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Niu HG, Zhang JJ, Yan YZ, Yang K, Zhang YS. Direct osteosynthesis in the treatment of atlas burst fractures: a systematic review. J Orthop Surg Res 2024; 19:129. [PMID: 38331873 PMCID: PMC10851607 DOI: 10.1186/s13018-024-04571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE The treatment of unstable atlas fractures remains a controversial topic. The study aims at assessing the prognosis and efficacy of osteosynthesis for unstable atlas fractures through a review of the current literature and additionally aims to compare outcomes between the transoral and posterior approaches. METHODS A systematic review of databases including PubMed, EMBASE, Cochrane, Web of Science, CNKI, and Wanfang was conducted. Titles and abstracts were screened by two reviewers to identify studies meeting pre-defined inclusion criteria for comprehensive analysis. RESULTS The systematic review included 28 articles, 19 employing the posterior approach and 9 utilizing the transoral approach. It covered osteosynthesis in 297 patients with unstable atlas fractures, comprising 169 treated via the posterior approach and 128 via the transoral approach. Analysis revealed high healing rates and clinical improvement in both approaches, evidenced by improvements in the visual analog scale, range of motion, atlantodens interval, and lateral displacement distance post-surgery. CONCLUSION Osteosynthesis offers effective treatment for unstable atlas fractures. Both transoral and posterior approaches can achieve good clinical outcomes for fracture, and biomechanical studies have confirmed that osteosynthesis can maintain the stability of the occipitocervical region, preserve the motor function of the atlantoaxial and occipito-atlantoaxial joints, and greatly improve the quality of life of patients. However, variations exist in the indications and surgical risks associated with each method, necessitating their selection based on a thorough clinical evaluation of the patient's condition.
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Affiliation(s)
- He-Gang Niu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Jing-Jing Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Yi-Zhu Yan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Kun Yang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China.
| | - Yin-Shun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China.
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Palmieri G, Cofano F, Marengo N, Ajello M, Zenga F, Garbossa D. Posterior arch reconstruction in cervical surgery to restore the global biomechanics of the Atlas: a technical note. Br J Neurosurg 2023; 37:1402-1405. [PMID: 33554670 DOI: 10.1080/02688697.2021.1881042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
The posterior arch of the atlas is usually not considered one of the main stabilizers of the cranio-cervical junction, allowing surgeons to its removal when needed with a relative certainty to preserve the stability of the atlo-axial segment. However, these considerations do not reflect the importance to examine the integrity of the posterior arch in the whole biomechanics of the atlas. Authors like Gebauer and Panjabi revealed, respectively in experimental and clinical conditions, how the atlas responds to an axial loading force, proving that the whole atlas is involved into horizontal conversion of axial forces and providing evidence supporting the preservation of the posterior arch. Other authors evaluated the risk for anterior arch fracture following C1 laminectomy. In this technical note three different techniques of posterior atlas arch reconstruction after surgical iatrogenic disruption are presented, considering both neoplastic and degenerative disease.
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Affiliation(s)
- Giuseppe Palmieri
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Nicola Marengo
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Marco Ajello
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
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Fiester P, Soule E, Rao D, Patel J, Jenson M, Rahmathulla G, Orallo P. Appropriateness of Cervical Magnetic Resonance Imaging in the Evaluation and Management of C1 Jefferson Fractures. World Neurosurg 2022; 167:e137-e145. [PMID: 35948216 DOI: 10.1016/j.wneu.2022.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traditionally, C1 fractures have been designated as stable or unstable based on the inherent integrity of the transverse altantal ligament. The purpose of our study was to identify adult trauma patients with C1 fractures on cervical computed tomography and evaluate whether C1-C2 alignment differed in patients with and without an associated transverse atlantal ligament injury on follow-up cervical magnetic resonance imaging. METHODS Adult trauma patients who suffered a C1 fracture were identified retrospectively. The cervical computed tomography examinations for these patients were reviewed for the following: C1 fracture classification, anterior atlantodens interval (ADI) widening, asymmetry in the lateral atlantodens interval, C1 lateral mass offset, and atlantoaxial rotation. RESULTS Acute C1 fractures were grouped into those with an unequivocal transverse atlantal ligament injury (n = 12), and patients with an unequivocally intact transverse atlantal ligament (n = 20). Three patients were classified as indeterminate for transverse atlantal ligament injury. Statistically significant increases in lateral ADI asymmetry and combined C1 lateral mass offset were identified in patients with transverse atlantal ligament tears. CONCLUSIONS Lateral ADI asymmetry (using a cutoff of >3 mm), combined C1 lateral mass offset, and anterior ADI demonstrate robust specificity to "rule in" transverse atlantal ligament injury. Atlantoaxial alignment was overall relatively insensitive as a screening test although sensitivity can be improved using a cutoff of >2 mm for lateral ADI asymmetry. Our findings reinforce the role of cervical magnetic resonance imaging in the diagnostic workup and clinical management of trauma patients with an acute burst fracture of the C1 vertebra.
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Affiliation(s)
- Peter Fiester
- Department of Neuroradiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
| | - Erik Soule
- Department of Neuroradiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Jeet Patel
- Department of Neuroradiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Matthew Jenson
- Department of Neuroradiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Gazanfar Rahmathulla
- Department of Neurosurgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Peaches Orallo
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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Shin JW, Suk KS, Kim HS, Yang JH, Kwon JW, Lee HM, Moon SH, Lee BH, Park SJ, Park SR, Kim SK. Direct Internal Fixation for Unstable Atlas Fractures. Yonsei Med J 2022; 63:265-271. [PMID: 35184429 PMCID: PMC8860933 DOI: 10.3349/ymj.2022.63.3.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. MATERIALS AND METHODS This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery. RESULTS The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. CONCLUSION C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.
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Affiliation(s)
- Jae-Won Shin
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Jun Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sub-Ri Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sun-Kyu Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Fujiwara Y, Harada T, Kotaka S, Ohta R, Nishimori M, Adachi N. Anterior Atlas Fracture After C1 Laminectomy Which Was Successfully Treated by Brace Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00048. [PMID: 34319946 DOI: 10.2106/jbjs.cc.21.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of a 67-year-old male patient who underwent a C1 laminectomy with laminoplasty at C2-3 because of cervical ossification of the posterior longitudinal ligament. At 6 weeks after surgery, neck pain occurred after minor trauma without neurological deterioration. Computed tomography (CT) demonstrated C1 anterior atlas fracture with a 3-mm gap. After a 3-month brace therapy using a Philadelphia collar, the patient's neck pain disappeared with complete bone union according to the CT. CONCLUSION Among 14 cases that were reported previously, none of the adult patients achieved bone union by brace therapy. Therefore, this is the only case report in which bone union could be achieved by brace therapy.
