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Huang S, Nascene DR, Shanley R, Pena-Pino I, Lund TC, Gupta AO, Orchard PJ, Sandoval-Garcia C. Natural history of craniovertebral abnormalities in a single-center study in 54 patients with Hurler syndrome. J Neurosurg Pediatr 2024:1-9. [PMID: 38489810 DOI: 10.3171/2024.1.peds23281] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/04/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Craniovertebral junction (CVJ) abnormalities are common and well documented in mucopolysaccharidosis type I-Hurler syndrome (MPS IH), often causing severe spinal canal narrowing. However, the requirement for surgical decompression and/or fusion is uncommon. Although hematopoietic cell transplant (HCT) has been shown to prolong the lives of patients with MPS IH, its effect in halting or reversing musculoskeletal abnormalities is less clear. Unfortunately, there are currently no universal guidelines for imaging or indication for surgical interventions in these patients. The goal of this study was to track the progression of the CVJ anatomy in patients with MPS IH following HCT, and to examine radiographic features in patients who needed surgical intervention. METHODS Patients with MPS IH treated at the University of Minnesota with allogeneic HCT between 2008 and 2020 were retrospectively reviewed. Patients who underwent CVJ surgery were identified with chart review. All MPS IH cervical scans were examined, and the odontoid retroflexion angle, clivoaxial angle (CXA), canal width, and Grabb-Oakes distance (pB-C2) were measured yearly for up to 7 years after HCT. Longitudinal models based on the measurements were made. An intraclass correlation coefficient was used to measure interrater reliability. Nine children without MPS IH were examined for control CVJ measurements. RESULTS A total of 253 cervical spine MRI scans were reviewed in 54 patients with MPS IH. Only 4 (7.4%) patients in the study cohort required surgery. Three of them had posterior fossa and C1 decompression, and 1 had a C1-2 fusion. There was no statistically significant difference in the spinal parameters that were examined between surgery and nonsurgery groups. Among the measurements, canal width and CXA varied drastically in patients with different neck positions. Odontoid retroflexion angle and CXA tended to decrease with age. Canal width and pB-C2 tended to increase with age. CONCLUSIONS Based on the data, the authors observed an increase in canal width and pB-C2, whereas the CXA and odontoid retroflexion angle became more acute as the patients aged after HCT. The longitudinal models derived from these data mirrored the development in children without MPS IH. Spinal measurements obtained on MR images alone are not sufficient in identifying patients who require surgical intervention. Symptom monitoring and clinical examination, as well as pathological spinal cord changes on MRI, are more crucial in assessing the need for surgery than is obtaining serial imaging.
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Affiliation(s)
| | | | - Ryan Shanley
- 3Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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Wang M, Shen J, Tan J, Zhu X, Ma H, Wen Z, Tian Y, Jiang W. Risk factors for cervical instability in rheumatoid arthritis: a meta-analysis. Arch Med Sci 2024; 20:375-383. [PMID: 38757018 PMCID: PMC11094836 DOI: 10.5114/aoms/173494] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/08/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction The aim of the study was to evaluate the risk factors for cervical instability in rheumatoid arthritis (RA). Material and methods Computer searches were conducted in PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI) database, the Wan Fang database, the Chinese Scientific Journal Databases (VIP) database, and the Chinese Biomedical Literature database (CBM) from their establishment until November 2022. Results A total of 8 articles were included in this study, including 1 cross-sectional study, 5 case-control studies, and 2 cohort study, including 3078 patients with RA. Meta-analysis results showed that: male sex (OR = 1.70, 95% CI: 1.19-2.42), course of disease (OR = 1.72, 95% CI: 1.29-2.28), long-term glucocorticosteroid use (OR = 2.84, 95% CI: 1.97-2.40), Steinbrocker staging (OR = 2.30, 95% CI: 1.61-3.28), disability at baseline (OR = 24.57, 95% CI: 5.51-109.60), peripheral joint destruction (OR = 2.24, 95% CI: 1.56-3.21), Steinbrocker stage I-IV progression to disability (OR = 20.08, 95% CI: 4.18-96.53), and previous joint surgery (OR = 1.54, 95% CI: 1.06-2.26) are the main risk factors for cervical instability in RA. Conclusions There are many risk factors for cervical instability in RA. In clinical practice, special attention should be paid to patients who are male, have a longer course of disease, have long-term glucocorticosteroid use, have previous joint surgery, have peripheral joint damage, and develop disability in Steinbrocker stage I-IV. Attention should be paid to the high-risk groups mentioned above, and effective measures such as early screening and full monitoring should be taken to prevent the occurrence of cervical instability in RA.
