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Varun R Kshettry, Andrew T Healy, Robb Colbrunn, Dylan T Beckler, Edward C Benzel, Pablo F Recinos
OBJECTIVE The far lateral transcondylar approach to the ventral foramen magnum requires partial resection of the occipital condyle. Early biomechanical studies suggest that occipitocervical (OC) fusion should be considered if 50% of the condyle is resected. In clinical practice, however, a joint-sparing condylectomy has often been employed without the need for OC fusion. The biomechanics of the joint-sparing technique have not been reported. Authors of the present study hypothesized that the clinically relevant joint-sparing condylectomy would result in added stability of the craniovertebral junction as compared with earlier reports...
October 14, 2016: Journal of Neurosurgery
James M Elliott, Sudarshan Dayanidhi, Charles Hazle, Mark A Hoggarth, Jacob McPherson, Cheryl L Sparks, Kenneth A Weber
Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates...
October 2016: Journal of Orthopaedic and Sports Physical Therapy
Anna E Nidecker, Peter Y Shen
The superb stability and flexibility of the craniovertebral junction (CVJ) are enabled by the ligaments that connect the occipital bone and the C1 and C2 vertebral bodies. Radiographically, these ligaments are best assessed with magnetic resonance imaging (MRI), which has excellent soft tissue contrast, but typically poor spatial resolution. With the advent of advanced MRI techniques, including volumetric sequences, high spatial resolution and contrast resolution can both be attained, allowing for detailed analysis of the ligaments, particularly in trauma settings...
October 2016: Journal of Neurological Surgery. Part B, Skull Base
Kingsley O Abode-Iyamah, Brian J Dlouhy, Alejandro J Lopez, Arnold H Menezes, Patrick W Hitchon, Nader S Dahdaleh
INTRODUCTION: A rigid construct that employs an occipital plate and upper cervical screws and rods is the current standard treatment for craniovertebral junction (CVJ) instability. A rod is contoured to accommodate the occipitocervical angle. Fatigue failure has been associated these acute bends. Hinged rod systems have been developed to obviate intraoperative rod contouring. OBJECT: The aim of this study is to determine the safety and efficacy of the hinged rod system in occipitocervical fusion...
July 2016: Journal of Craniovertebral Junction and Spine
Atul Goel
No abstract text is available yet for this article.
July 2016: Journal of Craniovertebral Junction and Spine
Yujiro Hirao, Hirotaka Chikuda, Yasushi Oshima, Yoshitaka Matsubayashi, Sakae Tanaka
INTRODUCTION: Ectopic ossification of the spinal ligaments is not uncommon in patients with Vitamin D-resistant rickets (VDRR), but the long-term consequences of this condition have not been reported. PRESENTATION OF CASE: The case was a 65-year-old female with VDRR who reported progressive weakness of the upper extremities, difficulty walking, neck pain, and numbness in the left arm. Imaging studies demonstrated cord compression with ectopic ossification at the rim of the occipital bone and OPLL at C1 level...
2016: International Journal of Surgery Case Reports
Shala Cunningham
Rheumatoid arthritis (RA) affects between 1 and 2 million individuals in the United States. Atlantoaxial instability (AAI) has been shown to have 40-85% prevalence among individuals with RA. Despite the high incidence of craniovertebral involvement, overt symptoms of instability are rare. The high risk of AAI and limited symptomology should increase therapist suspicion of potential contraindications and precautions to initiation of therapy for the cervical spine without prior diagnostic imaging. The purpose of this case study is to describe the historical, clinical, and diagnostic imaging complexity of AAI associated with RA, and to illustrate the use of these factors in the clinical reasoning within a patient case...
July 2016: Journal of Manual & Manipulative Therapy
Jayesh Sardhara, Sindgikar Pavaman, Kuntal Das, Arun Srivastava, Anant Mehrotra, Sanjay Behari
BACKGROUND: Congenital spondylolytic spondylolisthesis of C2 vertebra resulting from deficient posterior element of the axis is very rarely described in the literature. CASE DESCRIPTION: We describe a unique case of agenesis of posterior elements of C2 with cranio-vertebral junction anomalies consist of osseous, vascular and soft tissue anomalies. A young 26 year old young man presented with symptoms of upper cervical myelopathy of 12 months duration. CT scan of the cervical spine including the craniovertebral junction revealed spondylolisthesis of C2 over C3, atlanto axial dislocation, occipitalisation of atlas, hypoplasia of the odontoid and cleft posterior C1 arch...
