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Craniocervical instability

Muhammad M Abd-El-Barr, Brian D Snyder, John B Emans, Mark R Proctor, Daniel Hedequist
Severe os odontoideum causing ventral brainstem compression is a rare and difficult entity to treat. It is generally accepted that severe os odontoideum causing ventral brainstem compression and neurological deficits warrants surgical treatment. This often requires both anterior and posterior procedures. Anterior approaches to the craniocervical junction are fraught with complications, including infection and risk of injury to neurovascular structures. External traction systems traditionally require long-term bedrest...
August 26, 2016: Journal of Neurosurgery. Pediatrics
Idiris Altun, Kasım Zafer Yuksel
STUDY DESIGN: Retrospective review. PURPOSE: We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. OVERVIEW OF LITERATURE: Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability...
August 2016: Asian Spine Journal
Atul Goel, Trimurti Nadkarni, Abhidha Shah, Prashant Sathe, Manoj Patil
BACKGROUND: We evaluated the radiological features of 75 patients having Group B basilar invagination, meaning thereby that there was no evidence of atlantoaxial instability when measured by conventional parameter of abnormal increase in the atlantodental interval. OBJECTIVE: The variability and possible significance of presence of CSF within and outside the confines of neural tissues were specially studied. MATERIAL AND METHODS: During the period January 2008 to May 2015, we encountered 75 cases having Group B basilar invagination...
August 17, 2016: World Neurosurgery
Atsushi Fujita, Ryohei Nishimura
The atlanto-occipital (AO) overlap in combination with atlanto-axial (AA) instability was found in a dog. We hypothesized that ventral fixation of the AA junction can stabilize the atlas and prevent AO overlap by reviewing our past cases with AA instability. A standard ventral fixation of the AA junction using stainless k-wires and polymethyl methacrylate (PMMA) was performed. The dog fully recovered, and no complication was noted. The results of the postoperative CT imaging supported our hypothesis. The ventral fixation of the AA junction is a feasible treatment option for similar cases, although craniocervical junction abnormalities (CJA) including AA instability are varied, and careful consideration is required for each case...
May 2016: Japanese Journal of Veterinary Research
F T Mendonça, I Barreto de Moura, D Pellizzaro, B J Grossi, R Carvalho Diniz
OBJECTIVE: We report the anesthesia management of a 15 years-old patient with neurofibromatosis type 1, scheduled for resection of a tumor located in the occipitocervical region. In addition, we review the pertaining literature, emphasizing the anesthetic implications of neurofibromatosis manipulation. CASE : A 15-years-old female patient, with Neurofibromatosis type 1 was diagnosed with a large tumor in occipitocervical region suggestive of a plexiform neurofibroma. She presented with cervical instability, difficulty in positioning due to the large cervical mass and other predictors of airway difficulty...
2016: Acta Anaesthesiologica Belgica
Kei Ando, Shiro Imagama, Zenya Ito, Kazuyoshi Kobayashi, Hideki Yagi, Ryuichi Shinjo, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Naoki Ishiguro
STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To evaluate the clinical outcome of patients who had undergone occipitocervical (OC) fusion using pedicle screws and rods over a minimum 5-year follow-up. SUMMARY OF BACKGROUND DATA: Few studies have evaluated occipitocervical (OC) fusion using pedicle screws and rods for long term follow-up. METHODS: Twenty-seven consecutive patients treated underwent posterior OC fusion using pedicle screws and rods over a minimum 5-year follow-up...
June 28, 2016: Clinical Spine Surgery
Zachary Child, Daniel Rau, Michael J Lee, Randall Ching, Richard Bransford, Jens Chapman, Carlo Bellabarba
BACKGROUND CONTEXT: Craniocervical dissociation is a rare but serious condition, and missed injuries have been associated with poor neurologic outcomes and deterioration. A fluoroscopic traction test is employed to interrogate the craniocervical ligaments when clinical and imaging findings are equivocal. However, no specific protocol or known parameters with respect to traction or force applied have been established. PURPOSE: This study sought to define the parameters of the radiographic traction test with sequential sectioning of the primary ligamentous restraints under controlled distraction of the craniocervical junction in a biomechanical model...
