Axis, Cervical Vertebra ; injuries ; Cervical Atlas ; injuries ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Odontoid Process ; injuries ; Spinal Fractures ; diagnosis ; surgery ; Spinal Fusion

Adult ; Cervical Atlas ; injuries ; Fracture Fixation, Internal ; Humans ; Male ; Spinal Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Vertebral Artery

Congenital anomalies in arches of the atlas are rare, and are usually discovered incidentally. However, a very rare subgroup of patients with unique radiographic features is predisposed to transient quadriparesis after minor cervical or head trauma. A 46-year-old male presented with a 2-month history of tremor and hyperesthesia of the lower extremities after experiencing a minor head trauma. He said that he had been quadriplegic for about 2 weeks after that trauma. Radiographs of his cervical spine revealed bilateral bony defects of the lateral aspects of the posterior arch of C1 and a midline cleft within the anterior arch of the atlas. A magnetic resonance imaging revealed an increased cord signal at the C2 level on the T2-weighted sagittal image. A posterior, suboccipital midline approach for excision of the remnant posterior tubercle was performed. The patient showed significant improvement of his motor and sensory functions. Since major neurologic deficits can be produced by a minor trauma, it is crucial to recognize this anomaly.
Cervical Atlas ; Craniocerebral Trauma ; Humans ; Hyperesthesia ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurologic Manifestations ; Quadriplegia ; Sensation ; Spinal Cord Injuries ; Spine ; Tremor

OBJECTIVETo evaluate the efficacy and safety of transoral plate internal fixation for instability atlas fracture.

METHODSA retrospective study was performed in eight patients with instability atlas fractures, who were treated by a transoral plate internal fixation from July 2007 to June 2011. There were 6 males and 2 females,with an average age of 39.5 years old ranging from 23 to 48 years. Among them, 5 case were falling injury, 3 cases were traffic accident injury. Three patients had bilateral fractures of the anterior arch (prehalf Jefferson fractures, Landells type I), 5 had anterior are fracture associated posterior are fracture (Half-ring Jefferson fractures, Landells type II), and 2 had anterior and posterior are fracture associated with single lateral mass fractures (Landells type III).

RESULTSAll patients were followed up for 6 to 24 months after operation (av- eraged 13 months), and all the patients had the clinical symptoms improved to some extent. Operation time ranged from 80 to 140 min (averaged 98 min); the intra-operative blood loss was 120 to 300 ml (averaged 180 ml); and the average fluoroscopic time was 55 s. No patients happened neurological and vertebral artery injuries-related complications or other complications after operation. The followed-up X-ray and CT manifested osseous fusion in all the 8 patients,no loosening or breakage of the screws.

CONCLUSIONTransoral plate internal fixation for instability atlas fracture is a reliable and safety technique that allows maintenance of rotatory mobility in the C1,2 joint and restoration of congruency in the atlanto-occipital and atlanto-axial joints.

Adult ; Bone Plates ; Cervical Atlas ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: To evaluate diagnostic value of spiral CT reconstruction in atlantoaxial injuries. METHODS: The images of 25 cases of spiral CT reconstruction were analyzed and compared with images of CT scan and X-ray. RESULTS: In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan. CONCLUSION Spiral CT reconstruction can provide the most accurate and integrity imaging information and is very useful in the diagnosis of atlantoaxial injuries and deformity.
Accidents, Traffic ; Adolescent ; Adult ; Atlanto-Axial Joint/injuries* ; Cervical Atlas/injuries* ; Child ; Female ; Forensic Medicine/methods* ; Humans ; Joint Dislocations/diagnostic imaging* ; Male ; Middle Aged ; Odontoid Process/injuries* ; Retrospective Studies ; Spinal Injuries/diagnostic imaging* ; Tomography, Spiral Computed/methods* ; Young Adult

OBJECTIVETo evaluate the value of multi-spiral CT thinner scanning and three-dimensional and multi-planar reconstruction in the diagnosis of atlantoaxial fracture and dislocation.

METHODSSixty-nine patients suffered from atlantoaxial injuries included 54 males and 15 females with an average age of 46.5 years ranging from 17 to 73. Roentgenograph, multi-spiral CT thinner scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) were applied for patients before and after surgery.

RESULTSMulti-spiral CT thinner scanning and reconstruction provided clear images for all subjects. There were 49 odontoid bone fractures (Anderson type II 35, type III 14), 9 cases combined injuries of C1 and C2 (Jeffson's fracture associated with Hangman fracture), 6 of C1 burst fractures and 5 of C2 vertebral body fractures. While only 38 cases (38/69) were correctly diagnosed according to roentgenographs, 23 missed diagnosis, 6 couldn't be diagnosed clearly and 2 misdiagnosis. The position of internal fixation could be seen clearly in CT imaging after surgery. There were two screws perforated the lateral wall of C1 and three perforated the superior wall.

CONCLUSIONThe multi-spiral CT thinner-scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) provide clear imagings to diagnose the details of atlantoaxial fractures and dislocations, and to select the therapeutic regimen. It can also be used to check the position of the internal fixation after surgeries. So it can be the first eikonic choice for atlantoaxial injuries.

Adolescent ; Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Cervical Atlas ; injuries ; Female ; Fracture Fixation, Internal ; Humans ; Image Processing, Computer-Assisted ; methods ; Internal Fixators ; Male ; Middle Aged ; Multi-Institutional Systems ; Odontoid Process ; injuries ; Spinal Fractures ; therapy ; Tomography, Spiral Computed ; methods ; Young Adult

OBJECTIVETo evaluate the therapeutic effects of fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws for the treatment of upper vertebral instability.

METHODSTen patients with atlantoaxial instability, including 3 with old odontoid fracture and 7 with fresh odontoid fracture (Aderson II) received surgeries for fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws.

RESULTSNo spinal cord or vertebral artery injuries occurred in these patients after the surgery. The follow-up duration ranged from 3 to 15 months with an average of 8 months. The postoperative JOA scores were from l3.2 to l6.8, with an average of l4.8. Clinical improvement was achieved in 87.5% of the patients, and the implanted bones all fused successfully without internal fixation rupture or mobilization.

CONCLUSIONLateral mass screws of the atlas combined with vertebra dentata pedicle screws allows three-dimensional fixation for treatment of atlantoaxial instability.

Adult ; Atlanto-Axial Joint ; diagnostic imaging ; surgery ; Axis, Cervical Vertebra ; injuries ; surgery ; Bone Screws ; Cervical Atlas ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; etiology ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; complications ; diagnostic imaging ; surgery ; Spinal Fusion ; methods

OBJECTIVETo evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases.

METHODSTwenty-three consecutive patients with upper cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation (4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson II C, 3 ruptures of the C(1) transverse ligament, and 2 fractures of C(1)), 2 cases of C2 tumor (instability after the resection of the tumors), and 2 giant neurilemomas of C(2)-C(3)(instability after resection of the tumors), were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of C1. The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT.

RESULTSIn the 23 patients, 46 C(1) pedicle screws, 42 C(2) pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months (average 15 months). Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure.

CONCLUSIONSPosterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.

Adult ; Bone Screws ; Cervical Atlas ; diagnostic imaging ; injuries ; pathology ; surgery ; Feasibility Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Odontoid Process ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Spinal Fractures ; diagnostic imaging ; surgery ; Spinal Fusion ; instrumentation ; Spinal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome