Craniocervical abnormalities

Menezes, Arnold H.; VanGilder, John C.; Graf, Carl J.; McDonnell, Dennis E.

doi:10.3171/jns.1980.53.4.0444

Cited by 265 publications

(64 citation statements)

References 61 publications

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“…None of our patients with os odontoideum had a history of preceding trauma. Os odontoideum is associated with other subtle signs like hypertrophy of the anterior arch of atlas and a hypoplastic/absent posterior C1 arch [23]. …”

Section: Discussionmentioning

confidence: 99%

Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India

Kumar

Nayak²

2002

Pediatr Neurosurg

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From July 1996 to August 2001, we operated on 23 children (age 4–12 years) with congenital atlantoaxial dislocation (AAD). Sixteen had reducible AAD and 6 had the fixed type, while a single patient had basilar invagination. Preoperatively, these children were divided into four functional grades depending on the level of neurological deficits and dependence on others for activities of daily living (Di Lorenzo grades I–IV). There were only 2 patients with no deficits (grade I), while 15 of the 23 children presented with severe neurological deficits and were completely dependent for all activities of daily living (grade IV). Stigmata suggestive of congenital AAD were documented in 6 children and radiological osseous anomalies in 18 children. Transoral decompression and posterior stabilization was performed in 7 children, while 16 patients underwent the posterior stabilization procedure only. All patients were immobilized with a hard cervical collar postoperatively. Six children developed one or other treatable complications, of whom reoperation was indicated in 3, but could only be undertaken in 2 children. Retightening of the wire was done in 1 and further decompression of the odontoid process was carried out in the other. There was no postoperative deterioration in patients with no preoperative deficits (grade I). Ten out of the 15 children who were completely dependent for all activities in the preoperative period (grade IV) improved, and 6 children achieved normalcy or near normalcy (grade I or II). Three children deteriorated in the postoperative period, of whom 2 subsequently improved at follow-up. There were 2 deaths in the series; both these patients belonged to the severely compromised group (grade IV) and in addition had respiratory compromise. Bony fusion at the posterior stabilization site could be seen in 14 out of 16 patients screened. The various problems faced by the authors in managing these very fragile and severely compromised children with cervicomedullary compression due to congenital atlantoaxial dislocation in a setting with limited resources are discussed.

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Section: Discussionmentioning

confidence: 99%

Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India

Kumar

Nayak²

2002

Pediatr Neurosurg

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“…Immediate surgery was considered in cases with tuberculous abscess with respiratory difficulty or in cases having rapid neurological deterioration [11,14]. In patients with irreducible fixed AAD or basilar invagination, a short-term traction for 1–2 days was applied [15,16]. To start with, 7–8% of the total body weight was applied with gradual increments in weight up to a maximum of 7 kg.…”

Section: Methodsmentioning

confidence: 99%

A 6-Year Experience of 100 Cases of Pediatric Bony Craniovertebral Junction Abnormalities: Treatment and Outcomes

et al. 2011

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The authors studied 100 consecutive cases of pediatric bony craniovertebral junction abnormalities operated between 2001 and 2006. The pathologies were developmental (n = 86), traumatic (n = 10) and tuberculous (n = 4). Surgical procedures included transoral decompression (n = 59), occipitocervical fusion (OCF, n = 69), C₁-C₂ fusion (n = 22), occiput-C₂ wiring (n = 5), and posterior fossa decompression (n = 5). Implants for OCF included contoured stainless steel rods (n = 47), titanium lateral mass screws and plates (n = 16) and steel wires (n = 5). Adequate bone fusion was observed in all patients with OCF at a mean follow-up of 16.5 months, irrespective of the type of implant used for posterior fixation. Good neurological outcome was observed even in poor-grade patients. No significant effect on the curvature or growth of the spine was observed at follow-up.

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“…Nevertheless, disruption of the normal bony and ligamentous complex comprising the craniocervical junction can occur traumatically, with inflammatory processes, and iatrogenically, as with skull base tumor resections or ventral craniocervical decompression for spinal anomalies. Additionally, various congenital diseases such as the mucopolysaccharidoses, spondyloepiphyseal dysplasia, Down’s syndrome and Klippel-Feil deformities may all predispose children to craniocervical instability [1, 2, 3, 4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Pediatric Occipitocervical Arthrodesis

Schultz

Petronio²,

Haid³

et al. 2000

Pediatr Neurosurg

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Object: Few reports exist on the options and effectiveness of craniocervical stabilization in the pediatric population compared with the adult literature. Traditional options in children include onlay grafting and semi-rigid occipitocervical wiring. Recently, reports on the use of rigid internal fixation devices such as occipitocervical plates and contoured loops have provided excellent results in adults, and their use has often obviated the need for external orthosis. The purpose of this article is to report our experience with both traditional and newer rigid internal fixation methods for occipitocervical fusion in children. Methods: During the past 4.5 years, 14 children (ages 4 months to 16 years) have undergone occipitocervical fusion. Indications for fusion included trauma (n = 4), congenital instability/stenosis (n = 6), postinfectious instability (n = 1) and basilar invagination (n = 3). Techniques using onlay grafting (n = 3) as well as rigid internal fixation using plates (n = 1) and contoured craniocervical titanium loops (n = 10) were used. Postoperative orthosis included halo vests (n = 7), minerva jackets (n = 3), sterno-occipital mandibular immobilizer (n = 1), and a cervical collar (n = 3). Long-term follow-up (range 13–58 months) was available for 13 of the 14 children. Conclusions: While each occipitocervical fusion in pediatric patients requires a customized treatment plan, we believe children older than 12 months of age should be considered candidates for rigid internal fixation methods. The rigidity afforded by this method may eliminate the need for rigid external orthotic support in selected individuals. In our experience, anatomic constraints in children less than 1 year old usually require fusion with more traditional onlay techniques. Long-term follow-up studies are still required to assess the effects of rigid internal fixation in the skeletally immature spine.

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Craniocervical abnormalities

Cited by 265 publications

References 61 publications

Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India

Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India

A 6-Year Experience of 100 Cases of Pediatric Bony Craniovertebral Junction Abnormalities: Treatment and Outcomes

Pediatric Occipitocervical Arthrodesis

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