September 2016: Spine Journal: Official Journal of the North American Spine Society
Gaston O Camino Willhuber, Santiago T Bosio, Miguel H Puigdevall, Carolina Halliburton, Carlos A Sola, Ruben A Maenza
To present and describe an unusual case of spinal instability after craniocervical spinal decompression for a type-1 Chiari malformation. Type-1 Chiari malformation is a craniocervical disorder characterized by tonsillar displacement greater than 5 mm into the vertebral canal; posterior fossa decompression is the most common surgical treatment for this condition. Postoperative complications have been described: cerebrospinal fluid leak, pseudomeningocele, aseptic meningitis, wound infection, and neurological deficit...
June 2, 2016: Journal of Pediatric Orthopedics. Part B
Sebastian Hartmann, Anja Tschugg, Pujan Kavakebi, Claudius Thomé
BACKGROUND: Intradural synovial cysts of the cervical spine represent a rare disease entity, causing stenosis of the spinal canal and thereby leading to progressive myelopathy. In particular, at the cranio-cervical junction early intervention is necessary to prevent permanent neurological dysfunction. We present the case of a 74-year-old man who presented with moderate cervicogenic headache, gait disturbance and progressive left-sided weakness. Magnetic resonance imaging (MRI) of the cervical spine confirmed a left-sided cystic mass located anteriorly at the craniovertebral junction compressing the surrounding structures...
August 2016: Acta Neurochirurgica
M Re, M Iacoangeli, L Di Somma, L Alvaro, D Nasi, G Magliulo, F M Gioacchini, D Fradeani, M Scerrati
We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours...
April 2016: Acta Otorhinolaryngologica Italica
Raiya Saif Al Bahri, David B MacDonald, Ahmed Haroun M Mahmoud
Intubation or neck extension can compress the spinal cord in patients with craniocervical instability. Protective motor evoked potential (MEP) and somatosensory evoked potential (SEP) monitoring of these maneuvers is an obvious consideration when these patients undergo already-monitored spinal surgery, but might be overlooked when they undergo other normally unmonitored procedures. Here we report monitoring intubation and neck extension for the unusual indication of thyroidectomy in a Down syndrome boy with atlantoaxial instability...
January 28, 2016: Journal of Clinical Monitoring and Computing
Kei Ando, Shiro Imagama, Zenya Ito, Kazuyoshi Kobayashi, Hideki Yagi, Ryuichi Shinjo, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Naoki Ishiguro
STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To evaluate the clinical outcome of patients who had undergone occipitocervical (OC) fusion using pedicle screws and rods over a minimum 5-year follow-up. SUMMARY OF BACKGROUND DATA: Few studies have evaluated occipitocervical (OC) fusion using pedicle screws and rods for long term follow-up. METHODS: Twenty-seven consecutive patients treated underwent posterior OC fusion using pedicle screws and rods over a minimum 5-year follow-up...
June 28, 2016: Clinical Spine Surgery
Abolfazl Rahimizadeh, Housain F Soufiani, Valiolah Hassani, Ava Rahimizadeh
The authors report the first example of an adult achondroplastic dwarf with progressive quadriparesis secondary to atlantoaxial subluxation as a consequence of an os odontoideum. Actually, craniocervical region is a frequent site of compression and myelopathy in achondroplasia particularly in children as a result of small foramen magnum and hypertrophied opisthion. Moreover, very rarely in achondroplastic patients, coexistence of atlantoaxial instability as the sequel of os odontoideum can result in further compression of the already compromised cervicomedullary neural tissues, the scenario that has been reported only in five achondroplastic children...
