Vertebral subluxation

BACKGROUND: Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by high-energy trauma. Pediatric patients with a traumatic spine injury, particularly spondyloptosis are surgically demanding as reduction and achieving realignment of the spinal column requires diligent planning and execution. OBJECTIVE: To enlighten readers about this rare but severest form of thoracolumbar spine injury and its management...

BACKGROUND: Occipito-cervical fixation (OCF) provides immediate rigid fixation to cranio-vertebral junction (CVJ); however, in current practice, the optimal occipito-cervical fixation method is arguable. AIM: The aim of this study was to test the safety and efficacy of a newly designed inside-outside occipital (OC) plate system for the treatment of cranio-vertebral junction instability. MATERIAL AND METHODS: Thirty-two patients of CVJ instability were treated using this new OC plate system...

Klippel-Feil syndrome (KFS) is the congenital fusion of two or more cervical vertebrae which is often associated with various other abnormalities in the cervical spine. Involvement the upper cervical segments leads to atlanto-axial instability which manifests as progressive neurological symptoms due to compression on the spinal cord. These cases pose a surgical challenge due the abnormal and unique anatomy of each patient. A 37-year-old patient presented with neck pain and cervical myelopathy due to a posterior subluxation of C2-3 fused segment over C4-6 fused segment...

INTRODUCTION: To investigate the remodeling morphology of subluxated osteotomy vertebra in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis after single-level closing-opening wedge osteotomy (COWO). MATERIALS AND METHODS: Standing lateral radiographs were taken to evaluate sagittal parameters including lumbar lordosis (LL), C7 sagittal vertical axis (SVA), global kyphosis (GK), sacral slope (SS), and pelvic tilt (PT). Radiographic parameters of the osteotomy vertebra included osteotomized vertebra angle (OVA), sagittal translation (ST), anterior height (AH), posterior height (PH), and middle height (MH) of the osteotomy vertebrae...

STUDY DESIGN: A retrospective observational study. OBJECTIVE: To introduce a novel hybrid technique using segmentation correction (SC) and to compare it with traditional correction (TC) in treating non-dystrophic scoliosis secondary to neurofibromatosis type 1 (NF1-S) lacking pedicles in the apical area. METHODS: We reviewed the NF1-S cases lacking pedicles diagnosed in our hospital between January 2015 and December 2019. Patients were divided into the SC and TC groups and were followed up for at least two years...

Background: Although osteosarcoma is the most common primary malignant bone tumor in children, its location in the axial skeleton is rare, particularly at the cervical spine. Early diagnosis, together with multidisciplinary management, improves survival rates. Safe resection and stable reconstruction are complicated by the particular anatomy of the cervical spine, which raises the risks. Case Presentation: A 12-year-old male patient presented with cervical pain for several months and a recent weight loss of 3 kg...

Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients...

A privately-owned 4-year-old female showa koi Cyprinus carpio was presented for erratic swimming, air gasping, water spitting, and abnormal orientation in the water column. Initial physical examination revealed an obese patient with no external abnormalities excepting a small plaque localized to filaments on a right gill hemibranch. The fish was anesthetized using AQUI-S 20E (10% eugenol solution) at 50mg/L to facilitate diagnostic evaluation. Biopsy of the gill lesion yielded no significant findings. Whole-body CT confirmed an excess of adipose tissue and mild scoliosis with narrowing of the 10-11th intervertebral space...

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy against foot processes of aquaporin-4 (AQP4) water channels. Patients with NMOSD tend to have other coexisting autoimmune/connective tissue diseases. However, AQP-4-antibody-positive NMOSD coexisting with ankylosing spondylitis (AS) is rare. AS is an immune-mediated disorder, a subset of axial spondyloarthropathies, which commonly manifests as chronic inflammatory back pain in young people, and it has a strong association with HLA-B27...

BACKGROUND: Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS: The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact...

STUDY OBJECTIVE: To minimize the risk of cervical spinal cord injury in patients who have cervical spine pathology, minimizing cervical spine motion during laryngoscopy and tracheal intubation is commonly recommended. However, clinicians may better aim to reduce cervical spinal cord strain during airway management of their patients. The aim of this study was to predict laryngoscope force characteristics (location, magnitude, and direction) that would minimize cervical spine motions and cord strains...

