In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dis...In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults＇ fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the .width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces： mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.展开更多
Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysi...Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.展开更多
We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints afte...We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints after bone union. Four patients had Anderson Type II fractures and 6 patients had Type III fractures. Bone union was observed in all patients within 3 months after injury. After halo-vest fitting, cervical muscular atrophy increased with time, however, it gradually improved after removal of the halo-vest. Patients fixed with a halo-vest for more than 10 weeks complained of cervical discomfort and limited range of motion. No patients with fixation for less than 10 weeks had problems in bone union or had cervical complaints. Thus, less than a 10-week fixation period was considered to be appropriate.展开更多
Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most commo...Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most common variety. This injury is associated with a high incidence of morbidity, mortality and nonunion in </span><span>the </span><span>elderly irrespective of mode of treatment. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha</span><span>s</span><span> some controversial issues. Objective of this review is to find </span><span>a </span><span>controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words</span><span>: </span><span>odontoid, fracture, type-2, management, nonoperative and operative management. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. Though surgical treatment has </span><span>a </span><span>better outcome</span><span>, it </span><span>is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Conservative treatment of this fracture in </span><span>the </span><span>elderly should preferably be carried out with hard collar or avoiding halo vest. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy.</span>展开更多
Introduction: Representing up to 15% of cervical injuries, odontoid type II fractures may cause spinal cord compression through atlanto-axial instability. Anterior screw fixation provides direct fracture site stabilit...Introduction: Representing up to 15% of cervical injuries, odontoid type II fractures may cause spinal cord compression through atlanto-axial instability. Anterior screw fixation provides direct fracture site stability, high fusion rate and most importantly keeping cervical spine move free. We will highlight success keys in early experience for better outcome. Methods: We operated ten cases with traumatic type II odontoid fractures in neurotrauma unit, Cairo University hospitals from March 2015 till June 2017. Six males and four females were included. Preoperative MRI and dynamic CT were among the assessment criteria. Uni-planner fluoroscopy was used. Results: No post-operative deficit appeared. One screw was inserted in all cases. Immediate and 6 weeks later CT cervical spine showed stable reduced fracture site. Conclusions: Anterior odontoid screw fixation done with prior good selection of the patient and fracture shape is an effective motion preserving surgical option for type II odontoid fractures. Limited resources shouldn’t prevent starting experience especially in developing countries, but larger studies are needed.展开更多
<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of...<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. <strong>Objective:</strong> To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. <strong>Patients and Methods: </strong>12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. <strong>Results:</strong> Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. <strong>Conclusion:</strong> Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.展开更多
Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involve...Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with展开更多
Two cases of typeⅡodontoid fractures were reported to share our experience in surgery treatment of such cases.A 33-year-old woman with comminuted typeⅡodontoid fracture and a 42-year-old man with fracture end harden...Two cases of typeⅡodontoid fractures were reported to share our experience in surgery treatment of such cases.A 33-year-old woman with comminuted typeⅡodontoid fracture and a 42-year-old man with fracture end hardened typeⅡodontoid fracture received surgical treatment in our hospital.Though imaging examination suggested that these two patients were suitable for anterior screw fixation,we encountered difficulties during the operation.The two patients eventually underwent posterior C1–C2 fusion surgery and recovered well.According to the experience of these two cases,we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making.Although anterior screw fixation is the ideal choice for typeⅡodontoid fractures with anterior superior to posterior inferior fracture line,it may not be the best choice for comminuted or fracture end hardened typeⅡodontoid fractures.展开更多
文摘In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults＇ fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the .width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces： mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.
文摘Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.
文摘We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints after bone union. Four patients had Anderson Type II fractures and 6 patients had Type III fractures. Bone union was observed in all patients within 3 months after injury. After halo-vest fitting, cervical muscular atrophy increased with time, however, it gradually improved after removal of the halo-vest. Patients fixed with a halo-vest for more than 10 weeks complained of cervical discomfort and limited range of motion. No patients with fixation for less than 10 weeks had problems in bone union or had cervical complaints. Thus, less than a 10-week fixation period was considered to be appropriate.
文摘Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most common variety. This injury is associated with a high incidence of morbidity, mortality and nonunion in </span><span>the </span><span>elderly irrespective of mode of treatment. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha</span><span>s</span><span> some controversial issues. Objective of this review is to find </span><span>a </span><span>controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words</span><span>: </span><span>odontoid, fracture, type-2, management, nonoperative and operative management. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. Though surgical treatment has </span><span>a </span><span>better outcome</span><span>, it </span><span>is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Conservative treatment of this fracture in </span><span>the </span><span>elderly should preferably be carried out with hard collar or avoiding halo vest. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy.</span>
文摘Introduction: Representing up to 15% of cervical injuries, odontoid type II fractures may cause spinal cord compression through atlanto-axial instability. Anterior screw fixation provides direct fracture site stability, high fusion rate and most importantly keeping cervical spine move free. We will highlight success keys in early experience for better outcome. Methods: We operated ten cases with traumatic type II odontoid fractures in neurotrauma unit, Cairo University hospitals from March 2015 till June 2017. Six males and four females were included. Preoperative MRI and dynamic CT were among the assessment criteria. Uni-planner fluoroscopy was used. Results: No post-operative deficit appeared. One screw was inserted in all cases. Immediate and 6 weeks later CT cervical spine showed stable reduced fracture site. Conclusions: Anterior odontoid screw fixation done with prior good selection of the patient and fracture shape is an effective motion preserving surgical option for type II odontoid fractures. Limited resources shouldn’t prevent starting experience especially in developing countries, but larger studies are needed.
文摘<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. <strong>Objective:</strong> To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. <strong>Patients and Methods: </strong>12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. <strong>Results:</strong> Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. <strong>Conclusion:</strong> Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.
文摘Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with
文摘Two cases of typeⅡodontoid fractures were reported to share our experience in surgery treatment of such cases.A 33-year-old woman with comminuted typeⅡodontoid fracture and a 42-year-old man with fracture end hardened typeⅡodontoid fracture received surgical treatment in our hospital.Though imaging examination suggested that these two patients were suitable for anterior screw fixation,we encountered difficulties during the operation.The two patients eventually underwent posterior C1–C2 fusion surgery and recovered well.According to the experience of these two cases,we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making.Although anterior screw fixation is the ideal choice for typeⅡodontoid fractures with anterior superior to posterior inferior fracture line,it may not be the best choice for comminuted or fracture end hardened typeⅡodontoid fractures.
