Ectasia or abnormal dilatation of a vessel may affect any vein within the body including the neck region. Internal jugular vein (IJV) ectasia commonly presents as a painless, soft swelling on the neck which appears to be prominent with increased intrapleural pressure such as during Valsalva manoeuvre. To the best of our knowledge, the occurrence of venous ectasia is infrequent with limited number of reports on this anomaly available. However with the advancement of technology especially in imaging modalities, there is improvement in detecting this condition. We describe here an incidental finding of focal IJV ectasia in an elderly lady following a cervical spine magnetic resonance imaging (MRI) for bilateral hand numbness, and discuss the management of this rare presentation.
Cervical spine MRI

OBJECTIVE: The purpose of this study was to investigate the relationship between menarche and cervical vertebral maturation. METHODS: Lateral cephalograms of 67 young korean girls within the range of 1 year before or after their menarche were gathered. The concavity of the cervical vertebrae base and the ratio of the base length to the 3rd and 4th cervical vertebrae anterior height were measured and analyzed. RESULTS: The mean measured values were as follows; concavity of the 3rd cervical vertebrae base: 1.27 (+/- 0.18) mm, concavity of the 4th cervical vertebrae base: 1.06 (+/- 0.15) mm, ratio of the base length to the 3rd cervical vertebrae anterior height: 0.73 (+/- 0.06) and ratio of the base length to the 4th cervical vertebrae anterior height: 0.70 (+/- 0.05). There was a significant increase in the ratio of the base length to the 3rd vertebrae anterior height and the base concavity of the 3rd and 4th cervical vertebrae during the period of 1 year before to 1 year after their menarche. CONCLUSIONS: These characteristics of the 3rd and 4th cervical vertebrae on the lateral cephalogram can provide useful clues on evaluating the growth stage.
Cervical Vertebrae ; Female ; Menarche ; Spine

OBJECTIVE: This study was undertaken to study pedicle morphology in Koreans to provide a reference guide in transpedicular screw fixation. METHODS: Pedicle measurements were obtained from 35 dried human lumbar columns(175 lumbar vertebrae). Anatomic evaluation was focused on pedicle transverse diameter, pedicle axis length and the distance from the pedicle axis point to the midline of the transverse process. Pedicle angle and vertebral body length also were measured. RESULT: In the transverse plan, pedicle diameter increased from L1(7.8mm) to L5(15.5mm). But in 20.0% of L1 and L2, its diameters was under 6.0mm. In the sagittal plan, it was not as constant and had similar diameter from L1 to L5. In the transverse plan, the pedicle angle increased from L1 to L5. But in the sagittal plan it decreased from L1 to L5. Also, the pedicle axis length did not show concordant change, but rather had similar length in lumbar vertebrae. In 15%, its length was under 45mm. CONCLUSION: These results suggest that using above 6mm diameter and 45mm length of screw for L1 and L2 can violate the pedicle and vertebrae. Above L4, the pedicle axis point was superior to the midline of the transverse process, below L4, it was inferior to the midline of the transverse process. This information may prove to be helpful when contemplating the placement of screws to the lumbar pedicles.
Axis, Cervical Vertebra ; Humans ; Lumbar Vertebrae* ; Spine

Chondrosarcomas are malignant cartilage forming tumours. They form the second most common primary malignant tumour involving the vertebral axis. We present a rare presentation of a secondary chondrosarcoma from the spinous process of lumbar vertebra and discussed its management. The main emphasis is on the rare presentation and the need for awareness and suspicion of the pathology.
Axis, Cervical Vertebra ; Cartilage ; Chondrosarcoma ; Spine

PURPOSE: To analysis the effects of reduction of stiffness in transverse ligament and wire diameter on atlanto-axial posterior fusion and fixations using finite element model. MATERIALS AND METHODS: The finite element model of occipito-atlanto-axis was made based on cadaver with a normal occiput and cervical spine. In order to investigate the effects of the wire diameter on the posterior fusion and fixations, an unstable atlanto-axial finite element model was made to reduce stiffness of the transverse ligament orderly (50%, 75%, 100%). And the wire was tied according to Brooks and Jenkins'method after modeling the grafted bone to fit in the space between the atlas and axis. The wire diameter was 18G, 20G and 22G. Anterior atlanto-dens interval (AADI) was measured after placing 1.5 Nm pure flexion movement on the occiput. RESULTS: The AADI was increased as the stiffness of transverse ligament was reduced. In the case of 50%, 75% and 100% decrement, the AADI were 3.37 mm, 3.87 mm and 4.94 mm. In the case of 50% and 75% decrement, the sufficient fixations were obtained although we used thin wire. However, in the 100% decrement, the AADI was exceeded the 3 mm when we used thin wire (20G, 22G) and sufficient fixations were obtained with only 18G. CONCLUSION: The sufficient fixations were obtained regardless of wire diameter in the partial tear of transverse ligament. In the complete tear, the minimal 18G wire diameter was useful to acquire sufficient fixations. However, the results were derived from the finite element model analysis. Thus further verification should be necessary to confirm the results using cadaver experiments.
Axis, Cervical Vertebra ; Cadaver ; Ligaments* ; Spine ; Transplants