BACKGROUND CONTEXT: Prior studies have demonstrated an association between cervical spine fractures and blunt cerebrovascular injuries (BCVI) due to the intimate anatomic relationship between the cervical spine and the vertebral arteries. Digital subtraction angiography (DSA) has historically been the gold standard, but computed tomography angiography (CTA) is commonly used to screen for BCVI in the trauma setting. However, there is no consensus regarding which fracture patterns mandate screening...

Introduction: Hypoplasia of the anterior portion of the vertebral body is a relatively rare subtype of juvenile vertebral deformity. The common manifestations of this type of deformity are scoliosis and kyphoscoliosis, while kyphosis without scoliosis is rare. Here, we present a very rare case of adolescent-onset local kyphosis with anterior column hypoplasia and subluxation of the facet joints of the lumbar spine, as demonstrated by dynamic lateral radiograms, which was successfully treated by spine-shortening osteotomy...

Traumatic vertebral fracture or luxation often results in spinal instability requiring surgical stabilization. This study describes the long-term outcome of spinal stabilization using a unilateral 5-hole 2-0 UniLock implant in eight dogs and two cats with trauma-induced thoracolumbar vertebral luxation/subluxation and presumed instability, as assessed by a combination of preoperative radiographs and MRI using a 3-compartment method. The UniLock plate was secured with four monocortical locking screws in adjacent vertebral bodies...

OBJECTIVE: The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST). METHODS: A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD. RESULTS: Patients were divided in subsets of axial spine injury and subaxial spine injury...

BACKGROUND: Direct rear head impact can occur during falls, road accidents, or sports accidents. They induce anterior shear, flexion and compression loads suspected to cause flexion-distraction injuries at the cervical spine. However, post-mortem human subject experiments mostly focus on sled impacts and not direct head impacts. METHODS: Six male cadavers were subjected to a direct rear head impact of 3.5 to 5.5 m/s with a 40 kg impactor. The subjects were equipped with accelerometers at the forehead, mouth and sternum...

BACKGROUND: Rheumatoid arthritis (RA) may affect any diarthrodial joint with a predilection on the peripheral skeleton in a symmetrical manner. When the axial skeleton is affected, it is the cervical spine (CS) that gets involved with potentially detrimental effects, if not treated promptly. CASE: A 60-year-old female suffering from RA presented with severe neck pain and stiffness, difficulty of standing and walking with brisk tendon reflexes, Babinski sign positive, and clonus...

BACKGROUND: Three-column osteotomy (3-CO) is sometimes challenging when confronting many anterior unsegmented vertebrae in congenital kyphosis (CK-AUVs). OBJECTIVE: To compare the surgical outcomes of single level 3-CO and the associated complications between CK with increasing number of AUVs. METHODS: 25 consecutive operated patients with CK-AUVs at a mean age of 16.2±10.3 years were retrospectively reviewed. They were stratified into two groups according to the number of AUVs: 3-AUVs group and ≥4 AUVs group...

OBJECTIVE: Cervical kyphosis is rare in the pediatric population. It may be syndromic or acquired secondary to laminectomy, neoplasia, or trauma. Regardless, this should be avoided to prevent progressive spinal deformity and neurological deficit. Long-term follow-up is needed to evaluate fusion status, spine growth, potential instability, and neurological function. METHODS AND MATERIALS: A retrospective review of 27 children (6 months to 16 years) with cervical kyphotic deformity was performed and limited to the MRI era until 2008, to provide a long-term follow-up after which complex instrumentation was available...

OBJECTIVE: Determine patient and injury characteristics predictive of vascular injury (VAI) in blunt cervical spine (BCS) trauma to identify high-risk patients and propose an alternative screening protocol. METHODS: Patients presenting between 2014 and 2018 with BCS injury and cervical spine CT imaging were included. Demographics and injury characteristics of BCS injuries were collected. Univariate and multivariate analyses to determine risk factors for VAI were performed...