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Affiliation(s)
- Yasushi Fujiwara
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Takahiro Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Ryo Ohta
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Makoto Nishimori
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Tomaszewski R, Sesia SB, Studer D, Rutz E, Mayr JM. Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series. Medicine (Baltimore) 2021; 100:e25334. [PMID: 33787631 PMCID: PMC8021376 DOI: 10.1097/md.0000000000025334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children's Health Centre
- University of Silesia, Faculty of Science and Technology, Institute of Biomedical Engineering, Katowice, Poland
| | - Sergio B. Sesia
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern
| | - Daniel Studer
- Department of Pediatric Orthopedics, University Children's Hospital Basel, University of Basel, Switzerland
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Johannes M. Mayr
- Department of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Switzerland
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Wang W, Liu Z, Guo H, Wang H. Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review. Orthop Surg 2021; 13:360-365. [PMID: 33274600 PMCID: PMC7862144 DOI: 10.1111/os.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/19/2020] [Accepted: 10/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The arcuate foramen is a complete or partial bony bridge over the vertebral artery groove of atlas. The mechanism of the arcuate foramen is not clearly understood. Omission of the arcuate foramen sometimes causes lethal iatrogenic injury during spinal surgery. CASE PRESENTATION We describe a patient who was diagnosed with multiple fractures of the cervical vertebrae, arcuate foramen, and right vertebral artery occlusion based on clinical and radiological exams. After conservative treatment, he resumed a normal and productive life. CONCLUSIONS Arcuate foramen is a common variation that causes symptoms such as dizziness, headache, and migraine. If the patient does not develop severe symptoms, conservative treatment can achieve very good results without the necessity to remove the bone bridge. When serious symptoms occur, surgical treatment to resect the bony ridges can relieve the symptoms dramatically.
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Affiliation(s)
- Wei‐hao Wang
- Department of OrthopaedicsFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Zhao‐yong Liu
- Department of OrthopaedicsFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Huan‐cheng Guo
- Department of OrthopaedicsFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Hu Wang
- Department of OrthopaedicsFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Abstract
At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ± 14.9 min (range: 82-135 min), and mean blood loss was 386.2 ± 147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.
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Affiliation(s)
- Wei Guo
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Yang Lin
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Jingwen Huang
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Feng Hu
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Zhou Ding
- Department of Spine Surgery, The First People's Hospital of Changde City, Hunan Province, P.R. China
| | - Zengming Xiao
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
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Abstract
RATIONALE To our knowledge, this is the first report of traumatic combined vertical atlanto-occipital dislocation (AOD) and atlanto-axial dislocation (AAD) with 2-part fracture of the atlas. PATIENT CONCERNS The first case was of a 31-year-old woman admitted to the emergency room comatose after a traffic accident. The second case was of a 21-year-old woman admitted to the emergency room comatose after a fall. DIAGNOSES Traumatic combined vertical AOD and AAD with 2-part fractures of the atlas was diagnosed using plain radiography, 2-dimensional computed tomography, and/or magnetic resonance imaging of the cervical spine. INTERVENTION The first patient received immediate intubation and cardiopulmonary resuscitation in the emergency room. The second patient also received immediate intubation in the emergency room. After her vitals stabilized, she underwent occipitocervical fusion with instrumentation. OUTCOMES The first patient died 2 days after the accident. The second patient remained quadriplegic in a ventilatory-dependent state at 1 year after surgery. She continues to receive comprehensive rehabilitation. LESSONS Immediate respiratory support and surgical stabilization are important for saving lives in this kind of extremely unstable and fatal complex upper cervical spine injury.
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Affiliation(s)
- Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul
| | - Whoan Jeang Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Eung Sic Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do
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Park HJ, Chang DG, Park JB, Kim WJ, Song KJ, Min WK, Park SC. Radiologic criteria to predict injury of the transverse atlantal ligament in unilateral sagittal split fractures of the C1 lateral mass. Medicine (Baltimore) 2019; 98:e17077. [PMID: 31490410 PMCID: PMC6739003 DOI: 10.1097/md.0000000000017077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Unilateral sagittal split fracture (USSF) of the C1 lateral mass (LM) has been recently recognized as a rare variant of C1 atlas fracture. To date, there has been no study to investigate whether radiologic criteria can be applied to determine the presence or absence of transverse atlantal ligament (TAL) injury in USSF of the C1 LM.Twenty six consecutive cases of USSF of the C1 LM were included in this study. According to Dickman classification, 16 cases were TAL injury, and 10 cases were TAL intact. Radiologic parameters were measured and compared between the 2 groups.Total LM displacement (LMD) of the 2 sides (5.9 ± 2.0 mm vs 1.2 ± 2.0 mm), unilateral LMD of the fracture side (4.3 ± 1.2 mm vs 1.0 ± 1.1 mm), atlanto-dental interval (ADI) (2.0 ± 0.9 mm vs 1.5 ± 0.4 mm), and fracture gap (6.9 ± 2.7 mm vs 2.1 ± 1.1 mm) were statistically higher in the TAL injury group than the TAL intact group. However, basion-dental interval, clivus canal angle, and atlanto-occipital joint axis angle were not different between the 2 groups. Total LMD and unilateral LMD positively correlated with ADI and fracture gap. The incidence of fracture gap larger than 7 mm was statistically higher in the TAL injury group than the TAL intact group (81% vs 30%).In conclusion, total LMD > 5.9 mm or unilateral LMD > 4.3 mm suggests the presence of TAL injury in USSF of the C1 LM. The possibility of diagnostic error for TAL injury can be further reduced in USSF of the C1 LM by considering the fracture gap larger than 7 mm.
