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Stephen Clark, Alysa Nash, Mark Shasti, Luke Brown, Julio J Jauregui, Katherine Mistretta, Eugene Koh, Kelley Banagan, Steven Ludwig, Daniel Gelb
STUDY DESIGN: Retrospective cohort study OBJECTIVE.: To assess 30-day and one-year mortality rates as well as the most common complications associated with posterior C1-2 fusion in an octogenarian cohort. SUMMARY OF BACKGROUND DATA: Treatment of unstable type II odontoid fractures in elderly patients can present challenges. Recent evidence indicates in patients older than 80 years, posterior C1-2 fusion results in improved survival as compared to other modes of treatment...
March 13, 2018: Spine
Avinash Rao, Hesham Soliman, Mayank Kaushal, Oleysa Motovylak, Aditya Vedantam, Matthew D Budde, Brian Schmit, Marjorie Wang, Shekar N Kurpad
BACKGROUND: Fractional anisotropy (FA) of the high cervical cord correlates with upper limb function in acute cervical cord injury. We investigated the correlation between preoperative FA at the level of maximal compression and functional recovery in a group of patients after decompressive surgery for cervical spondylotic myelopathy (CSM). OBJECTIVE: To determine the usefulness of FA as a biomarker for severity of CSM and as a prognostic biomarker for improvement after surgery...
February 23, 2018: Neurosurgery
Myoung Soo Kim
OBJECTIVE: Sometimes a vertebral artery (VA) enters the spinal canal via the C1-2 intervertebral space, a variation regarded as a C2 segmental-type VA. This paper describes the anatomy of the C2 segmental-type VA and reviews its clinical importance. METHODS: Between March 2014 and November 2015, 3386 patients underwent computed tomographic angiography. I identified C2 segmental-type VAs, associated vascular variation, the origin of ipsilateral posterior inferior cerebellar arteries (PICAs), and the clinical symptoms associated with C2 segmental-type VAs...
March 2018: Journal of Korean Neurosurgical Society
Daeyeong Chung, Dae-Chul Cho, Seong-Hyun Park, Kyoung-Tae Kim, Joo-Kyung Sung, Younghoon Jeon
OBJECTIVE: The purpose of this study was to evaluate pain-related behaviors after bilateral C2 root resection and change in pain patterns in the suboccipital region in rats. METHODS: Male Sprague-Dawley rats were randomly assigned to three groups (n=25/group); näive, sham, and C2 resection. Three, 7, 10, and 14 days after surgery, cold allodynia was assessed using 20 μL of 99.7% acetone. c-Fos and c-Jun were immunohistochemically stained to evaluate activation of dorsal horn gray matter in C2 segments of the spinal cord 2 hours, 1 day, 7 days, and 14 days after surgery...
March 2018: Journal of Korean Neurosurgical Society
Taylor E Purvis, Rafael De la Garza-Ramos, Nancy Abu-Bonsrah, C Rory Goodwin, Mari L Groves, Michael C Ain, Daniel M Sciubba
OBJECTIVE: To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries undergoing either external fixation or surgical fusion. PATIENTS AND METHODS: Baseline and outcome data were obtained from the 2002-2011 Nationwide Inpatient Sample (NIS) for patients under the age of 18 with a diagnosis of cervical spine fracture without spinal cord injury or cervical spine subluxation. Patients who underwent external immobilization or internal fixation were included for analysis...
February 5, 2018: Clinical Neurology and Neurosurgery
Dong Hyun Chun, Do Heum Yoon, Keung Nyun Kim, Seong Yi, Dong Ah Shin, Yoon Ha
STUDY DESIGN: Finite element analysis. OBJECTIVE: To compare the biomechanical stability imparted to the C1 and C2 vertebrae by the transarticular(TA), C1 lateral mass(LM)-C2 pedicle(PS), C1LM-C2 pars, and C1LM-C2 translaminar screw(TL) fixation techniques. SUMMARY OF BACKGROUND DATA: Cadaveric biomechanical studies of several atlantoaxial posterior fixation techniques have been performed, showing significant heterogeneity in biomechanical properties among the studies...
