Biomech 2017; 60:110-115. [PMID: 28662932 DOI: 10.1016/j.jbiomech.2017.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
Abstract
Diagnosing dysfunctional atlantoaxial motion is challenging given limitations of current diagnostic imaging techniques. Three-dimensional imaging during upright functional motion may be useful in identifying dynamic instability not apparent on static imaging. Abnormal atlantoaxial motion has been linked to numerous pathologies including whiplash, cervicogenic headaches, C2 fractures, and rheumatoid arthritis. However, normal C1/C2 rotational kinematics under dynamic physiologic loading have not been previously reported owing to imaging difficulties. The objective of this study was to determine dynamic three-dimensional in vivo C1/C2 kinematics during upright axial rotation. Twenty young healthy adults performed full head rotation while seated within a biplane X-ray system while radiographs were collected at 30 images per second. Six degree-of-freedom kinematics were determined for C1 and C2 via a validated volumetric model-based tracking process. The maximum global head rotation (to one side) was 73.6±8.3°, whereas maximum C1 rotation relative to C2 was 36.8±6.7°. The relationship between C1/C2 rotation and head rotation was linear through midrange motion (±20° head rotation from neutral) in a nearly 1:1 ratio. Coupled rotation between C1 and C2 included 4.5±3.1° of flexion and 6.4±8.2° of extension, and 9.8±3.8° of contralateral bending. Translational motion of C1 relative to C2 was 7.8±1.5mm ipsilaterally, 2.2±1.2mm inferiorly, and 3.3±1.0mm posteriorly. We believe this is the first study describing 3D dynamic atlantoaxial kinematics under true physiologic conditions in healthy subjects. C1/C2 rotation accounts for approximately half of total head axial rotation. Additionally, C1 undergoes coupled flexion/extension and contralateral bending, in addition to inferior, lateral and posterior translation.
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Affiliation(s)
- William Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, United States.
| | - Bryan Rynearson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Tyler West
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - William Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Joon Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
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Matsumoto Y, Mizutani J, Suzuki N, Otsuka S, Hayakawa K, Fukuoka M, Wada I. Temporary Internal Fixation Using C1 Lateral Mass Screw and C2 Pedicle Screw (Goel-Harms Technique) without Bone Grafting for Chronic Atlantoaxial Rotatory Fixation. World Neurosurg 2017; 102:696.e1-696.e6. [PMID: 28377256 DOI: 10.1016/j.wneu.2017.03.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The primary treatment strategy for chronic atlantoaxial rotatory fixation (chro-AARF) is traction followed by bracing or application of a halo device. However, to complete these conservative therapies, patient cooperation is mandatory. If conservative therapy fails, surgery is required for reduction and prevention of recurrence. It has been considered that surgery for atlantoaxial rotatory fixation necessitates solid bony fusion. However, once bony fusion is achieved, loss of range of motion is problematic. Here, we report a patient with chro-AARF who was successfully treated with temporary internal fixation using a C1 lateral mass screw and C2 pedicle screw (Goel-Harms technique) without any grafting of bone or use of bone substitute materials. CASE DESCRIPTION A 9-year-old boy with chro-AARF was referred to our institution. He had a history of pervasive developmental disorders. He did not cooperate for the completion of conservative therapy and could not tolerate this therapy. Therefore, the orthopedic staff and his parents considered surgery. Under general anesthesia, reduction was easily performed. The Goel-Harms screw-rod construct was completed as a temporary internal fixator without any grafting of bone or use of bone substitute materials. After 6 months, the screw-rod construct was removed. Removal of the screw-rod construct was performed easily without complication. There was no ankylosis of the C1-2 joint, and cervical range of motion was maintained 2.8 years after removal of the construct. CONCLUSIONS When conservative therapy cannot be continued, Goel-Harms surgery as a temporary internal fixator without bone grafting might be a suitable alternative for selected patients with chro-AARF.