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Affiliation(s)
- Heui-Jeon Park
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul
| | - Whoan Jeang Kim
- Department of Orthopaedic Surgery, College of Medicine, Eulji University Hospital, Daejeon
| | - Kyung-Jin Song
- Department of Orthopaedic Surgery, College of Medicine, Chonbuk National University, Jeonju
| | - Woo-Kie Min
- Department of Orthopaedic Surgery, College of Medicine, Kyungbuk National University, Daegu, Korea
| | - Seung Chan Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul
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Kim MK, Shin JJ. Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures. Acta Neurochir (Wien) 2019; 161:685-693. [PMID: 30710241 DOI: 10.1007/s00701-019-03824-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unstable atlas fractures with concomitant transverse atlantal ligament (TAL) injury may be conservatively managed by halo-vest immobilization (HVI) or surgically treated by various fixation techniques. Many surgeons prefer surgical management due to complications, nonunion, and further dislocations with HVI. There are no comparative studies on surgical and nonsurgical management of unstable atlas fractures. We retrospectively assessed the radiological and clinical outcomes of surgical reduction with fixation vs. non-operative treatments for unstable atlas fractures with TAL rupture. METHODS We analyzed records of 24 patients (15 men, 9 women; mean age, 48.3 years) with at least 1 year of follow-up. They underwent HVI or surgical reduction with fixation for unstable atlas fracture combined with TAL injury. Clinical outcomes, including neck visual analog scale and neck disability index (NDI), and radiological measurements, including degree of fracture displacement, atlantodental interval (ADI), range of motion (ROM), cervical alignment, fusion rate, and time-to-fusion, were assessed. RESULTS Of the 24 patients, 13 were treated by surgical reduction with fixation (C1 lateral mass screw-C2 pedicle screw with a cross-link) and 11 by HVI. A significant reduction in lateral displacement of fractured lateral masses was identified in surgical reduction with fixation (3.21 ± 1.21 mm) compared with HVI (0.97 ± 2.69 mm). The mean reduction in ADI was 1.47 ± 1.08 mm with surgical fixation and 0.66 ± 1.02 mm with HVI. The bony rate and time-to-fusion were 100% and 14.91 ± 3.9 weeks with surgical reduction, and 72.7% and 22.31 ± 10.85 weeks with HVI. The postoperative neck pain relief and NDI after surgical fixation were higher than those after HVI. CONCLUSIONS Compared with HVI, surgical reduction with fixation reduces fractured lateral mass displacements, increases fusion rate, and reduces time-to-fusion while maintaining cervical curvature and improving neck pain and daily activities.
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Affiliation(s)
- Moon Kyu Kim
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea.
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Sharbel D, Chat V, Blumenthal D, Biddinger P, Byrd JK. Cervical nodal metastasis after malignant conversion of sinonasal inverted papilloma: Report of a rare case and literature review. Oral Oncol 2019; 90:45-47. [PMID: 30846175 DOI: 10.1016/j.oraloncology.2019.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 11/18/2022]
Abstract
Malignant conversion of sinonasal inverted papilloma (SNIP) occurs in approximately ten percent of cases. These tumors are classically described as locally destructive, but without metastatic potential. Only four cases of malignant conversion with cervical nodal metastases have been described in the English literature. We present the rare case of a 61-year-old Caucasian male with a nasopharyngeal recurrence of malignant SNIP with cervical and retropharyngeal nodal metastases. The patient underwent endoscopic transpterygoid with nasoseptal flap reconstruction, followed by staged bilateral and retropharyngeal node dissection. Histopathology of the specimens demonstrated poorly differentiated invasive nonkeratinizing squamous cell carcinoma with inverted-type features. Three months after surgery, the patient suffered from C1-C2 fractures consistent with osteoradionecrosis and expired. Although the rate of malignant conversion of SNIP is low, this case highlights the need for aggressive, definitive treatment and surveillance.
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Affiliation(s)
- Daniel Sharbel
- Augusta University, Department of Otolaryngology-Head and Neck Surgery, Augusta, GA 30912, United States.
| | - Vipawee Chat
- Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Daniel Blumenthal
- Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Paul Biddinger
- Augusta University, Department of Pathology, Augusta, GA 30912, United States
| | - J Kenneth Byrd
- Augusta University, Department of Otolaryngology-Head and Neck Surgery, Augusta, GA 30912, United States
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Tsuboi H, Takazakura R, Idota N, Takaso M, Ikegaya H. Rare atlas fracture detected using postmortem computed tomography: A case report. J Forensic Leg Med 2018; 60:38-41. [PMID: 30286388 DOI: 10.1016/j.jflm.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/26/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
Abstract
We report the autopsy of a traffic accident victim with a rare atlas fracture. The deceased was 52-year-old man found dead on the road because of a traffic accident. We performed a postmortem computed tomography and an autopsy on the body. The sagittal reformation image of postmortem computed tomography showed a vertically separated anterior arch of atlas, suggesting a "horizontal fracture." Therefore, we assumed that cervical hyperextension may have been one of the forces that affected him during the accident. Minor spinal cord injury was also noted. In this case, postmortem computed tomography played an important role in detecting the spinal cord injury, considering the mechanism of the traffic accident, and supported the autopsy.
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Affiliation(s)
- Hajime Tsuboi
- Department of Forensic Medicine, Graduate School of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ryutaro Takazakura
- Department of Forensic Medicine, Graduate School of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Nozomi Idota
- Department of Forensic Medicine, Graduate School of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Marin Takaso
- Department of Forensic Medicine, Graduate School of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
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Ouyang PR, He XJ, Cai X. [Classification of upper cervical fractures: a review]. Zhongguo Gu Shang 2017; 30:872-875. [PMID: 29455493 DOI: 10.3969/j.issn.1003-0034.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 06/08/2023]
Abstract
Upper cervical fracture-dislocations are series of pathological injuries occurred in occipital, atlas and axis caused by traumatic impact, which often results in severe clinical consequences, such as paraplegia, quadriplegia, and even death. In light of the potential severe clinical outcomes, it is important to define the type of upper cervical fracture-dislocations depending on which the clinician can deal with the disease properly. Owing to its specific anatomical structures, the upper cervical fractures occurr to the unique osseous structures or ligamentous connections always present in predictable patterns. Common fracture include occipital condylar fracture, atlanto-occipital dislocation, atlas fracture, and the three types of fractures of axis, including odontoid fracture, Hangman's fracture and axis body fracture. In this paper we will review the literatures about the classification and management of upper cervical fracture, to help the clinicians to treat their patients better.
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Affiliation(s)
- Peng-Rong Ouyang
- The Second Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
| | - Xi-Jing He
- The Second Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China;
| | - Xuan Cai
- The Second Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
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Xue D, Chen Q, Chen G, Zhuo W, Li F. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise: A case report and literature review. Medicine (Baltimore) 2017; 96:e5841. [PMID: 28072744 PMCID: PMC5228704 DOI: 10.1097/md.0000000000005841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture. CASE SUMMARY We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up. CONCLUSION Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis.