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Affiliation(s)
- Min Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Jinhua Shen
- First People’s Hospital of Changde City, Changde, China
| | - Jianghong Tan
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Xiaoling Zhu
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Hongxia Ma
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zhenhua Wen
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Yanzhen Tian
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Weimin Jiang
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
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Fermo OP. Evaluation and management of orthostatic headache in hypermobility disorders. Front Neurol 2023; 14:1321350. [PMID: 38162438 PMCID: PMC10755912 DOI: 10.3389/fneur.2023.1321350] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Headache is a frequent symptom among patients with hypermobility spectrum disorders. This mini review focuses specifically on a challenging aspect of headache evaluation in all patients, but especially those with hypermobility - the orthostatic headache. While the differential for an orthostatic headache is overall limited, patients with hypermobility disorders have risk factors for all of the most commonly encountered orthostatic headache disorders. The most common conditions to produce orthostatic headaches are discussed - spontaneous intracranial hypotension, cervicogenic headache, and postural orthostatic tachycardia syndrome. Less common etiologies of orthostatic headache pertinent to any patient are presented in table format.
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Affiliation(s)
- Olga P. Fermo
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, United States
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Lucas AT, Lin AE, Cohen A, Muñoz W, Kahle KT, Shin JH, Buch K, Sahai I, Carroll RW. Atlantoaxial instability associated with ALDH18A1 mutation. Am J Med Genet A 2023; 191:2898-2902. [PMID: 37655511 DOI: 10.1002/ajmg.a.63388] [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: 06/30/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
We report a 10-year-old boy with a de novo pathogenic variant in ALDH18A1, a rare form of metabolic cutis laxa, which was complicated by atlantoaxial instability and spinal cord compression following a fall from standing height. The patient required emergent cervical spine fusion and decompression followed by a 2-month hospitalization and rehabilitation. In addition to the core clinical features of joint and skin laxity, hypotonia, and developmental delays, we expand the connective tissue phenotype by adding a new potential feature of cervical spine instability. Patients with pathogenic variants in ALDH18A1 may warrant cervical spine screening to minimize possible morbidity. Neurosurgeons, geneticists, primary care providers, and families should be aware of the increased risk of severe cervical injury from minor trauma.
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Affiliation(s)
- Alexandra T Lucas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
| | - Angela E Lin
- Medical Genetics, Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
| | - Andrew Cohen
- Department of Pediatrics, MassGeneral for Children, Harvard Medical School, Boston, Massachusetts, USA
| | - William Muñoz
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Inderneel Sahai
- Medical Genetics, Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
| | - Ryan W Carroll
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
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Roohollahi F, Iranmehr A, Fatahi Andabili E. A case of atlantoaxial instability following skull base osteomyelitis: Tips for diagnosis and management. Clin Case Rep 2022; 10:e6744. [PMID: 36583201 PMCID: PMC9792648 DOI: 10.1002/ccr3.6744] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022] Open
Abstract
Skull base osteomyelitis is a rare but dangerous consequence of untreated malignant otitis externa. Pseudomonas aeruginosa is responsible for most cases with typical presentation. Here, we discuss a diabetic 54-year-old female presented with malignant otitis externa and bilateral facial paresis followed by cervical spondylitis and C1-C2 instability. Skull base osteomyelitis confirmed by clinical presentation, imaging, and laboratory data. Fortunately, she responded well to antibacterial and antifungal therapy. Due to limited data, there is no confirmed standard of treatment for cervical instability secondary to SBO. It seems antibiotic therapy is the mainstay of treatment. In case of poor response to antibiotic therapy, surgical intervention is inevitable. This article introduces the first case of SBO-related AAI successfully managed with conservative treatment.