February 16, 2018: Spine
Kai Shen, Zhongliang Deng, Junsong Yang, Chao Liu, Ranxi Zhang
OBJECTIVE Atlantoaxial instability is usually corrected by anterior and/or posterior C1-2 fusion. However, fusion can lead to considerable loss of movement at the C1-2 level, which can adversely impact a patient's quality of life. In this study, the authors investigated the stability and function of a novel posterior artificial atlanto-odontoid joint (NPAAJ) by using cadaveric cervical spines. METHODS The Oc-C7 regions from 10 cadaveric spines were used for anteroposterior (AP) translation and range of motion (ROM) tests while intact and after destabilization, NPAAJ implantation, and double-rod fixation...
February 16, 2018: Journal of Neurosurgery. Spine
Atul Goel, Apurva Prasad, Abhidha Shah, Sandeep More
BACKGROUND: We present 2 cases involving a previously unreported clinical situation in which basilar invagination, atlantoaxial instability, and C2-3 instability were associated with a bifid posterior arch of the axis bone. CASE DESCRIPTIONS: Two young males presented with limb weakness, spasticity, and paresthesias. Both patients had altered voice quality, with reduced and thin volume, and difficulty sleeping supine. Radiologic imaging showed an absence of the posterior elements of the C2 vertebrae...
February 2018: World Neurosurgery
K Venugopal Menon, Sameer B Raniga
BACKGROUND: To date, trabecular morphology studies have been conducted on thin-section computed tomography (CT) scans of cadaveric bone. Here we describe the trabecular anatomy of the axis vertebra as revealed by an innovative imaging tool. METHODS: Ten patients who underwent thin-slice CT scans for suspected cervical spine injury were prospectively subjected to shaded volume-rendered 3-dimensional reconstruction of the images. The trabecular anatomy thus depicted was recreated, and the mechanical vectors were deduced independently by a senior radiologist and spine surgeon and then matched...
February 2018: World Neurosurgery
Benjamin M Ellingson, Noriko Salamon, Davis C Woodworth, Hajime Yokota, Langston T Holly
OBJECTIVE The purpose of this study was to quantify the reproducibility, temporal stability, and functional correlation of diffusion MR characteristics in the spinal cord in patients with cervical stenosis with or without myelopathy. The association between longitudinal diffusion tensor imaging (DTI) measurements and serial neurological function assessment was explored at both the group and individual level. METHODS Sixty-six nonoperatively treated patients with cervical stenosis were prospectively followed (3 months to > 5 years) using synchronous serial MRI and functional outcome assessment...
February 9, 2018: Journal of Neurosurgery. Spine
Prashant Kumar Prasad, Pravin Salunke, Daisy Sahni, Parveen Kalra
Purpose: The existing literature on lateral atlantoaxial joints is predominantly on bony facets and is unable to explain various C1-2 motions observed. Geometric morphometry of facets would help us in understanding the role of cartilages in C1-2 biomechanics/kinematics. Objective: Anthropometric measurements (bone and cartilage) of the atlantoaxial joint and to assess the role of cartilages in joint biomechanics. Materials and Methods: The authors studied 10 cadaveric atlantoaxial lateral joints with the articular cartilage in situ and after removing it, using three-dimensional laser scanner...
October 2017: Journal of Craniovertebral Junction and Spine
Mazda K Turel, Mena G Kerolus, Vincent C Traynelis
Background: The use of cervical interfacet spacers (CISs) to augment stability and provide solid arthrodesis at the atlantoaxial joint has not been studied in detail. The aim of this work is to report the outcomes with the use of machined allograft CISs at C1-2. Methods: A retrospective review of 19 patients who underwent an atlantoaxial fusion with the use of CISs was performed. All patients had instability documented with flexion and extension lateral radiographs...
October 2017: Journal of Craniovertebral Junction and Spine
Jun Mizutani, Atsushi Inada, Kenji Kato, Akira Kondo, Shingo Kainuma, Kazuhiko Fujita, Kiyoshi Yagi, Yasuteru Shimamura, Muneyoshi Fukuoka, Yuta Shibamoto, Ikuo Wada, Takanobu Otsuka
The goal of fixation surgery for atlantoaxial instability is to achieve solid bony fusion. Achieving bony fusion as early as possible is beneficial for patients. Although placement of a transverse cross-link connector (XL) provides greater biomechanical strength, XLs have not been able to be placed when performing the Goel/Harms procedure. Recently, placing a XL on the screw head (on-the-head XL [OH-XL]) has become a viable option during the Goel/Harms procedure. However, there is little evidence demonstrating whether applying an OH-XL achieves early solid bony union...