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Zhang MC, Shi YY, Chen DY, Huang SR, Wang X, Yuan WA, Chen B, Wang HH, Zhan HS. [Study on the clinical value of cervical spondylosis with articulatio atlantoepistrophica sublaxation]. Zhongguo Gu Shang 2016; 29:898-902. [PMID: 29285907 DOI: 10.3969/j.issn.1003-0034.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the effect of articulatio atlantoepistrophica sublaxation on the pathogenesis of cervical spondylosis, and provide a thread for diagnosis and treatment of cervical spondylosis with manipulation. METHODS There were two groups in the study, which were non cervical spondylosis group and cervical spondylosis group. There were 333 patients in cervical spondylosis group, included 119 males and 214 females with the mean age of(48.11±12.21) years old. The patients were recruited from clinic service of orthopaedics in Shuguang Hospital between March 2006 and December 2008. There were 73 subjects in non cervical spondylosis group, included 18 males and 55 females with the mean of(45.99±11.47) years old. The subjects were recruited from undergraduate students, postgraduate, advanced study persons, and community personnel. The position relation of the atlanto axial joint was observed by cervical X rays with opening position, and the incidence rate of articulatio atlantoepistrophica sublaxation was compared between two groups, and their clinical characteristics were analyzed. RESULTS The incidence of articulatio atlantoepistrophica sublaxation in cervical spondylosis group was 81.38%(271/333)and was more than non cervical spondylosis group(P<0.01). Furthermore, the pattern of the articulatio atlantoepistrophica sublaxation in cervical spondylosis group was complicated and diversified, which was 50.55% (137/271)with single moving sublaxation, 7.01%(19/271) with revolving sublaxation, 42.44%(115/271) with single moving and revolving sublaxation. CONCLUSIONS The articulatio atlantoepistrophica sublaxation may be a X ray diagnostic indication to the cervical spondylosis, which should be grouping studied in clinic. It will provide guidance for the diagnosis and treatment of cervical spondylosis.
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Affiliation(s)
- Ming-Cai Zhang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yin-Yu Shi
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Dong-Yu Chen
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shi-Rong Huang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xiang Wang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Wei-An Yuan
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Bo Chen
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Hui-Hao Wang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Hong-Sheng Zhan
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
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Li Q, Jiang Z, Zhuo X, Zhang X. Endoscopic removal of bullets from the cranial ridge junction region via transoral and transnasal approaches: Two case reports and review of literature. Medicine (Baltimore) 2016; 95:e3918. [PMID: 27310999 PMCID: PMC4998485 DOI: 10.1097/md.0000000000003918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Endoscopes in otolaryngology may facilitate accessing the lumens and sites such as upper cervical spine with minimally invasive surgical exposure. Here, we present 2 interesting cases of youth who underwent endoscopic removal of bullets in the cranial ridge junction region.The first case was a 20-year-old young man who underwent a gunshot in the face. A CT scan showed that a metallic foreign body located inside the right lateral body of Atlas that presented a comminuted fracture. The second case a 36-year-old man who also underwent a gunshot in the face. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture. The bullets in these 2 patients were removed under the endoscopes with minimal damage, respectively. The patients were discharged without neck activity obstacle.The advantage of endoscopic technique is obvious because limited visualization does not damage surrounding tissues, thus decreasing surgical complications. This was an interesting experience of surgical operation in this region.
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Syre P, Petrov D, Malhotra NR. Management of upper cervical spine injuries: a review. J Neurosurg Sci 2013; 57:219-240. [PMID: 23877268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Upper cervical spine injuries are commonly associated with trauma and require significant forces to produce. When these injuries occur they can have devastating functional consequences. The distinctive anatomy of the upper cervical spine leads injuries to occur in predictable patterns. Injuries can occur to the unique osseus structures or ligamentous connections. Common injuries include occipital condylar fractures, atlanto-occipital dislocation, fractures of the ring of C1, ligamentous injuries involving the ring of C1, and the three types of fractures of C2, pars fractures, odontoid fractures and C2 body fractures. We present these common injuries found in the occipital-atlantoaxial complex and their management based on the current and historical literature.
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Affiliation(s)
- P Syre
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA -
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Pigott TJD. Reviewer's comment concerning "Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach" (10.1007/s00586-013-2870-x by Weihu Ma, Nanjian Xu, Yong Hu, Guoqing Li, Liujun Zhao, Shaohua Sun, Weiyu Jiang, Guanyi Liu, Yongjie Gu, Jiayong Liu and Liang Yu). Eur Spine J 2013; 22:2240. [PMID: 23900686 DOI: 10.1007/s00586-013-2913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Tim J D Pigott
- Department of Neurosurgery, Walton Centre for Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK,
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Hudek R, Wanner G, Simmen HP, Werner CML. C1 fracture in a patient with a congenital cleft in the posterior arch: report on a failed conservative treatment. BMJ Case Rep 2013; 2013:bcr-2013-008872. [PMID: 23771964 DOI: 10.1136/bcr-2013-008872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Unstable burst fractures of the atlas require sufficient immobilisation either with an external device or by surgical fusion. In patients with pre-existing congenital atlantal defects the decision whether to recommend non-operative or operative therapy is difficult. Treatment options are controversially discussed and standardised guidelines are not available. Although most surgeons advise operative fusion or osteosynthesis in atlanto-axial instability, non-operative immobilisation can be successful. We report on a patient with an unstable C1 burst fracture with a congenital posterior cleft in the atlantal arch who was treated with cervical extension and halovest immobilisation. Although callus bridging was initially observed, 9 months after the injury there was no sufficient fracture consolidation and surgical fusion had to be advised. While non-operative treatment may work in patients without congenital defects of the C1 arch, such is not recommended in patients who present with this anomaly.
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Affiliation(s)
- Robert Hudek
- Department of Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt, Germany.
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Sun SH, Fang JL, Ma WH, Liu GY. [Transoral plate internal fixation for treatment of instability atlas fracture]. Zhongguo Gu Shang 2013; 26:81-84. [PMID: 23617151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of transoral plate internal fixation for instability atlas fracture. METHODS A retrospective study was performed in eight patients with instability atlas fractures, who were treated by a transoral plate internal fixation from July 2007 to June 2011. There were 6 males and 2 females,with an average age of 39.5 years old ranging from 23 to 48 years. Among them, 5 case were falling injury, 3 cases were traffic accident injury. Three patients had bilateral fractures of the anterior arch (prehalf Jefferson fractures, Landells type I), 5 had anterior are fracture associated posterior are fracture (Half-ring Jefferson fractures, Landells type II), and 2 had anterior and posterior are fracture associated with single lateral mass fractures (Landells type III). RESULTS All patients were followed up for 6 to 24 months after operation (av- eraged 13 months), and all the patients had the clinical symptoms improved to some extent. Operation time ranged from 80 to 140 min (averaged 98 min); the intra-operative blood loss was 120 to 300 ml (averaged 180 ml); and the average fluoroscopic time was 55 s. No patients happened neurological and vertebral artery injuries-related complications or other complications after operation. The followed-up X-ray and CT manifested osseous fusion in all the 8 patients,no loosening or breakage of the screws. CONCLUSION Transoral plate internal fixation for instability atlas fracture is a reliable and safety technique that allows maintenance of rotatory mobility in the C1,2 joint and restoration of congruency in the atlanto-occipital and atlanto-axial joints.
