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atlantoaxial rotatory displacement in children

World Journal of Orthopedics 2017年第11期8卷 836-845页

作者： David Spiegel Shikshya Shrestha Prakash Sitoula Norma Rendon John Dormans Division of Orthopaedic Surgery Children’s Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Kathmandu Model Hospital Department of Orthopedics Nobel Medical College Teaching Hospital Center for Fetal Diagnosis and Treatment Children’s Hospital of Philadelphia Department of Orthopaedic Surgery Texas Children’s Hospital

AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis.METHODS Forty-seven dynamic rotational computed tomography(CT) scans in 35 patients were classified into one of the five types defined by Pang and Li, including types Ⅰ(atlantoaxial rotatopry fixation), Ⅱ("pathologic stickiness" without crossover of C1 on C2), Ⅲ("pathologic stickiness" with crossover of C1 on C2), Ⅳ(normal or muscular torticollis), and Ⅴ(diagnostic grey zone). The Pang and Li class was then compared with the radiologist's report, which was graded abnormal, diagnosis of rotatory subluxation or fixation, or non-diagnostic. Medical records were reviewed and the clinical course was compared among the five subtypes.RESULTS We reviewed 47 CT scans in 35 patients, and the majority were performed without sedation. The average age was 7.7 years(4-14 years old) and associated conditions included minor trauma(20%), surgical procedures around the head and neck(29%), and Grisels syndrome(20%). Twenty-six percent of our studies fell within the pathologic spectrum(5% type 1 or rotatory fixation, 21% types 2 and 3 or rotatory subluxation), while 45% were classified as muscular torticollis(45%) and 28% fell within the diagnostic grey zone. Seven radiologists interpreted these studies, and their interpretation was discordant in 45% of cases. Clinical resolution occurred in 27 of 29 cases for which follow-up was available. One of two patients with fixed rotatory subluxation required a C1-C2 arthrodesis.CONCLUSION The Pang and Li classification characterizes a spectrum of abnormalities in rotation to facilitate communication, although the indications for dynamic CT scan should be further defined.

关键词： Atlanto-axial rotatory subluxation atlantoaxial rotatory fixation Dynamic rotational computed tomography Atlanto-axial rotatory displacement

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C1-C2 pedicle screw fixation for adolescent with os odontoideum associated atlantoaxial dislocation and a compound reduction technique for irreducible atlantoaxial dislocation

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Chinese Medical Journal 2019年第10期132卷 1253-1256页

作者： Jia Liu Ling-Jun Zhu En-Ze Jiang Xiao-Gang Bao Bo Hu Dong-Yang Niu Guo-Hua Xu Department of Orthopaedic Surgery Spine Center Changzheng Hospital Second Military Medical University Shanghai 200003 China Jiangxi Province Hospital of Integrated Chinese & Western Medicine NanchangJiangxi 330000 China

To the Editor: Os odontoideum (OO) is a rare congenital anomaly of the second cervical vertebra that is defined as occurring when an independent ossicle is separated from the base of the odontoid process?⑴ In general, it requires surgeries for the patients who suffer from OO-associated atlantoaxial dislocation (AAD), especially for young patients due to their immature bones and the unavoidable tumbles and physical impacts in their daily lives.

关键词： atlantoaxial dislocation compound reduction technique

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Posterior atlantoaxial Fusion Using C1 Lateral Mass and C2 Pedicle by Polyaxial Screw in atlantoaxial Instability

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Open Journal of Modern Neurosurgery 2014年第3期4卷 154-161页

作者： O. Rezaee R. Salar R. Jabari A. Shams Akhtari M. Taghizadeh Neurosugery Department Shahid Beheshti University of Medical Sciences Tehran Iran

Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.

关键词： atlantoaxial Instability Polyaxial Screw C1 Lateral Mass C2 Pedicle Fusion

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Chordomas of the upper cervical spine： clinical characteristics and surgical management of a series of 21 patients

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Chinese Medical Journal 2014年第15期127卷 2759-2764页

作者： Zhou Hua Jiang Liang Wei Feng Yu Miao Wu Fengliang Liu Xiaoguang Liu Zhongjun Dang Gengting Department of Orthopaedics Peking University Third HospitalBeijing Key Laboratory of Spinal Diseases Beijing 100191 China

Background Chordomas of the upper cervical spine are rare and present unique surgical challenge.This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.Methods Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed.Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.Results The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case.The mean operative time was 9.5 hours （range 6-17 hours）,and the mean blood loss was 2 812 ml （range 700-4 800 ml）.There were two postoperative deaths.Unilateral vertebral artery ligation was performed in six patients,cervical nerve roots were cut in six patients,and the external branch of the superior laryngeal nerve was repaired after being cut in one case.Two patients developed postoperative velopharyngeal incompetence,and loosening of the occipitocervical screws was observed in one patient.The recurrence rate was 66.7% （10/15） after a mean follow-up period of 46.8 months （range 14-150 months）.The 5-and 10-year overall survival rates were （39.8±13.1）% and （31.9±12.7）%,respectively.There was a significant difference in survival rate between patients who underwent surgery and those who did not.Conclusion In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine,intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.

关键词： chordoma atlases general surgery therapeutics atlantoaxial

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Advances in the treatment of cervical rheumatoid: Less surgery and less morbidity

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World Journal of Orthopedics 2014年第3期5卷 292-303页

作者： Grant W Mallory Sasha R Halasz Michelle J Clarke Department of Neurologic Surgery Mayo ClinicRochesterMN 55905United States

Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.

关键词： atlantoaxial instability Cranial settling Subaxial subluxation Cervical Surgery Morbidity Rheumatoid arthritis

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Conservative Treatment in Grisel’s Syndrome Following Tonsillectomy

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World Journal of Neuroscience 2018年第1期8卷 38-43页

作者： Youssouf Sogoba Abdoulaye Barry Issa Amadou Boubacar Sogoba Drissa Kanikomo Seybou Hassane Diallo Oumar Coulibaly Youssoufa Maiga Siaka Soumaoro Dianguina dit Noumou Soumaré Kadidiatou Singaré Mohamed Keita Department of Neurosurgery Hopital Gabriel Touré Bamako Mali Department of Pediatrics Hopital de Kati Bamako Mali Department of Pediatric Surgery Hopital Gabriel Touré Bamako Mali Department of Neurology Hopital Gabriel Touré Bamako Mali Department of ENT Hopital Gabriel Touré Bamako Mali Department of Pneumonology Hopital du Point G Bamako Mali

Grisel’s syndrome is a rare complication that is characterized by non-traumatic atlantoaxial subluxation. It is most commonly seen in children after an upper respiratory tract infection or neck surgery, such as an adenoidectomy, tonsillectomy and mastoidectomy. Grisel’s Syndrome is characterized by torticollis and a limited range of motion of the neck with pain. Here the authors report a case of a Malian 5-year-old girl with Grisel’s syndrome following tonsillectomy. The patient’s complaints were fully resolved after 2 weeks of conservative treatment.

关键词： atlantoaxial Subluxation Grisel’s Syndrome Torticollis

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