August 12, 2016: World Neurosurgery
Sun-Myung Lee, Chang-Hyung Lee, David O'Sullivan, Joo-Ha Jung, Jung-Jun Park
[Purpose] This study compared the effects of pilates and an exercise program on the craniovertebral angle, cervical range of motion, pain, and muscle fatigue in subjects with a forward head posture (FHP). [Subjects and Methods] A total of 28 sedentary females (age 20 to 39 years) with FHP were randomly assigned to pilates (n=14) and combined (n=14) exercise groups. The study was a randomized, controlled, double-blind study with the two groups performing exercise 50 min/day, 3 days/week, with an intensity of 11-15 rating of perceived exertion (RPE) for ten weeks...
July 2016: Journal of Physical Therapy Science
A E Korshunov, Yu V Kushel'
AIM: The study objective was to develop a rational approach for defining the extent of posterior decompression in children with Chiari 1 malformation. MATERIAL AND METHODS: Posterior decompression was performed in 76 children with Chiari 1 malformation, under 18 years of age, in the period between 2001 and 2015. Fifty two (68%) children had syringomyelia. Extradural decompression (EDD) was performed in 14 (18%) cases, extra-arachnoid duraplasty (EAD) in 21 (28%) cases, intra-arachnoid dissection and duraplasty in 21 (28%) cases, and foramen of Magendie stenting and duraplasty in 20 (26%) cases...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Eduardo Martinez-Del-Campo, Jay D Turner, Hector Soriano-Baron, Anna G U S Newcomb, Samuel Kalb, Nicholas Theodore
OBJECTIVE The authors assessed the rate of vertebral growth, curvature, and alignment for multilevel constructs in the cervical spine after occipitocervical fixation (OCF) in pediatric patients and compared these results with those in published reports of growth in normal children. METHODS The authors assessed cervical spine radiographs and CT images of 18 patients who underwent occipitocervical arthrodesis. Measurements were made using postoperative and follow-up images available for 16 patients to determine cervical alignment (cervical spine alignment [CSA], C1-7 sagittal vertical axis [SVA], and C2-7 SVA) and curvature (cervical spine curvature [CSC] and C2-7 lordosis angle)...
July 29, 2016: Journal of Neurosurgery. Pediatrics
Roberto Altieri, Valentina Tardivo, Paolo Pacca, Valentina Pennacchietti, Federica Penner, Diego Garbossa, Alessandro Ducati, Massimiliano Garzaro, Francesco Zenga
The introduction of modern endoscopy in neurosurgery brought light to one of the darkest areas: the skull base. In particular, the trans-nasal route allowed skull base surgeons to visualize and dominate the entire midline skull base. We analyzed our surgical series of 199 patients that were affected by several pathologies (pituitary adenomas, clivalchordomas, craniopharyngioma, Rathke's cleft cysts, tuberculum sellaemeningiomas, and craniovertebral junction pathologies with bulbar compression) and treated each by using a 3D-HD endoscope between December 2012 and December 2015 and reviewed the literature...
July 29, 2016: Surgical Technology International
Michael F Shriver, Varun R Kshettry, Raj Sindwani, Troy Woodard, Edward C Benzel, Pablo F Recinos
OBJECT: The craniovertebral junction (CVJ) is a complex region of the spine with unique anatomical and functional relationships. To alleviate symptoms associated with pathological processes involving the odontoid process, decompression is often required, including odontoidectomy. Accurate knowledge of the complication rates following the transoral and transnasal techniques is essential for both patients and surgeons. METHODS: We conducted MEDLINE, Scopus and Web of Science database searches for studies reporting complications associated with the transoral and transnasal techniques for odontoidectomy...
September 2016: Clinical Neurology and Neurosurgery
Anil Nanda, Subhas Konar, Shyamal C Bir, Tanmoy Kumar Maiti, Sudheer Ambekar
OBJECTIVE: The modified far lateral approach is a modified version of the far lateral approach without drilling of the condyle. This approach can be used for accessing aneurysms anterior and anterolateral to the brainstem and craniovertebral junction. We describe the surgical outcome and complications of the modified far lateral approach for vertebrobasilar, proximal posterior inferior cerebellar artery, and vertebral artery aneurysms. METHODS: The records of 26 patients with vertebrobasilar aneurysms who underwent surgery using the modified far lateral approach from 1994 to 2015 were retrospectively reviewed to analyze the clinical outcomes...