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Affiliation(s)
- Faramarz Roohollahi
- Neurological Surgery Department, Shariati Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Arad Iranmehr
- Neurological Surgery Department, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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MacDowall A, Barany L, Bodon G. Surgical treatment outcome on a national cohort of 176 patients with cervical manifestation of rheumatoid arthritis. J Craniovertebr Junction Spine 2021; 12:248-256. [PMID: 34728991 PMCID: PMC8501822 DOI: 10.4103/jcvjs.jcvjs_200_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Rheumatoid arthritis (RA) affecting the cervical spine results in instability and deformity that can be divided into the subtypes C1–C2 horizontal (atlantoaxial instability), C0–C2 vertical (basilar invagination), subaxial, and combined instabilities. The aim of this study was to compare the surgical treatments and outcomes of RA-related deformity and instability in a population-based setting. Patients and Methods: All patients with RA in the national Swespine register from January 1, 2006, to March 20, 2019, were assessed. Baseline characteristics, surgical treatments, European Myelopathy Scale (EMS), Neck Disability Index, the Visual Analog Scale for neck and arm pain as well as pre- and postoperative imaging were analyzed. The follow-up time points were at 1-, 2-, and 5 years after surgery. Results: A total of 176 patients were included. There were 62 (35%) patients with C1–C2 horizontal instability, 48 (27%) with C0–C2 vertical instability, 19 (11%) patients with subaxial instability, 43 (24%) patients with combined instability, and 4 patients without instability served as controls. The EMS improved in the C1–C2 horizontal instability group after fusion surgery (Δ =2.6 p) but remained within baseline confidence intervals in the other groups. All patients regardless of instability improved in pain. The subaxial instability had the highest risk of death within 5 years after surgery (11/19, 58%). The most dangerous complications due to implant failure were seen in patients instrumented with laminar hooks. Conclusion: The neurological outcome after fusion surgery is poor and the death rate is high in patients with cervical RA-related instability and deformity.
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Affiliation(s)
- Anna MacDowall
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Laszlo Barany
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gergely Bodon
- Department of Anatomy, Laboratory for Applied and Clinical Anatomy, Histology and Embryology, Semmelweis University Budapest, Hungary, Europe.,Department of Orthopaedic Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany
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Fedorchuk C, Comer RD, Stockwell TL, Stockwell J, Stockwell R, Lightstone DF. Prevalence of Cervical Spondylolisthesis in the Sagittal Plane Using Radiographic Imaging in a Pediatric Population: A Cross Sectional Analysis of Vertebral Subluxation. J Radiol Case Rep 2021; 15:1-18. [PMID: 34276876 PMCID: PMC8253154 DOI: 10.3941/jrcr.v15i6.4280] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cervical Spondylolisthesis (CS) in children is under-studied. This cross-sectional study reports the CS prevalence in children. MATERIALS & METHODS Subjects were selected from a private practice. Inclusion criteria: 0-17 years of age; documented demographics and health complaints; neutral lateral cervical (NLC) radiographs; and CS. Exclusion criteria: pseudosubluxation. RESULTS 342 NLC radiographs were analyzed. 73 (21.3%) had CS greater than 2.0 mm. 42 (57.5%) had no musculoskeletal complaints. 8 (2.3%) had the presence of a CS greater than 3.5 mm. 5 (62.5%) had no musculoskeletal complaints. DISCUSSION Pediatric populations endure various traumas. Pediatric cervical spine biomechanics has an increased risk of upper cervical spine injury. Regular spinal radiographic exams may help identify serious spinal conditions in their pre-symptomatic state. CONCLUSION CS in pediatric populations is under-studied. CS is present in children and adolescents with and without symptoms.