February 2, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Bulent Ozdemir, Ayhan Kanat, Sule Batcik, Osman Ersagun Batcik, Metin Celiker, Kamil Kayayurt
Cranial nerve palsies after gunshot injury are not uncommon. However, in the literature, only 1 patient with isolated hypoglossal nerve paralysis caused by gunshot has been published. The authors describe a 34-year-old man suffering from unilateral isolated hypoglossal nerve palsy caused by gunshot injury as a second reported patient. The bullet entered maxillary sinus, and caused condylar fracture, then ended up C1-2 interspace. The bullet was surgically removed by a posterior approach. It is important to pay attention to hypoglossal nerve injury when confronted with a gunshot wound...
January 19, 2018: Journal of Craniofacial Surgery
Zaid Aljuboori, Jacob Archer, Wei Huff, Amee Moreno, Andrew Jea
Intrathecal baclofen has been suggested as an effective and safe treatment for intractable spasticity and dystonia. Techniques of lumbar and intraventricular catheter placement have been previously described. The purpose of this study was to describe a technique to implant catheters for intrathecal baclofen infusion through C1-2 puncture. Four of 5 consecutively treated patients underwent successful placement of catheters for intrathecal baclofen. There were no instances of infection, CSF leak, or catheter migration seen during a follow-up period of at least 6 months; furthermore, there were no occurrences of vertebral artery or spinal cord injury...
January 26, 2018: Journal of Neurosurgery. Pediatrics
Alison Turnbull, Navreet Malhi, Jessica Tan, D Tim Harwood, Thomas Madigan
Paralytic shellfish toxin (PST) producing microalgal blooms have a significant economic impact on the Southern Rock Lobster ( Jasus edwardsii) fishery in Tasmania, Australia. The regulatory level of 0.8 mg of saxitoxin (STX) eq/kg in place for bivalve shellfish fisheries is applied to lobster hepatopancreas during blooms of toxic algae, resulting in harvest closures and ongoing risk management implications for the fishery. This cooking study was undertaken to inform a human health risk assessment, in conjunction with studies on the uptake and elimination of PST in J...
January 22, 2018: Journal of Food Protection
P B Karthik, Jayesh Sardhara, Nachiketa Tiwari, Sanjay Behari
The most common type of congenital C1-2 dislocation is a combined type in which atlanto-axial dislocation (AAD) and basilar invagination (BI) are often associated with a rotational dislocation and coronal tilt. An optimal surgical treatment involves reduction of AAD and BI with simultaneous correction of the rotation and coronal tilt to achieve an optimal cervical canal decompression, sagittal and coronal realignment and bony fusion. The most acceptable technique to facilitate this correction is the C1-C2 distraction technique, which is accomplished by the manual joint manipulation...
January 2018: Neurology India
Alireza K Nazemi, Stetson R Bickley, Caleb J Behrend, Jonathan J Carmouche
In posterior spinal fusion (PSF), the vertebral artery is most vulnerable to injury at C1-2. C2 pedicle screws are often placed into the dorsomedial isthmus of C2. Alternative techniques include C2 laminar screws and wiring techniques. A 67-year-old male underwent PSF for persistent severe intractable neck pain and degeneration at C1-2. The patient had an enlarged left vertebral artery with midline migration into the C2 body. This pattern was within one standard deviation of normal; however, it rendered typical placement of a C2 pedicle screw unsafe...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Suomao Yuan, Bin Wei, Yonghao Tian, Jun Yan, Wanlong Xu, Lianlei Wang, Xinyu Liu
BACKGROUND: Recently, the excellent outcomes of temporary fixation of C1-2 without fusion in the treatment of odontoid fracture had been reported. It is still unclear if this technique could achieve the equivalent outcomes as the golden standard technique of anterior screw fixation. The objective of this study is to compare the clinical outcome of two treatments of fresh type II odontoid fracture: anterior cannulated screws fixation (ACSF) versus posterior instrumentation of C1-2 without fusion (PIWF)...
January 8, 2018: Journal of Orthopaedic Surgery and Research
Jong-Beom Park, Sung Shik Kang, Jin S Yeom
RATIONALE: Traumatic C1-2 dislocation associated with contiguous or noncontiguous cervical spine injury is rare. Moreover, there have been no reports describing traumatic C1-2 dislocation associated with multiple contiguous and noncontiguous cervical injuries. PATIENT CONCERNS: The authors present a case of a 20-year-old male with painful limitation of motion of the neck. This complex cervical injury occurred due to hyperextension of the head in a rotated position...
December 2017: Medicine (Baltimore)
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