The association of dynamic VA compression and VAD at the same level suggests that the compression may contribute to the VAD. However, as dynamic compression was observed in nondissected VA and some VAD were not associated with dynamic compression, VAD may be multifactorial.
-Objective: To describe our experience with C1 lateral mass screws as part of a construct for C1-2 stabilization and report an alternate method of C1-C2 complex three-point fixation. Method: All patients that had at least one screw placed in the lateral mass of C1 as part of a construct for stabilization of the C1-C2 complex entered this study. In selected patients who had a higher chance of nonunion an alternate construct was used: transarticular C1-C2 screws combined with C1 lateral mass screws. Results: Twentyone C1 lateral mass screws were placed in 11 patients. In three patients the alternate construct was used. All patients had a demonstrable solid and stable fusion on follow-up. Conclusion: C1 lateral mass screws are safe and provide immediate stability. The use of C1-C2 transarticular screws combined with C1 lateral mass screws is a feasible and also an excellent alternative for a three-point fixation of the C1-C2 complex.KEY WORDS: C1 lateral mass, C1 lateral mass screws, C1-C2 instability, C1-C2 transarticular screws, atlantoaxial stabilization, cervical spine instrumentation. Parafusos na massa lateral de C1 para instrumentação segmentar da coluna cervical alta e um novo método de fixação em três pontos do complexo C1-C2RESUMO -Objetivo: Descrever nossa experiência com o uso de parafusos na massa lateral de C1 como parte de uma montagem para estabilização do complexo C1-C2 e relatar uma fixação alternativa em três pontos do complexo C1-C2. Método: Todos os pacientes em que pelo menos um parafuso na massa lateral de C1 foi colocado como parte de uma montagem para estabilização C1-C2 entraram neste estudo. Em certos pacientes com maior chance de não-união, uma montagem alternativa foi usada: parafusos transarticulares C1-C2 associados a parafusos na massa lateral de C1. Resultados: Foram colocados 21 parafusos na massa lateral de C1 em 11 pacientes e em três pacientes foi usada a montagem alternativa. Todos os pacientes evoluíram para uma união sólida e estável. Conclusão: Parafusos na massa lateral de C1 são seguros e conferem estabilidade imediata. Parafusos na massa lateral de C1 combinados a parafusos transarticulares são exequíveis e também excelente alternativa para fixação rígida em três pontos do complexo C1-C2. PALAVRAS-CHAVE: massa lateral de C1, parafusos na massa lateral de C1, instabilidade C1-C2, parafusos transarticulares C1-C2, estabilização atlantoaxial, instrumentação da coluna cervical.Atlantoaxial instability can be caused by trauma, infection, tumors, arthritis, congenital anomalies, iatrogenic (odontoidectomy) or other less common conditions. Most commonly instability at the C1-C2 complex requires internal fixation not only for immediate stability but also to provide long-term immobility so as to attain a solid fusion. Wiring techniques such as the Gallie, Brooks and modified Brooks are known to provide less than optimal immobilization of the C1-C2 complex not only for axial rotation but also for lateral bending and flexion-extension 1,2 . Newer internal fixation technique...
-Background: U-shaped sacral fractures are highly unstable, can cause significant neurological deficits, lead to progressive deformity and chronic pain if not treated appropriately. Objective: to report a case of a U-shaped sacral fracture treated with lumbopelvic fixation and decompression of sacral roots in a 23-years-old man. Method: Decompression of the sacral roots combined with internal reduction and lumbopelvic fixation using iliac screws. Results: restitution of lumbosacropelvic stability and recovery of sphincter function. Conclusion: Lumbopelvic fixation is effective in restoring lumbosacralpelvic stability and allows full mobilization in the postoperative period. Good neurological recovery can be expected in the absence of discontinuity of the sacral roots.KEY WOrDs: u-shaped, sacral fracture, lumbopelvic fixation, sacral roots.fixação lombopélvica e descompressão sacral para fratura em u do sacro: relato de caso rEsUmO -Introdução: As fraturas sacrais em U são instáveis e podem causar significativa lesão neurológi-ca, deformidade progressiva e dor crônica se não tratadas apropriadamente. Objetivo: relatar caso de um homem de 23 anos com fratura em U do sacro tratada com fixação lombopélvica e descompressão das raízes sacrais. Método: Descompressão da cauda equina associada a redução interna e fixação lombopél-vica usando parafusos ilíacos. Resultados: reconstituição da estabilidade lombosacropélvica e recuperação da continência esfincteriana Conclusão: A fixação lombopélvica é eficaz em restaurar a estabilidade lombo-sacro-pélvica e permite mobilização imediata no pós-operatório. recuperação neurológica pode ser esperada na ausência de neurotmese das raízes sacrais.PALAVrAs-CHAVE: fratura em U do sacro, fixação lombopélvica, raízes sacrais.Neurosurgery service, Hospital mater Dei, Belo Horizonte mG, Brazil.
The prompt initiation of intravenous broad-spectrum antibiotics represents the mainstay of treatment. Three questions should guide the management of pediatric patients with IIAs: (a) aneurysm rupture status, (b) the presence of intraparenchymal hemorrhage or elevated intracranial pressure, and (c) relationship of the parent vessel to eloquent brain tissue. Those three questions should orient the treating physician into either antibiotic therapy alone or in combination with microsurgical or endovascular interventions. This review discusses important aspects of the epidemiology, the diagnosis, and the management of IIAs in the pediatric population.
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