<strong>Background:</strong> Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired caus...<strong>Background:</strong> Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired causes but the aetiology still debated in the literature. It can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk. <strong>Methods:</strong> Eight cases of os odontoideum were symptomatic at time of presentation, submitted for general and neurological examination, and investigated with different radiological modalities and managed with surgical fixation and stabilization. These patients followed for one year postoperatively. <strong>Results: </strong>The study includes six male patients and two female patients with median age 18.7 years. All patients presented with myelopathy and showed clinical evidence of atlantoaxial instability. They submitted for complete radiological investigations (plain x ray, CT scan and MRI) craniocervical junction. They underwent cervical surgical stabilization, two cases by atlantoaxial arthrodesis with wiring, two atlantoaxial fixation by lateral mass screw one of them with transoral odontoiectomy, two atlantoaxial fixations by a Rosen’s Hooks, and two cases craniocervical fixation by Tie frame. Death postoperatively recorded in two patients. Follow-up one year revealed resolution of symptoms in two patients and four patients remained stationary but without deterioration. <strong>Conclusion:</strong> Os odontoideum is a rare but sometimes lethal abnormality that requires radiological and clinical judgement to ensure the best choice of management and optimum patient’s care.展开更多
Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secon...Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary展开更多
BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatme...BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.展开更多
目的评估后路寰枢椎椎弓根螺钉内固定系统在治疗青少年游离齿状突小骨伴寰枢椎脱位患者中的长期临床效果,并介绍一种针对难复性寰枢椎脱位的综合复位技术。方法回顾性研究2014年1月~2016年9月期间在笔者医院手术治疗的21例游离齿状突小...目的评估后路寰枢椎椎弓根螺钉内固定系统在治疗青少年游离齿状突小骨伴寰枢椎脱位患者中的长期临床效果,并介绍一种针对难复性寰枢椎脱位的综合复位技术。方法回顾性研究2014年1月~2016年9月期间在笔者医院手术治疗的21例游离齿状突小骨伴寰枢椎脱位的12~18岁青少年患者,所有患者均采用后路寰枢椎椎弓根螺钉复位固定系统治疗,对于5例术前通过颅骨牵引不能达到满意寰枢椎复位的患者应用了综合提拉复位的手术技术。通过术前术后颈椎过伸过屈位的影像学资料,测量以下指标:寰椎椎管内径(inner diameter of the atlantal ring,D atl)、椎管最小径(minimum diameter of the spinal canal,D min)、椎管最大径(maximum distance of the spinal canal,D max)、寰齿前间距(atlantodens interval,ADI)、延髓脊髓角(cervico-medullary angle,CMA)、C2~C7 Cobb角、并随访术前术后JOA和NDI评分。采用独立样本t检验比较患者术前术后各项指标。结果所有患者术后均获得满意的寰枢椎复位及神经症状改善,术中未发生神经损伤、椎动脉损伤等并发症,所有患者随访24~48个月,颈椎功能障碍指数(NDI)从17.4±6.7分改善为10.1±3.6分,JOA评分从11.2±1.9分提高到14.4±1.9分。术后随访影像学数据表明,C2~C7 Cobb角由术前25.4°±10.5°变为17.2°±6.4°。寰椎椎管内径从术前16.6±2.1mm变为16.7±2.4mm,椎管最小直径从9.1±2.4mm明显改善为15.3±1.9mm,寰齿前间距(ADI)由术前1.5±0.7mm变为术后1.5±0.6mm。延髓脊髓角(CMA)由术前135.2°±7.6°明显改善为152.0°±6.1°。结论后路寰枢椎椎弓根螺钉固定系统在治疗青少年游离齿状突畸形伴寰枢椎脱位中能够获得较满意的长期临床疗效。同时采用的综合提拉复位方法在难复性寰枢椎脱位的治疗中初步得到满意复位效果。展开更多
文摘<strong>Background:</strong> Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired causes but the aetiology still debated in the literature. It can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk. <strong>Methods:</strong> Eight cases of os odontoideum were symptomatic at time of presentation, submitted for general and neurological examination, and investigated with different radiological modalities and managed with surgical fixation and stabilization. These patients followed for one year postoperatively. <strong>Results: </strong>The study includes six male patients and two female patients with median age 18.7 years. All patients presented with myelopathy and showed clinical evidence of atlantoaxial instability. They submitted for complete radiological investigations (plain x ray, CT scan and MRI) craniocervical junction. They underwent cervical surgical stabilization, two cases by atlantoaxial arthrodesis with wiring, two atlantoaxial fixation by lateral mass screw one of them with transoral odontoiectomy, two atlantoaxial fixations by a Rosen’s Hooks, and two cases craniocervical fixation by Tie frame. Death postoperatively recorded in two patients. Follow-up one year revealed resolution of symptoms in two patients and four patients remained stationary but without deterioration. <strong>Conclusion:</strong> Os odontoideum is a rare but sometimes lethal abnormality that requires radiological and clinical judgement to ensure the best choice of management and optimum patient’s care.
文摘Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary
文摘BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.
文摘目的评估后路寰枢椎椎弓根螺钉内固定系统在治疗青少年游离齿状突小骨伴寰枢椎脱位患者中的长期临床效果,并介绍一种针对难复性寰枢椎脱位的综合复位技术。方法回顾性研究2014年1月~2016年9月期间在笔者医院手术治疗的21例游离齿状突小骨伴寰枢椎脱位的12~18岁青少年患者,所有患者均采用后路寰枢椎椎弓根螺钉复位固定系统治疗,对于5例术前通过颅骨牵引不能达到满意寰枢椎复位的患者应用了综合提拉复位的手术技术。通过术前术后颈椎过伸过屈位的影像学资料,测量以下指标:寰椎椎管内径(inner diameter of the atlantal ring,D atl)、椎管最小径(minimum diameter of the spinal canal,D min)、椎管最大径(maximum distance of the spinal canal,D max)、寰齿前间距(atlantodens interval,ADI)、延髓脊髓角(cervico-medullary angle,CMA)、C2~C7 Cobb角、并随访术前术后JOA和NDI评分。采用独立样本t检验比较患者术前术后各项指标。结果所有患者术后均获得满意的寰枢椎复位及神经症状改善,术中未发生神经损伤、椎动脉损伤等并发症,所有患者随访24~48个月,颈椎功能障碍指数(NDI)从17.4±6.7分改善为10.1±3.6分,JOA评分从11.2±1.9分提高到14.4±1.9分。术后随访影像学数据表明,C2~C7 Cobb角由术前25.4°±10.5°变为17.2°±6.4°。寰椎椎管内径从术前16.6±2.1mm变为16.7±2.4mm,椎管最小直径从9.1±2.4mm明显改善为15.3±1.9mm,寰齿前间距(ADI)由术前1.5±0.7mm变为术后1.5±0.6mm。延髓脊髓角(CMA)由术前135.2°±7.6°明显改善为152.0°±6.1°。结论后路寰枢椎椎弓根螺钉固定系统在治疗青少年游离齿状突畸形伴寰枢椎脱位中能够获得较满意的长期临床疗效。同时采用的综合提拉复位方法在难复性寰枢椎脱位的治疗中初步得到满意复位效果。