October 2016: World Neurosurgery
Eduardo Martinez-Del-Campo, Jay D Turner, Samuel Kalb, Leonardo Rangel-Castilla, Luis Perez-Orribo, Hector Soriano-Baron, Nicholas Theodore
BACKGROUND: Occipitocervical junction instability can lead to serious neurological injury or death. Open surgical fixation is often necessary to provide definitive stabilization. However, long-term results are limited to small case series. OBJECTIVE: To review the causes of occipitocervical instability, discuss the indications for surgical intervention, and evaluate long-term surgical outcomes after occipitocervical fixation. METHODS: The charts of all patients undergoing posterior surgical fixation of the occipitocervical junction by the senior author were retrospectively reviewed...
October 2016: Neurosurgery
Lubdha M Shah, Jeffrey S Ross
: Imaging with computed tomography and magnetic resonance imaging is fundamental to the evaluation of traumatic spinal injury. Specifically, neuroradiologic techniques show the exact location of injury, evaluate the stability of the spine, and determine neural element compromise. This review focuses on the complementary role of different radiologic modalities in the diagnosis of patients with traumatic injuries of the spine. The role of imaging in spinal trauma classifications will be addressed...
July 12, 2016: Neurosurgery
Anand Kaul, Ahmed Abbas, Gabriel Smith, Sunil Manjila, Jonathan Pace, Michael Steinmetz
Fatal craniovertebral junction (CVJ) injuries were the most common cause of death in high-speed motor sports prior to 2001. Following the death of a mutual friend and race car driver, Patrick Jacquemart (1946-1981), biomechanical engineer Dr. Robert Hubbard, along with race car driver and brother-in-law Jim Downing, developed the concept for the Head and Neck Support (HANS) device to prevent flexion-distraction injuries during high-velocity impact. Biomechanical testing showed that neck shear and loading forces experienced during collisions were 3 times the required amount for a catastrophic injury...
July 12, 2016: Journal of Neurosurgery. Spine
Pavaman Pandit Sindgikar, Kuntal Kanti Das, Awadesh K Jaiswal, Rabi Narayan Sahu, Arun K Srivastava, Anant Mehrotra, Jayesh Chunilal Sardhara, Kamlesh Singh Bhaisora, Sanjay Behari
INTRODUCTION: Surgery for craniovertebral junction (CVJ) abnormalities like atlantoaxial dislocation (AAD) with or without basilar invagination (BI) and/or with or without associated Arnold-Chiari malformation (ACM) cause high cervical myelopathy. Occasionally, mechanical factors such as inadequate canal decompression, torticollis, and/or scoliosis may lead to lack of improvement following the primary surgery. Also, implant-related factors requiring its revision/removal or surgical site infections may cause patient to undergo resurgery...
August 2016: Neurosurgery
Tae-Woon Kim, Da-In An, Hye-Yun Lee, Ho-Young Jeong, Dong-Hyun Kim, Yun-Hee Sung
[Purpose] This study performed to investigate the effect of elastic band exercise program on the posture of subjects with rounded shoulder and forward head posture. [Subjects and Methods] The body length, forward shoulder angle, craniovertebral angle, and cranial rotation angle of participants (n=12) were measured before and after the exercise program. Furthermore, the thicknesses of the pectoralis major, rhomboid major, and upper trapezius were measured using an ultrasonographic imaging device. The exercises program was conducted with elastic bands, with 15 repetitions per set and 3 sets in total...
June 2016: Journal of Physical Therapy Science
Zhen-Feng Li, Xian-Hao Shao, Li-Qiang Zhang, Zhi-Ping Yang, Xin Li, Qiang Yang, Jian-Min Li
OBJECTIVE: To develop an endoscopic transnasal approach to atlas tumors and study its practicability. METHODS: This article comprises two components: an illustrative case report and observational data on 50 volunteers. As to the case report, a 34 year old man presented with occipital pain for more than 3 months and underwent systematic investigation in Qilu Hospital of Shandong University. CT and MRI scans showed bony destruction in the craniovertebral junction (CVJ) suggestive of tumor...
May 2016: Orthopaedic Surgery
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