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Affiliation(s)
- Shao-Hua Sun
- Department of Orthopaedics, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang, China.
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Yuan B, Liang GJ, Pan S. [Jefferson fracture with foramen arch of vertebral artery of atlas: a case report]. Zhongguo Gu Shang 2012; 25:940-941. [PMID: 23427597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Bo Yuan
- Department of Spine, People's Hospital of Xinchang County, Shaoxing 312500, Zhejiang, China.
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Abstract
CONTEXT Head-first sports-induced impacts cause cervical fractures and dislocations and spinal cord lesions. In previous biomechanical studies, researchers have vertically dropped human cadavers, head-neck specimens, or surrogate models in inverted postures. OBJECTIVE To develop a cadaveric neck model to simulate horizontally aligned, head-first impacts with a straightened neck and to use the model to investigate biomechanical responses and failure mechanisms. DESIGN Descriptive laboratory study. SETTING Biomechanics research laboratory. PATIENTS OR OTHER PARTICIPANTS Five human cadaveric cervical spine specimens. INTERVENTION(S) The model consisted of the neck specimen mounted horizontally to a torso-equivalent mass on a sled and carrying a surrogate head. Head-first impacts were simulated at 4.1 m/s into a padded, deformable barrier. MAIN OUTCOME MEASURE(S) Time-history responses were determined for head and neck loads, accelerations, and motions. Average occurrence times of the compression force peaks at the impact barrier, occipital condyles, and neck were compared. RESULTS The first local compression force peaks at the impact barrier (3070.0 ± 168.0 N at 18.8 milliseconds), occipital condyles (2868.1 ± 732.4 N at 19.6 milliseconds), and neck (2884.6 ± 910.7 N at 25.0 milliseconds) occurred earlier than all global compression peaks, which reached 7531.6 N in the neck at 46.6 milliseconds (P < .001). Average peak head motions relative to the torso were 6.0 cm in compression, 2.4 cm in posterior shear, and 6.4° in flexion. Neck compression fractures included occipital condyle, atlas, odontoid, and subaxial comminuted burst and facet fractures. CONCLUSIONS Neck injuries due to excessive axial compression occurred within 20 milliseconds of impact and were caused by abrupt deceleration of the head and continued forward torso momentum before simultaneous rebound of the head and torso. Improved understanding of neck injury mechanisms during sports-induced impacts will increase clinical awareness and immediate care and ultimately lead to improved protective equipment, reducing the frequency and severity of neck injuries and their associated societal costs.
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Affiliation(s)
- Paul C Ivancic
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar Street, PO Box 208071, New Haven, CT 06520-8071, USA.
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Kulbacki E, Wang E. Pathological bone fractures in a 20-year old athletic male with multifocal solitary plasmacytoma of bone. Am J Hematol 2012; 87:626-7. [PMID: 22213270 DOI: 10.1002/ajh.22267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/28/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Evan Kulbacki
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Zhang D, He Q, Huang YX. [Lateral mass screws of the atlas combined with vertebra dentata pedicle screws for treatment of upper cervical vertebral instability]. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30:359-361. [PMID: 20159722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effects of fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws for the treatment of upper vertebral instability. METHODS Ten patients with atlantoaxial instability, including 3 with old odontoid fracture and 7 with fresh odontoid fracture (Aderson II) received surgeries for fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws. RESULTS No spinal cord or vertebral artery injuries occurred in these patients after the surgery. The follow-up duration ranged from 3 to 15 months with an average of 8 months. The postoperative JOA scores were from l3.2 to l6.8, with an average of l4.8. Clinical improvement was achieved in 87.5% of the patients, and the implanted bones all fused successfully without internal fixation rupture or mobilization. CONCLUSION Lateral mass screws of the atlas combined with vertebra dentata pedicle screws allows three-dimensional fixation for treatment of atlantoaxial instability.
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Affiliation(s)
- Dong Zhang
- Department of Spine Surgery, Dazhou Central Hospital, Dazhou 635000, China.
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Xu XM, Zheng CF, Liu XB, Liu JH. [Application of spiral CT reconstruction in the forensic identification of atlantoaxial injuries]. Fa Yi Xue Za Zhi 2010; 26:40-42. [PMID: 20232743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate diagnostic value of spiral CT reconstruction in atlantoaxial injuries. METHODS The images of 25 cases of spiral CT reconstruction were analyzed and compared with images of CT scan and X-ray. RESULTS In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan. CONCLUSION Spiral CT reconstruction can provide the most accurate and integrity imaging information and is very useful in the diagnosis of atlantoaxial injuries and deformity.
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Affiliation(s)
- Xiao-ming Xu
- School of Forensic Medicine, China Medical University, Shenyang 110001, China.
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Vita LR. Atlas malalignments and TMD symptoms. J N J Dent Assoc 2010; 81:30-33. [PMID: 21338037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Louis R Vita
- VITA Head, Neck, and Facial Pain Relief Center, Clifton, NJ, USA
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Wang C, Wang S. Visocchi M, Pietrini D, Tufo T, Fernandez E, Di Rocco C (2009) Pre-operative irreducible C1-C2 dislocations: intra-operative reduction and posterior fixation. The "always posterior strategy". Acta Neurochir 151(5):551-560; discussion. Acta Neurochir (Wien) 2009; 151:1329-31; author reply 1333-6. [PMID: 19727547 DOI: 10.1007/s00701-009-0477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 07/20/2009] [Indexed: 11/26/2022]
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Guo X, Ni B, Wang M, Wang J, Li S, Zhou F. Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture. Arch Orthop Trauma Surg 2009; 129:1203-9. [PMID: 18661139 DOI: 10.1007/s00402-008-0706-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The unstable atlas burst fracture ("Jefferson fracture") is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The posterior atlantoaxial fusion is frequently used to reconstruct the stability of atlantoaxial joint. Conventional posterior atlantoaxial fixations are associated with high rates of pseudoarthrosis and chronic atlantoaxial instability. As a modified three-point fixation the bilateral C1-2 transarticular screws combined with C1 laminar hook and bone grafts can provide best biomechanical stability, but no standard protocol has been reported for the use of this fusion technique. A retrospective review of clinical series should be conducted to evaluate the clinical outcome of bilateral atlas laminar hook combined with transarticular screw fixation for unstable bursting atlantal fracture. MATERIALS AND METHODS From March 2002 to March 2006, there were total 12 cases of unstable atlantal bursting fractures, 10 males and 2 females, age ranging 18-54, with mean of 36 years old. All patients were operated on posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation after atlantoaxial joint were reduced and followed up for 12-24 months. The medical records and radiographs of the 12 patients were reviewed. Each patient underwent a complete cervical radiograph series including lateral flexion-extension view and a computed topographic scan. The Frankel grades and ASIA scores were applied to assess the neurologic status. RESULTS In all patients, a good bony fusion of the atlanto-axial segment was achieved. All patients showed significant improvement of the neurologic defect and no instability on their follow-up plain radiographs and computerized tomography in follow-up interval. CONCLUSIONS For the patients who suffer from the unstable bursting atlantal fracture, the nonoperative methods could carry some clinical complications including infection, nerve injury, etc. and is frequently failure, Posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation is an effective treatment.