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Affiliation(s)
- Yoshihisa Matsumoto
- Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Mizutani
- Department of Rehabilitation Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Seiji Otsuka
- Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuo Hayakawa
- Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Muneyoshi Fukuoka
- Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Ikuo Wada
- Department of Rehabilitation Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
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Sakaida H, Akeda K, Sudo A, Takeuchi K. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children. Patient Saf Surg 2017; 11:5. [PMID: 28184249 PMCID: PMC5289022 DOI: 10.1186/s13037-016-0116-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature. CASE PRESENTATION One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the "cock-robin" position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment. CONCLUSION The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the range of head and neck motion, proper intraoperative positioning and monitoring of the position, and postoperative follow-up. Postoperative atlantoaxial rotatory fixation is not completely preventable, but good perioperative management can minimize the damage resulting from this condition.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology - Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Koji Akeda
- Department of Orthopaedic surgery, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Akihiro Sudo
- Department of Orthopaedic surgery, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology - Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
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Fusion Surgery Required for Recurrent Pediatric Atlantoaxial Rotatory Fixation after Failure of Temporary Fixation with Instrumentation. Case Rep Orthop 2017. [PMID: 29527367 PMCID: PMC5758859 DOI: 10.1155/2017/1017307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In cases of chronic irreducible and recurrent unstable atlantoaxial rotatory fixation (AARF), closed reduction and its maintenance are often unsuccessful, requiring surgical treatment. The purpose of the present report is to describe a rare case of pediatric AARF that required multiple treatments. A 6-year-old boy was diagnosed as having type 2 AARF. After conservative treatment, the patient was treated with temporary fixation surgery (C1-C2 Magerl) without a bone graft in consideration of motion preservation after screw removal. AARF recurred after the screw removal and required fusion surgery (Magerl–Brooks) with an iliac bone graft. Ultimately, bone union was achieved and the screws were removed 11 months after the surgery. We recommend surgeons be cautious when choosing temporary fixation surgery for AARF in small children. Further investigation is needed to determine the optimal time before screw removal.
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Abstract
Pediatric emergency physicians must have a high clinical suspicion for atlantoaxial rotatory subluxation (AARS), particularly when a child presents with neck pain and an abnormal head posture without the ability to return to a neutral position. As shown in the neurosurgical literature, timely diagnosis and swift initiation of treatment have a greater chance of treatment success for the patient. However, timely treatment is complicated because torticollis can result from a variety of maladies, including: congenital abnormalities involving the C1-C2 joint or the surrounding supporting muscles and ligaments, central nervous system abnormalities, obstetric palsies from brachial plexus injuries, clavicle fractures, head and neck surgery, and infection. The treating pediatrician must discern the etiology of the underlying problem to determine both timing and treatment paradigms, which vary widely between these illnesses. We present a comprehensive review of AARS that is intended for pediatric emergency physicians. Management of AARS can vary widely bases on factors, such as duration of symptoms, as well as the patient's history. The goal of this review is to streamline the management paradigms and provide an inclusive review for pediatric emergency first responders.
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Wang JH, Daniels AH, Palumbo MA, Eberson CP. Cervical Traction for the Treatment of Spinal Injury and Deformity. JBJS Rev 2016; 2:01874474-201405000-00004. [PMID: 27500609 DOI: 10.2106/jbjs.rvw.m.00108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joanne H Wang
- Hasbro Children's Hospital, 2 Dudley Street, Suite 200, Providence, RI, 02903
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Mifsud M, Abela M, Wilson NIL. The delayed presentation of atlantoaxial rotatory fixation in children: a review of the management. Bone Joint J 2016; 98-B:715-20. [PMID: 27143747 DOI: 10.1302/0301-620x.98b5.36306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
AIMS Although atlantoaxial rotatory fixation (AARF) is a common cause of torticollis in children, the diagnosis may be delayed. The condition is characterised by a lack of rotation at the atlantoaxial joint which becomes fixed in a rotated and subluxed position. The management of children with a delayed presentation of this condition is controversial. This is a retrospective study of a group of such children. PATIENTS AND METHODS Children who were admitted to two institutions between 1988 and 2014 with a diagnosis of AARF were included. We identified 12 children (four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4), in whom the duration of symptoms on presentation was at least four weeks (four to 39). All were treated with halo traction followed by a period of cervical immobilisation in a halo vest or a Minerva jacket. We describe a simple modification to the halo traction that allows the child to move their head whilst maintaining traction. The mean follow-up was 59.6 weeks (24 to 156). RESULTS Despite the delay in referral, the subluxation was successfully reduced in all children. Only two children required atlantoaxial fusion. CONCLUSION The results of our study suggest that normal anatomy with restoration of movement may be achieved even in cases of AARF presenting late, obviating the need for fusion. We also show a simple modification to the halo traction that allows the child to move their head about while still maintaining traction. TAKE HOME MESSAGE Prompt diagnosis and management with halo traction (with a simple modification as described) is associated with good results in patients with AARF who present late. Cite this article: Bone Joint J 2016;98-B:715-20.