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8
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Ying J, Teng H, Qian Y, Hu Y, Wen T, Ruan D, Zhu M. Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy. Acta Radiol 2019; 60:196-203. [PMID: 29788751 DOI: 10.1177/0284185118778866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ossification of the nuchal ligament (ONL) caused by chronic injury to the nuchal ligament (NL) is very common in instability-related cervical disorders. PURPOSE To determine possible correlations between ONL, sagittal alignment, and segmental stability of the cervical spine. MATERIAL AND METHODS Seventy-three patients with cervical spondylotic myelopathy (CSM) and ONL (ONL group) and 118 patients with CSM only (control group) were recruited. Radiographic data included the characteristics of ONL, sagittal alignment and segmental stability, and ossification of the posterior longitudinal ligament (OPLL). We performed comparisons in terms of radiographic parameters between the ONL and control groups. The correlations between ONL size, cervical sagittal alignment, and segmental stability were analyzed. Multivariate logistic regression was used to identify the independent risk factors of the development of ONL. RESULTS C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), T1S minus cervical lordosis (T1S-CL) on the lateral plain, angular displacement (AD), and horizontal displacement (HD) on the dynamic radiograph increased significantly in the ONL group compared with the control group. The size of ONL significantly correlated with C2-C7 SVA, T1S, AD, and HD. The incidence of ONL was higher in patients with OPLL and segmental instability. Cervical instability, sagittal malalignment, and OPLL were independent predictors of the development of ONL through multivariate analysis. CONCLUSION Patients with ONL are more likely to have abnormal sagittal alignment and instability of the cervical spine. Thus, increased awareness and appreciation of this often-overlooked radiographic finding is warranted during diagnosis and treatment of instability-related cervical pathologies and injuries.
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Affiliation(s)
- Jinwei Ying
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, PR China
- Department of Orthopedic Surgery, Navy General Hospital, Beijing, PR China
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Honglin Teng
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yunfan Qian
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yingying Hu
- Department of Radiology, Navy General Hospital, Beijing, PR China
| | - Tianyong Wen
- Department of Orthopedic Surgery, Navy General Hospital, Beijing, PR China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, PR China
- Department of Orthopedic Surgery, Navy General Hospital, Beijing, PR China
| | - Minyu Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
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Foss KD, Smith RL, da Costa RC. Kinetic and kinematic follow-up gait analysis in Doberman Pinschers with cervical spondylomyelopathy treated medically and surgically. J Vet Intern Med 2018; 32:1126-1132. [PMID: 29572944 PMCID: PMC5980253 DOI: 10.1111/jvim.15096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/24/2018] [Accepted: 02/13/2018] [Indexed: 01/01/2023] Open
Abstract
Background The efficacy of treatment of dogs with cervical spondylomyelopathy (CSM) is commonly based on the owner's and clinician's perception of the gait, which is highly subjective and suffers from observer bias. Hypothesis/Objectives To compare selected kinetic and kinematic parameters before and after treatments and to correlate the findings of gait analysis to clinical outcome. Animals Eight Doberman Pinschers with CSM confirmed by magnetic resonsance imaging. Methods Patients were prospectively studied and treated with either medical management (n = 5) or surgery (n = 3). Force plate analysis and 3‐D kinematic motion capture were performed at initial presentation and approximately 8 weeks later. Force plate parameters evaluated included peak vertical force (PVF). Kinematic parameters measured included number of pelvic limb strides, stifle flexion and extension, maximum and minimum thoracic limb distance, truncal sway, and thoracic limb stride duration. Results Kinematic analysis showed that deviation of the spine to the right (truncal sway) was significantly smaller (P < .001) and the degree of right stifle flexion was significantly larger (P = .029) after treatment. Force plate analysis indicated that PVF was significantly different after treatment (P = .049) and the difference of the PVF also was significantly larger (P = .027). However, no correlation was found with either method of gait analysis and clinical recovery. Conclusions and Clinical Importance Kinetic and kinematic gait analysis were able to detect differences in dogs with CSM before and after treatment. A correlation of gait analysis to clinical improvement could not be determined.
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Affiliation(s)
- Kari D Foss
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, The University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Rebecca L Smith
- Department of Pathobiology, College of Veterinary Medicine, The University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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Herrera R, Rojas H, Estramian A, Gómez J, Ledesma JL, Pablo J, Pastore J. [Adult Grisel Syndrome and Cervical Skull instability. Transnasal endoscopic odontoidectomy and occipito-cervical fusion. Case report and literature review]. Surg Neurol Int 2018; 9:S8-S15. [PMID: 29430326 PMCID: PMC5799945 DOI: 10.4103/sni.sni_281_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Craniocervical junction pathology is infrequent in daily neurosurgical practice. In general, most of these lesions are of traumatic or rheumatic origin. Atlantoaxial instability of inflammatory origin (Grisel syndrome) is a rare entity of which only 16 adult cases have been reported in the literature. This pathology is characterized by the development of an osteolytic lesion at the level of the atlantoaxial joint after an infectious event, usually of the upper airways. CASE DESCRIPTION We present the case of a 76-year-old patient who attended our office for clinical symptoms of spinal instability secondary to an osteolytic lesion, with involvement of C1 and C2. The symptomatology began after an infectious respiratory process. A posterior cervical occiput fixation and an endoscopic transnasal odontoidectomy with anterior decompression were performed. The patient evolved with complete resolution of symptoms. The cultures were negative, and the pathological anatomy study concluded nonspecific inflammatory changes. CONCLUSION Until a few years ago, the only option to address this pathology was the transoral pathway with microsurgical technique. Nowadays, endoscopy offers many technical advantages. This is an option to be considered when planning approaches to craniocervical junction.