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Affiliation(s)
- Xiang Guo
- Department of Orthopaedics, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, People's Republic of China
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Ottink KD, van Middendorp JJ, Kleinveld S, Breemans E. [Traumatic atlas fracture in a child following fall on head]. Ned Tijdschr Geneeskd 2009; 153:1084-1089. [PMID: 19757753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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31
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Hua Q, Ma WH, Zhao LJ, Fang Y. [Clinical application of multi-spiral CT thinner scanning and reconstruction in the diagnosis of atlantoaxial fracture and dislocation]. Zhongguo Gu Shang 2009; 22:349-352. [PMID: 19522392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the value of multi-spiral CT thinner scanning and three-dimensional and multi-planar reconstruction in the diagnosis of atlantoaxial fracture and dislocation. METHODS Sixty-nine patients suffered from atlantoaxial injuries included 54 males and 15 females with an average age of 46.5 years ranging from 17 to 73. Roentgenograph, multi-spiral CT thinner scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) were applied for patients before and after surgery. RESULTS Multi-spiral CT thinner scanning and reconstruction provided clear images for all subjects. There were 49 odontoid bone fractures (Anderson type II 35, type III 14), 9 cases combined injuries of C1 and C2 (Jeffson's fracture associated with Hangman fracture), 6 of C1 burst fractures and 5 of C2 vertebral body fractures. While only 38 cases (38/69) were correctly diagnosed according to roentgenographs, 23 missed diagnosis, 6 couldn't be diagnosed clearly and 2 misdiagnosis. The position of internal fixation could be seen clearly in CT imaging after surgery. There were two screws perforated the lateral wall of C1 and three perforated the superior wall. CONCLUSION The multi-spiral CT thinner-scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) provide clear imagings to diagnose the details of atlantoaxial fractures and dislocations, and to select the therapeutic regimen. It can also be used to check the position of the internal fixation after surgeries. So it can be the first eikonic choice for atlantoaxial injuries.
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Affiliation(s)
- Qun Hua
- Medical Imaging Department, the 6th Hospital of Ningbo, Ningbo 315040, Zhejiang, China.
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32
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Ottink K, van Middendorp JJ, Kleinveld S, Breemans E. [Traumatic atlas fracture in a child following fall on head]. Ned Tijdschr Geneeskd 2009; 153:B285. [PMID: 19785780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
An 8-year-old girl presented at the Accident & Emergency Department with torticollis and neck pain after falling on her head from a climbing frame. A computed tomography scan revealed a Gehweiler type 1 avulsion fracture combined with widening of an anatomically variant single anterior synchondrosis. The child was successfully treated with halter traction, painkillers and bed rest. Physicians should look out for upper cervical spine injury in children who sustained a cranial axial load injury. Differential diagnosis between pain-reactive muscular torticollis and atlantoaxial rotatory subluxation is essential. Children presenting with posttraumatic torticollis require a conventional or dynamic computed tomography scan.
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Affiliation(s)
- KarstenD Ottink
- Gelre Ziekenhuis, Afd. Orthopedische Chirurgie, Apeldoorn, The Netherlands
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33
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D'Anastasio R. Perimortem weapon trauma in an adult male skeleton from the Italic necropolis of Opi Val Fondillo (VI-V century BC; Central Italy). Anthropol Anz 2008; 66:385-394. [PMID: 19216178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The author describes weapon traumatic lesions in an adult male skeleton, that was excavated in the Italic necropolis of Opi Val Fondillo, Central Italy. The preservation of the skeleton is very good. The skull shows a linear lesion across the diploE of the right parietal and occipital bones; the edge of the traumatic lesion is smooth and perpendicular to the bone surface. The injury was probably inflicted with a sharp-edged weapon and the violence of the stroke caused the detachment of bone fragments and fractures that radiate from the point of impact. A sharp-edged linear traumatic lesion, probably inflicted with a blade, is visible on the ventral surface of the vertebral bodies of atlas and axis; the blade detached the right transverse process of the atlas and penetrated in the vertebral body of the axis. Another sharp-edged linear traumatic injury is observed on the anterior surface of the body of thoracic vertebrae. There are no traumatic lesions of the ribs and the last injury was probably inflected down with a blade, while the body lying on the ground. The posterior surface of the diaphysis of the right femur shows an incomplete perimortem fracture, probably due to a compression down upon. Probably the adult male was killed during a fight and enemy had done with him, while he was lying on the ground holding fast his legs strongly. A comparison is made between the lesions and the modality of combat as well as the type of the weapons used by the Samnitic warriors.
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Affiliation(s)
- Ruggero D'Anastasio
- Section of Anthropology, Faculty of Medicine and Surgery, State University "G. d'Anunzio", Chieti, Italy.
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34
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Haus BM, Harris MB. Case report: nonoperative treatment of an unstable Jefferson fracture using a cervical collar. Clin Orthop Relat Res 2008; 466:1257-61. [PMID: 18259828 PMCID: PMC2311473 DOI: 10.1007/s11999-008-0143-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 01/18/2008] [Indexed: 01/31/2023]
Abstract
The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the "rules of Spence" to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1-C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.
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Affiliation(s)
- Brian M Haus
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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35
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Amirjamshidi A, Abbassioun K, Khazenifar M, Esmailijah A. Traumatic rotary posterior dislocation of the atlas on the axis without fracture. Report of a case and review of literature. ACTA ACUST UNITED AC 2008; 71:92-7; discussion 98. [PMID: 18262622 DOI: 10.1016/j.surneu.2007.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 07/03/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Traumatic rotary posterior dislocation of C1 on C2 without fracture (TRPDAAWF) is a very rare complication in severe accidents, and its pathophysiology is still under debate. CASE DESCRIPTION Although 6 similar cases have been reported previously, we report the lessons learned during handling of the patient. A young man who is a victim of severe car crash injury, with neglected displacement of the intact odontoid process to the front of the anterior arch of C1, is reported. Some problematic and life-threatening events in the management of the case are presented. CONCLUSIONS We report a new and rare case of TRPDAAWF. It is hypothesized that a similar situation could only be possible if rotary subluxation of C1 on C2 follows a severe hyperextension injury; otherwise, traumatic fracture of the odontoid process might have been inevitable.