The vertebral pedicle is an important structure used as an implant site for spinal instrumentation surgery. Since precise anatomical knowledge of lumbar pedicles in vivo is essential for risk - free surgery, we analyzed Korean vertebrae with radiologic imaging techniques. The authors analayzed 500 pedicles from L1 to L5 vertebrae with computerized tomograms (CT) and simple radiograms taken from patient free of vertebral abnormality. Five morphometric parameters: transverse pedicle width, transverse pedicle angle, sagittal pedicle width, sagittal pedicle angle depth to anterior cortex were measured. The transverse diameter and angle of pedicle increased gradually from L1 to L5, while the sagittal diameter and angle decreased from L1 to L5. The depth to anterior cortex from posterior elements was longer along the pedicle axis than along axis parallel to midline.
Axis, Cervical Vertebra ; Humans ; Lumbar Vertebrae* ; Spine

In clinical orthodontics, it is significant to understand the stage of growth in a growing patient. In order to assess the skeletal maturity of the patients, the hand-wrist radiograph and the cervical vertebrae (Cervical Vertebrae Maturation Indicators: CVNII) was evaluated from the lateral cephalograph and the skeletal maturity determined from the hand-wrist X-ray, (Skeletal Maurity Indicators: SMI) taken on the same day in the same patients, and its interrelationship examined to come up with the following results: 1. The skeletal maturity evaluated from the hand-wrist radiograph and the maturation of the cervical vertebrae from the lateral cephalograph showed a significant interrelationship with each other. 2. In the evaluation of the skeletal maturity using the SNIT and CVMI, the CVMI 1 showed a siginificant correlation with SMI 1, 2, the CVMI 2 with SNIT 3, 4, CVMI 3 with SMI 6, 7, CVMI 4 with SMI 7, 8, CVMI 5 with 9, 10 and CVNII 6 with SMI 11. 3. When the morphological changes in the 2nd and 3rd cervical vertebrae were separately observed, it was seldom that the concavity appeared in the lower border of the 2nd cervical vertebra and at the same time not appear in the 3rd cervical vertebra (CVMI 2 : 10.38 %, CVMI 3 : 6.56 %) 4. In each of the skeletal maturation stage evaluated from the hand-wrist and the cervical vertebrae, the average age and its standard deviation in male and female patients appeared to have large differences among individuals. Skeletal maturation seemed to appear earlier for the girls than for the boys, and its termination 24 months faster for girls.
Cervical Vertebrae* ; Female ; Humans ; Male ; Orthodontics ; Spine

OBJECTIVE: The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. METHODS: In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. RESULTS: Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. CONCLUSION: The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.
Axis, Cervical Vertebra ; Humans ; Medical Records ; Neurosurgery ; Spine ; Weights and Measures

Dens fractures are a common traumatic cervical spine injury. Among them, a type III fracture is the second common fracture. Although there are several treatment options, it has been accepted that type III fracture is usually healed by non-surgical method. After adequate reduction with traction, subsequent external immobilization has been associated with successful union rates. However, in the review of literatures, there are some cases with neurological deterioration after application of skull traction. So, the authors report a case of type III dens fracture with initially unrecognized ligamentous injury in which vertical dissociation and quadriplegia occurred after only five-pound Gardner-Well tongs traction. And also, the authors raise awareness of this potentially injury.
Cervical Vertebrae ; Female ; Immobilization ; Ligaments* ; Quadriplegia ; Skull ; Spine ; Traction*

Fibrous dysplasia is a benign disorder of bone primarily affecting young people from childhood through the third decade. It usually manifests as an enlargement of bones in and about the orbits or the the cranial vault. Whether localized or diffuse, it rarely involves the cervical spine. We report a case of fibrous dysplasia involving axis combined with atlantoaxial instability which was caused by odontoid process fracture. Transfacetal screw fixation augmented with Halifax interlaminar clamp technique was applied to obtain atlantoaxial stability. Postoperative course was unevenful and postoperative radiologic findings revealed favorable fixation of atlantoaxial joint. The pertinent literature on fibrous dysplasia and atlantoaxial instability is reviewed and discussed.
Atlanto-Axial Joint ; Axis, Cervical Vertebra ; Odontoid Process ; Orbit ; Spine*