2015: Case Reports in Orthopedics
Seok Woo Kim, Jae-Hoo Lee, Ho-Won Lee, Jae-Keun Oh, Yoon-Hae Kwak
Although conventional C1 laminectomy is the gold standard for decompression at the atlas, it provides little space for the bone graft to fuse. The fusion area can be extended cranially up to the occipital bone, but it requires sacrificing the function of the craniocervical junction. To date, no reports have focused on surgical techniques for successful decompression and fusion without disruption of the posterior C1 arch while providing enough room for the bone graft to fuse. This study introduces a new technique for C1-C2 fusion and C1 double-door laminoplasty in patients with C1-C2 instability, canal stenosis, and cervical spondylotic myelopathy...
March 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Catherine A Loughin, Dominic J Marino
The term craniocervical junction abnormality (CJA) is an umbrella term for a variety of malformations that occur in the craniocervical region. These abnormalities include Chiari-like malformation, atlantooccipital overlapping, atlantoaxial instability, occipitoatlantoaxial malformations, atlantoaxial dural bands, and dens abnormalities. Syringomyelia can occur secondary to any of these malformations or a combination. Clinical signs in dogs with a CJA typically include neck pain and varying signs associated with a cervical myelopathy...
March 2016: Veterinary Clinics of North America. Small Animal Practice
Roberto J Aranibar, Diana Cardenas Del Monaco, Phoebe Gonzales
Osteomyelitis of the spine is a fairly uncommon event following an orthopedic surgical procedure. However, a solitary osteomyelitic abscess of the upper cervical spine is very rare. Surgical intervention is often the only life-saving treatment method. A 70-year-old female patient with diabetes was received from a rural community with symptoms of progressive quadraparesis and progressive respiratory failure. A CT scan of the cervical spine showed a destruction of the C1 and C2 complex, as well as the left occipital condyle, and clear evidence of craniocervical instability...
2015: International Journal of Spine Surgery
Ehab Shiban, Elisabeth Török, Maria Wostrack, Bernhard Meyer, Jens Lehmberg
OBJECT Far-lateral or extreme-lateral approaches to the skull base allow access to the lateral and anterior portion of the lower posterior fossa and foramen magnum. These approaches include a certain extent of resection of the condyle, which potentially results in craniocervical junction instability. However, it is debated what extent of condyle resection is safe and at what extent of condyle resection an occipitocervical fusion should be recommended. The authors reviewed cases of condyle resection/destruction with regard to necessity of occipitocervical fusion...
July 2016: Journal of Neurosurgery
Wei-Hsin Wang, Kumar Abhinav, Eric Wang, Carl Snyderman, Paul A Gardner, Juan C Fernandez-Miranda
BACKGROUND: The endoscopic endonasal approach provides a direct route to ventral foramen magnum (FM) lesions like meningiomas, which are difficult to access. Endonasal access at the FM is limited laterally by the occipital condyles and inferiorly by the C1 anterior arch and the odontoid process, which may need partial resection. OBJECTIVE: We investigated the surgical anatomy and technical nuances for endonasally increasing the surgical corridor at the FM region both laterally and inferiorly...
November 3, 2015: Neurosurgery
Jin Bum Kim, Seung Won Park, Young Seok Lee, Taek Kyun Nam, Yong Sook Park, Young Baeg Kim
Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic deformity of upper cervical spine, which has been usually indicative to craniocervical fixation...
September 2015: Korean Journal of Spine
Benjamin C Kennedy, Randy S D'Amico, Brett E Youngerman, Michael M McDowell, Kristopher G Hooten, Daniel Couture, Andrew Jea, Jeffrey Leonard, Sean M Lew, David W Pincus, Luis Rodriguez, Gerald F Tuite, Michael L Diluna, Douglas L Brockmeyer, Richard C E Anderson
OBJECT The long-term consequences of atlantoaxial (AA) and occipitocervical (OC) fusion and instrumentation in young children are unknown. Anecdotal reports have raised concerns regarding altered growth and alignment of the cervical spine after surgical intervention. The purpose of this study was to determine the long-term effects of these surgeries on the growth and alignment of the maturing spine. METHODS A multiinstitutional retrospective chart review was conducted for patients less than or equal to 6 years of age who underwent OC or AA fusion with rigid instrumentation at 9 participating centers...
January 2016: Journal of Neurosurgery. Pediatrics
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