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Affiliation(s)
- Abbass Amirjamshidi
- Sina Hospital, Tehran University of Medical Sciences, Tehran 19585-678m, Iran.
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36
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Inaoka T, Ohashi K, El-Khoury GY. A single fracture in the ring of vertebrae below the atlas: report of four cases. Emerg Radiol 2007; 14:449-52. [PMID: 17453258 DOI: 10.1007/s10140-007-0614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 04/03/2007] [Indexed: 11/24/2022]
Abstract
A single fracture of the ring of a vertebra is a rare injury of the spine. In this report, we present five single fractures of the posterior ring of the cervical spine below the atlas from four patients after motor vehicle accidents. Initial radiographs failed to show any of these fractures; all were detected by computed tomography. Single ring fractures are stable and none of our patients presented with a neurological deficit. Patients were treated conservatively with a cervical collar or a cervicothoracic brace. They all recovered without any neurological abnormalities.
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Affiliation(s)
- Tsutomu Inaoka
- Department of Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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37
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Li L, Wang H, Cui S. [Application of atlas pedicle screw system fixation and fusion for treatment of upper cervical disease]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007; 21:461-4. [PMID: 17578282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. METHODS From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation (including 3 cases of congenital odontoid disconnection,4 cases of old odontoid fracture, 2 cases of new odontoid fracture (type II C), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture; 2 cases of tumor of C2; 1 case of giant neurilemoma of C2.3 with instability after the resection of tumors. JOA score before operation was 8.3+/-3.0. RESULTS The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mm without affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was 14.6+/-2.2. JOA improvement rates were 73%-91% (mean 82%). CONCLUSION The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has better outcomes, wider indications if conducted properly.
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Affiliation(s)
- Lei Li
- Department of Orthopaedics, the Second Affiliated Hospital, China Medical University, Shenyang Liaoning, 110004, P. R. China.
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38
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Abstract
Pedicle screw instrumentation of the upper cervical spine is rarely performed in trauma surgery because of the risk of damaging neurovascular structures. We report successful treatment of an unstable hangman's fracture with posterior pedicle screw fixation using Iso-C3D fluoroscopy-based computer navigation guidance. Postoperative computed tomographic images confirmed accurate placement of the pedicle screws. The navigation system is useful, especially in an unstable upper cervical spine injury where the likelihood of change in the inter-segmental relationship is maximal before and after positioning for surgery. The navigation system has the advantage of data acquisition after patient positioning, thus making safe pedicle fixation of the C1 and C2 vertebrae possible despite fractured posterior elements.
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Affiliation(s)
- S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
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39
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Wang C. [Several aspects of the diagnosis and treatment of atlanto-axial trauma]. Zhonghua Wai Ke Za Zhi 2007; 45:366-9. [PMID: 17537317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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40
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Inaoka T, Ohashi K, El-Khoury GY. A single fracture in the atlas ring: report of two cases and a review of the literature. Emerg Radiol 2007; 14:191-4. [PMID: 17333085 DOI: 10.1007/s10140-007-0584-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
Atlas fractures commonly present more than two breaks in its ring structure because of the unique anatomy and the mechanism of injury. The incidence of a single break in the atlas ring is exceedingly rare. However, we encountered two cases of a single fracture of the atlas. One patient was struck by a falling tree on the right side of the head and the other was involved in a motor vehicle accident. Radiographs of the cervical spine failed to show a single fracture or other abnormalities. Computed tomography demonstrated the single fracture. The patients were treated conservatively with a cervical collar, and they both recovered completely. In this article, we present two cases of a single fracture of the atlas with a review of the literature.
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Affiliation(s)
- Tsutomu Inaoka
- Department of Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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41
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Muthu SK, Cox S, Gunawardena WJ, Balakrishnan G. Anteroposterior spondyloschisis of the atlas. Two case reports and literature review. Emerg Radiol 2007; 13:337-40. [PMID: 17252248 DOI: 10.1007/s10140-006-0565-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 12/04/2006] [Indexed: 11/25/2022]
Abstract
Congenital bony defects of the atlas are uncommon; with isolated posterior clefts being the most frequent anomaly and combined anterior and posterior defects the least common, occurring in only 0.3-0.7% of the population. These anomalies can cause confusion, particularly in the setting of trauma when appearances on plain radiography may be misinterpreted as representing a fracture. Two cases of anteroposterior spondyloschisis are presented and the pathology, diagnosis and the clinical relevance of such defects discussed with reference to previous published literature.
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Affiliation(s)
- Senthil Kumar Muthu
- Department of Radiology, Hammersmith Hospital NHS trust, Duncan Road, London W12 0HS, UK.
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42
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de Zoete A, Langeveld UA. A congenital anomaly of the atlas as a diagnostic dilemma: a case report. J Manipulative Physiol Ther 2007; 30:62-4. [PMID: 17224357 DOI: 10.1016/j.jmpt.2006.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 05/25/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this case report is to draw attention to the differences between a Jefferson fracture and a congenital anomaly of the anterior and/or the posterior arch of the atlas. CLINICAL FEATURES A 42-year-old woman visited the chiropractic practice complaining of headache, neck pain, dizziness, and numbness in both of her arms after she fell vertically and directly on her head twice on a playground. Before this fall, she had no such complaints. After taking x-rays of the cervical spine, a Jefferson fracture was suspected. INTERVENTION AND OUTCOME After computed tomography and magnetic resonance imaging scanning, the patient was diagnosed with a congenital anomaly that looked very similar to a Jefferson fracture. After instability of the cervical spine was excluded by the neurosurgeon, chiropractic treatment was delivered. After 6 treatments, the complaints were significantly reduced. CONCLUSION It is important to be familiar with the differences between a congenital anomaly of the atlas and a Jefferson fracture and to exclude instability of the upper cervical spine before treatment is started.
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Affiliation(s)
- Annemarie de Zoete
- Praktijk Chiropractie Heiloo, Kennemerstraatweg 69, 1851 BB Heiloo, The Netherlands.
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43
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Abstract
This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. We introduce a new technique of direct reconstruction of the atlas vertebra. This technique leads to a stable ring construct that allows compression osteosynthesis of the fracture. Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.