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Affiliation(s)
- M Mifsud
- Mater Dei Hospital, Tal-Qroqq, Msida MSD2090, Malta
| | - M Abela
- Mater Dei Hospital, Tal-Qroqq, Msida MSD2090, Malta
| | - N I L Wilson
- Royal Hospital for Sick Children, Dalnair Street, Yorkhill, Glasgow G3 8SJ, UK
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Occipitocervical Fusions in Elderly Patients: Mortality and Reoperation Rates From a National Spine Registry. World Neurosurg 2016; 86:161-7. [DOI: 10.1016/j.wneu.2015.09.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 11/21/2022]
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Reintjes SL, Amankwah EK, Rodriguez LF, Carey CC, Tuite GF. Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates. J Neurosurg Pediatr 2016; 17:187-202. [PMID: 26496632 DOI: 10.3171/2015.6.peds1562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.
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Affiliation(s)
- Stephen L Reintjes
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Ernest K Amankwah
- Department of Clinical and Translational Research, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg
| | - Luis F Rodriguez
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Carolyn C Carey
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Gerald F Tuite
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Lemley K, Bauer P. Pediatric Spinal Cord Injury: Recognition of Injury and Initial Resuscitation, in Hospital Management, and Coordination of Care. J Pediatr Intensive Care 2015; 4:27-34. [PMID: 31110847 DOI: 10.1055/s-0035-1554986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Spinal cord injury is uncommon in the pediatric population with a lifelong impact for the patient and family. Knowledge of spine embryology, mechanisms of injury that lead to specific injuries, appropriate utilization of radiographic imaging based on suspected injury, prehospital and hospital management of various spinal cord injuries is essential for providers attending to traumatically injured patients. In addition to patients who present with soft tissue and bony injuries diagnosed with clinical examination and confirmed with computed tomography or magnetic resonance imaging, it is important to note that the pediatric population is at a higher risk for spinal cord injury without radiographic abnormality than the adult population. Patients who survive the acute phase of injury face long-term rehabilitation and have an increased risk of depression and mortality. Understanding the long-term sequelae of spinal cord injuries is also an essential management component of traumatically injured children. A program that provides long-term rehabilitation, psychosocial and spiritual support, and adaptive environmental supports gives patients and their families the best opportunity for long-term recovery. A review of the current literature on the diagnosis, management, and follow-up of pediatric spinal cord injury is presented.
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Affiliation(s)
- Kyle Lemley
- Department of Pediatric Critical Care, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Paul Bauer
- Department of Pediatric Critical Care, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Krengel WF, Kim PH, Wiater B. Spontaneous Ankylosis of Occiput to C2 following Closed Traction and Halo Treatment of Atlantoaxial Rotary Fixation. Global Spine J 2015; 5:233-8. [PMID: 26131392 PMCID: PMC4472283 DOI: 10.1055/s-0035-1549432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 02/10/2015] [Indexed: 11/24/2022] Open
Abstract
Study Design Case report. Objective We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing "spontaneous" ankylosis needs to be considered.
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Affiliation(s)
- Walter F. Krengel
- Department of Orthopedics, Seattle Children's Hospital and University of Washington, Seattle, Washington, United States
| | - Paul H. Kim
- Department of Orthopedics, University of Washington, Seattle, Washington, United States
| | - Brett Wiater
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, United States
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Brotis AG, Paraskevi TM, Tsitsopoulos P, Tasiou A, Fotakopoulos G, Fountas KN. An evidence-based approach towards the cranio-cervical junction injury classifications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:931-9. [DOI: 10.1007/s00586-015-3877-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/07/2015] [Accepted: 03/11/2015] [Indexed: 12/12/2022]
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Missori P, Marruzzo D, Peschillo S, Domenicucci M. Clinical Remarks on Acute Post-traumatic Atlanto-Axial Rotatory Subluxation in Pediatric-Aged Patients. World Neurosurg 2014; 82:e645-8. [DOI: 10.1016/j.wneu.2014.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/24/2014] [Indexed: 10/25/2022]
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