We treated 183 patients with fractures of the odontoid process (109 type II, 74 type III) non-operatively. Union was achieved in 59 (54%) with type-II fractures. All type-III fractures united, but in 16 patients union was delayed. There was no correlation between union and the clinical or radiological outcome of the fractures. Selective vertebral angiography, carried out in 18 patients ten with acute fractures and eight with nonunion, showed that the blood supply to the odontoid process was not disrupted. Studies on ten adult axis vertebrae at post-mortem showed that the difference in the surface area between type-II and type-III fractures was statistically significant. Our findings show that an age of more than 40 years, anterior displacement of more than 4 mm, posterior displacement and late presentation contribute towards nonunion of type-II fractures. (+info)
CT scans versus conventional tomography in acute fractures of the odontoid process.
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Four different radiological diagnostic methods were compared as to their diagnostic relevance in the analysis of odontoid fractures. Thirty-one patients with fresh odontoid fractures were investigated using standard anteroposterior and lateral radiographs, conventional tomography, axial computerized tomography and two-dimensional reconstruction in the sagittal and the coronal planes. As a control, 13 patients without odontoid fractures were examined. The results of the different investigations were correlated with the actual (clinical and/or intra-operative) findings. The coefficients of correlation for the conventional tomography and two-dimensional reconstruction were kappa=0.774 and kappa=0.907, respectively. For conventional radiography and axial computerized tomography (CT), the coefficients were clearly lower, at kappa=0.364 and kappa=0.627, respectively. The less time-consuming CT examination with sagittal and coronal reconstructions is equivalent with respect to diagnostic accuracy and can, therefore, replace conventional tomography in the evaluation fractures. (+info)
Laron syndrome abnormalities: spinal stenosis, os odontoideum, degenerative changes of the atlanto-odontoid joint, and small oropharynx.
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BACKGROUND AND PURPOSE: Patients with Laron syndrome have an inborn growth hormone resistance. We investigated abnormalities in the upper airways and cervical spine in patients with Laron syndrome. METHODS: We prospectively examined 11 patients (one child aged 9 years and 10 adults aged 36-68 years), 10 of whom underwent MR imaging of the spine or head; nine, radiography of the cervical spine; and four, CT of C1-C2. The width of the spinal canal was evaluated visually and quantitatively and compared with reference values. The smallest diameter of the oropharynx and the thickness of the palate were measured and compared with reference values. Nine age-matched female patients referred for MR imaging for unrelated reasons served as control subjects. RESULTS: Cervical spinal stenosis was present in seven of the adult patients, within a confidence interval of 95%. Anomaly of the dens compatible with os odontoideum was present in three patients, causing focal myelomalacia in two. The atlanto-odontoid joint showed osteoarthritic changes in six of the adult patients. The mediolateral diameter of the oropharynx was significantly smaller in the patients with Laron syndrome than in the control subjects (P <.005). There was no difference in the thickness of the soft palate. CONCLUSION: Patients with Laron syndrome develop significant narrowing of the cervical spinal canal and early degenerative changes of the atlanto-odontoid joint. Laron syndrome is associated with os odontoideum causing myelomalacia. The dimensions of the oropharynx are small. Patients may be prone to neurologic morbidity and sleep disturbances. Routine MR imaging of the cervical spine is recommended in these patients. (+info)
Traumatic cervical central cord syndrome due to intramedullary hemorrhage studied with MRI: case presentation.
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Cervical central cord syndrome is characterized by disproportionately greater motor impairment of the upper than the lower extremities, predominantly distal motor dysfunction, varying degrees of sensory abnormalities, and bladder dysfunction. Although the original description stated that intramedullary hemorrhage is a possible cause of traumatic cervical central cord syndrome, recent studies have not demonstrated its presence on the basis of magnetic resonance imaging (MRI) or pathological evidence. The authors describe and discuss a case of traumatic central cervical cord syndrome studied with MRI, which presented intramedullary hemorrhage. This supports hemorrhage as a possible cause of traumatic cervical central cord syndrome. (+info)
Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report.
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A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation. A long course of antibiotic administration finally resolved the infection. Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms. Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition. (+info)
Fatal instability following "odontoid sparing" transoral decompression of a periodontoid pseudotumour.
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Pseudotumour of the craniovertebral junction is an uncommon cause of high cervical myelopathy in the elderly. The anterior transoral approach is the preferred means of accessing these lesions. An "odontoid sparing" transoral approach, in which there is only minimal bone removal, is thought to preserve stability of the craniovertebral junction, obviating the need for posterior stabilisation. This report is of an 82 year old man who developed fatal atlanto-axial instability following an odontoid sparing transoral resection of a pseudotumour. This complication has not previously been described and its occurrence has important implications for the surgical management of this condition. (+info)
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Cervical spine imaging in children under 9 after trauma.
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A short cut review was carried out to establish whether the odontoid peg view is useful to radiologically exclude cervical spine injury in children under 9 years of age. Altogether 156 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. In addition recent guidelines are noted. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. (+info)
Stresses on the cervical column associated with vertical occlusal alteration.
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The biomechanical effects on cervical vertebral columns (C1-C7) during mastication were calculated using a three-dimensional (3D) finite element method. To verify the biomechanical influences of vertical occlusal alteration to the cervical column, three finite element models (FEM) showing a normal (model A), a steep (model B), and a flat occlusal plane (model C) were constructed. The occlusal stress distribution showed various patterns for the three models; the stress extended to the anterior area as the occlusal plane became steeper. The plots of the stresses on the mid sagittal section of the cervical columns showed different patterns for the three models; the stress converged at the odontoid process in models A and B, whereas the stresses at C7 in model B tended to decrease compared with model A. Concentrated stress was observed at C5 in model C, supporting the hypothesis that vertical occlusal alteration could influence stress distribution in the cervical columns. (+info)