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Affiliation(s)
- Roberto Herrera
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - Héctor Rojas
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - Ariel Estramian
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - Julieta Gómez
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - José Luis Ledesma
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - José Pablo
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
| | - Julián Pastore
- Sanatorio Los Arroyos, Rosario, Santa Fé, Argentina
- Clínica Adventista Belgrano, CABA, Buenos Aires, Argentina
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Segarra NG, Ballhausen D, Crawford H, Perreau M, Campos-Xavier B, van Spaendonck-Zwarts K, Vermeer C, Russo M, Zambelli PY, Stevenson B, Royer-Bertrand B, Rivolta C, Candotti F, Unger S, Munier FL, Superti-Furga A, Bonafé L. NBAS mutations cause a multisystem disorder involving bone, connective tissue, liver, immune system, and retina. Am J Med Genet A 2015; 167A:2902-12. [PMID: 26286438 DOI: 10.1002/ajmg.a.37338] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
We report two unrelated patients with a multisystem disease involving liver, eye, immune system, connective tissue, and bone, caused by biallelic mutations in the neuroblastoma amplified sequence (NBAS) gene. Both presented as infants with recurrent episodes triggered by fever with vomiting, dehydration, and elevated transaminases. They had frequent infections, hypogammaglobulinemia, reduced natural killer cells, and the Pelger-Huët anomaly of their granulocytes. Their facial features were similar with a pointed chin and proptosis; loose skin and reduced subcutaneous fat gave them a progeroid appearance. Skeletal features included short stature, slender bones, epiphyseal dysplasia with multiple phalangeal pseudo-epiphyses, and small C1-C2 vertebrae causing cervical instability and myelopathy. Retinal dystrophy and optic atrophy were present in one patient. NBAS is a component of the synthaxin-18 complex and is involved in nonsense-mediated mRNA decay control. Putative loss-of-function mutations in NBAS are already known to cause disease in humans. A specific founder mutation has been associated with short stature, optic nerve atrophy and Pelger-Huët anomaly of granulocytes (SOPH) in the Siberian Yakut population. A more recent report associates NBAS mutations with recurrent acute liver failure in infancy in a group of patients of European descent. Our observations indicate that the phenotypic spectrum of NBAS deficiency is wider than previously known and includes skeletal, hepatic, metabolic, and immunologic aspects. Early recognition of the skeletal phenotype is important for preventive management of cervical instability.
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Affiliation(s)
- Nuria Garcia Segarra
- Center for Molecular Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Diana Ballhausen
- Center for Molecular Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Heather Crawford
- Clinical Metabolic Genetics, Cook Children's Health Care System, Fort Worth, Texas, USA
| | - Matthieu Perreau
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Cees Vermeer
- VitaK and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Michel Russo
- Pediatric Service, Centre Hospitalier du Centre Valais, Sion, Switzerland
| | - Pierre-Yves Zambelli
- Service of Pediatric Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Brian Stevenson
- Vital-IT group, Swiss Institute of Bioinformatics, University of Lausanne, Switzerland
| | - Beryl Royer-Bertrand
- Department of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo Rivolta
- Department of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabio Candotti
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Sheila Unger
- Department of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Luisa Bonafé
- Center for Molecular Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J 2014; 8:326-45. [PMID: 25328557 PMCID: PMC4200875 DOI: 10.2174/1874325001408010326] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/26/2022] Open
Abstract
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.
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Affiliation(s)
- Danielle Steilen
- Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA
| | - Ross Hauser
- Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA
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