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Affiliation(s)
- H Böhm
- Klinik für Orthopädie und Wirbelsäulenchirurgie, Zentralklinik Bad Berka
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44
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De Wyngaert R, Mulkens T, Baeyaert M, Bellinck P, Salgado R, Ghijsen D, Van Dijck X, Termote JL. Bilateral occipital condylar fracture with associated haematomas. Emerg Radiol 2006; 13:79-82. [PMID: 16941109 DOI: 10.1007/s10140-006-0516-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 06/09/2006] [Indexed: 11/24/2022]
Abstract
Occipital condylar fractures (OCFs) seem to be rare. The exact incidence is unknown, but a few studies reported a 3-4% incidence of OCFs in patients with severe head injury and altered Glasgow Coma Scale score. The low incidence of OCFs and missed diagnoses in these patients may result in late neurological deficits. We report the history of a patient with bilateral OCFs, a combined fracture of the anterior arcus of the atlas and associated retropharyngeal and epidural cervical haematomas, who presented without life-threatening symptoms or neurological deficits.
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MESH Headings
- Accidents, Traffic
- Adult
- Cervical Atlas/diagnostic imaging
- Cervical Atlas/injuries
- Hematoma, Epidural, Spinal/diagnostic imaging
- Hematoma, Epidural, Spinal/etiology
- Hematoma, Epidural, Spinal/pathology
- Hematoma, Epidural, Spinal/rehabilitation
- Humans
- Magnetic Resonance Imaging
- Male
- Mandibular Condyle/diagnostic imaging
- Mandibular Condyle/injuries
- Motorcycles
- Occipital Bone/diagnostic imaging
- Occipital Bone/injuries
- Restraint, Physical
- Skull Fractures/diagnostic imaging
- Skull Fractures/etiology
- Skull Fractures/pathology
- Skull Fractures/rehabilitation
- Spinal Fractures/complications
- Spinal Fractures/diagnostic imaging
- Spinal Fractures/pathology
- Spinal Fractures/rehabilitation
- Tomography, X-Ray Computed
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45
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Abstract
We describe a patient who was not thought to fulfil the NICE criteria for imaging the cervical spine after head injury but who had two fractures of the atlas, thus rendering the vertebral ring unstable. The reasons for missing this injury in the emergency department are discussed.
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Affiliation(s)
- B Barry
- Horton Hospital, Oxford Radcliffe Hospitals NHS Trust, Banbury, Oxon, OX16 9AL, UK
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46
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Hagino T, Ochiai S, Tonotsuka H, Tokai M, Senga S, Hamada Y. Fracture of the atlas through a synchondrosis of the anterior arch complicated by atlantoaxial rotatory fixation in a four-year-old child. ACTA ACUST UNITED AC 2006; 88:1093-5. [PMID: 16877613 DOI: 10.1302/0301-620x.88b8.17624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fracture of the atlas is rare in children. We report a case of fracture of the atlas through a synchondrosis of the anterior arch complicated by atlantoaxial rotatory fixation in a four-year-old girl.
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Affiliation(s)
- T Hagino
- Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan.
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47
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Tan J, Ni CH, Li LJ, Zhou W, Qian L. [C1 lateral mass-C2 pedicle screws and crosslink compression fixation for instable atlas fracture]. Zhonghua Yi Xue Za Zhi 2006; 86:1743-7. [PMID: 17054838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To evaluate the feasibility and reliability of C(1) lateral-mass screw-C(2) pedicle screw and crosslink compression fixation for Jefferson fracture. METHODS Seventeen patients with atlas fracture, 12 males and 5 females, aged 42.5 (25 - 67), 4 of which with unstable atlas fracture, were treated. 11 cases underwent C(1) lateral mass and C(2) pedicle screws and crosslink fixation, 6 of which had axial instability and rupture of atlas transverse ligament, 1 had C(2) luminal fracture, and the other 4 had axial instability. With the assistant of regional anatomy study and fluoroscopy the C(1) lateral mass screw and C(2) pedicle screw were inserted properly. Connecting rods were applied into the two screws on each side. Crosslink between the two rods were applied, compressing to achieve the realignment of the C(1) lateral mass fracture and C(0)-C(1)-C(2) into anatomical position. C(1)-C(2) fusions with posterior bone graft were performed in the patients with axial instability or transverse ligament discontinuity. RESULTS The operative time ranged from 90 to 176 min with an average of 124 min. The intra-operative blood loss ranged from 270 to 1200 ml with an average of 432 ml. Fluoroscopic examination was used for 18 seconds on average. There were no neurological deficits, vertebral artery related complications or other complications in all the patients. No neurological deficit was aggravated after the patient's mobilization with brace 5 days after operation. One case of vertebral artery rupture happened because of the use of electrocautery. The bleeding was stopped by the use of hemostatic sponge and bone cement without causing cerebral hemodynamic deficit. X-ray examination showed bone fusion and stability in all the patients three months after the operation. The restoration of the C(2) fracture was confirmed by CT scan. CONCLUSION Osteosynthesis of the atlas by C(1) lateral-mass screw-C(2) pedicle screw and crosslink compression fixation is an ideal option for C(1) burst fracture with or without rupture of transverse ligament. The procedure allows a physiological reconstruction of the C(0)-C(1)-C(2) joint and short segmental solid fusion for Jefferson fracture.
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Affiliation(s)
- Jun Tan
- Department of Orthopedics, East Hospital, Tongji University, Shanghai 200120, China
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48
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Ashley WW, Rivet D, Cross DT, Santiago P. Development of a giant cervical vertebral artery pseudoaneurysm after a traumatic C1 fracture: case illustration. ACTA ACUST UNITED AC 2006; 66:80-1. [PMID: 16793451 DOI: 10.1016/j.surneu.2005.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 11/03/2005] [Indexed: 11/28/2022]
Affiliation(s)
- William W Ashley
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA
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49
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Affiliation(s)
- Michael S Patton
- Department of Orthopaedic Surgery, Woodend Hospital, Eday Road, Aberdeen, Scotland AB15 6ZQ, United Kingdom.
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50
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Sasaka KK, Decker GT, El-Khoury GY. Axial loading with hyperflexion injury to the atlas resulting in crushed lateral masses. Emerg Radiol 2006; 12:274-7. [PMID: 16786374 DOI: 10.1007/s10140-006-0481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 01/24/2006] [Indexed: 11/28/2022]
Abstract
A 40-year-old man was involved in an ATV accident, in which he landed on the top of his head. There was no neurological deficit. A plain radiograph showed prevertebral soft tissue swelling at the atlas and axis level. Computed tomography (CT) demonstrated vertical fractures of the anterior aspects of both lateral masses of the atlas, extending to the junction of the lateral mass with the anterior arch bilaterally. There was no lateral offset of the lateral masses. The mechanism of injury is believed to be axial loading along with hyperflexion.
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Affiliation(s)
- Kaoru K Sasaka
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA 52242, USA.
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