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

Objective To evaluate the clinical features of Rathke cleft cysts(RCCs) in children diagnosed by pituitary magnetic resonance(MR) and their features on MR.Methods Twenty-two children with RCCs aged 2-18 years old who visited the Affiliated Hospital of Qingdao University Medical College between Jan.2002 and Feb.2012 were enrolled.RCCs was conformed by pituitary MR.The clinical symptoms and imaging features were reviewed retrospectively.Results The clinical presentation of symptomatic children were as follows:endocrinopathy in 13 cases (59.1％),headache in 5 cases(22.7％) and visual disturbance in 1 case(4.5％) and variety of symptoms in 3 cases (13.6％),which including 1 case of short stature and dysgenitalism,1 case of type 1 diabetes with electrolyte disorder and the other of headache associated with visual impairment.Endocrinopathy included short stature 5 cases(22.7％),precocious puberty 4 cases(18.2％)and diabetes insipidus 4 cases(18.2％).Generally,RCCs appeared various on Tl-weighted MR,whereas on T2-weighted sequences the signal intensity was mostly high.High signals in the T1-weighted image on brain MR were related to pituitary hormone deficiency.Hypointensity of the cysts in T1-weighted was appeared when enhanced images.Conclusions The most common clinical manifestation of children with RCCs is endocrinopathy.Pituitary MR shows a certain characteristics and it is favorable in agreement with pathological diagnosis.MR may be of predictive value for the preoperative diagnosis.

Neoadjuvant chemoradiotherapy (NCRT) combined with total mesorectal excision (TME) has become the recommended standard treatment strategy for local advanced rectal cancer (cT3 or cN+). After neoadjuvant chemoradiotherapy, preoperative T/N re-staging and efficacy evaluation of rectal cancer are directly related to the available treatment options and prognosis, so they are the common questions concerned by physicians. At present, magnetic resonance imaging (MRI) is acknowledged to be one of the more effective and feasible methods of T/N re-staging and efficacy evaluation, especially in the molecular microscopic scale. The diffusion weighted imaging (DWI) can reflect the movement of water molecules outside the tumor cells, and the multi-phase dynamic contrast enhanced MRI (DCE-MRI) can indirectly reflect the permeability of tumor vascular wall and local blood perfusion of tumor from the view of pathophysiological point. Because of the influence of edema, inflammatory response and fibrous tissue proliferation after radiotherapy, scholars both at home and abroad increasingly pay more attentions to the accuracy of T/N re-staging and efficacy prediction in MRI following neoadjuvant therapy. In this review, we elucidate the application value and limitation of MRI based on T/N re-staging and local efficacy evaluation.
Chemoradiotherapy ; Humans ; Magnetic Resonance Imaging ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms ; diagnostic imaging ; therapy ; Treatment Outcome