Abstract:OBJECTIVEHalo-gravity traction (HGT) is an effective and safe method for gradual correction of severe cervical deformities in adults. However, the literature is limited on the use of HGT for cervical spine deformities that develop in children. The objective of the present study was to evaluate the safety and efficacy of HGT for pediatric cervical spine deformities.METHODSTwenty-eight patients (18 females) … Show more
“…Early diagnosis and effective initial reduction are key to successful management of AARF in childhood [10,12,[14][15][16][17]. In many instances, this can be achieved through simple conservative measures, comprising analgesia, muscle relaxants and collars without MUA [21,22]. However, where torticollis does not resolve promptly, escalation of treatment is essential as delay is a significant factor in poor long-term outcome [15,19].…”
Section: Discussionmentioning
confidence: 99%
“…The two main options for achieving closed reduction are traction (Halter or skull traction) and MUA with radiographic screening [12,[21][22][23][24]. Whilst there are reports of successful outcomes using traction, patient compliance particularly in the very young will not infrequently preclude its use in the awake patient.…”
Aims The aims were to evaluate the safety of manipulation under anaesthesia (MUA) for atlantoaxial rotatory fixation (AARF) and the relative efficacy of rigid collar vs halo-body orthosis (HBO) in avoiding relapse and the need for open surgery. Methods Cases of CT-verified AARF treated by MUA were identified from a neurosurgical operative database. Demographic details, time to presentation and aetiology of AARF were ascertained through case note review. Cases were divided according to method of immobilisation after successful reduction, either rigid collar (group 1) or HBO (group 2). The primary outcome measure was relapse requiring open surgical arthrodesis. Results Thirty-three patients (2.2-12.7 years) satisfied inclusion criteria. Time to presentation varied from 1 day to 18 months. There were 19 patients in group 1 and 14 in group 2. There were no adverse events associated with MUA. 9/19 (47%) patients in group 1 resolved without need for further treatment compared with 10/14 (71%) in group 2 (p = 0.15). Of the 10 patients who failed group 1 treatment, four resolved after HBO. A total of ten patients (30%) failed treatment and required open surgery. Conclusions MUA is a safe procedure for AARF where initial conservative measures have failed. MUA followed by immobilisation avoids the need for open surgery in over two thirds of cases. Immobilisation by cervical collar appears equally effective to HBO as an initial management, and so a step-wise approach may be reasonable. Delayed presentation may be a risk factor for relapse and need for open surgery.
“…Early diagnosis and effective initial reduction are key to successful management of AARF in childhood [10,12,[14][15][16][17]. In many instances, this can be achieved through simple conservative measures, comprising analgesia, muscle relaxants and collars without MUA [21,22]. However, where torticollis does not resolve promptly, escalation of treatment is essential as delay is a significant factor in poor long-term outcome [15,19].…”
Section: Discussionmentioning
confidence: 99%
“…The two main options for achieving closed reduction are traction (Halter or skull traction) and MUA with radiographic screening [12,[21][22][23][24]. Whilst there are reports of successful outcomes using traction, patient compliance particularly in the very young will not infrequently preclude its use in the awake patient.…”
Aims The aims were to evaluate the safety of manipulation under anaesthesia (MUA) for atlantoaxial rotatory fixation (AARF) and the relative efficacy of rigid collar vs halo-body orthosis (HBO) in avoiding relapse and the need for open surgery. Methods Cases of CT-verified AARF treated by MUA were identified from a neurosurgical operative database. Demographic details, time to presentation and aetiology of AARF were ascertained through case note review. Cases were divided according to method of immobilisation after successful reduction, either rigid collar (group 1) or HBO (group 2). The primary outcome measure was relapse requiring open surgical arthrodesis. Results Thirty-three patients (2.2-12.7 years) satisfied inclusion criteria. Time to presentation varied from 1 day to 18 months. There were 19 patients in group 1 and 14 in group 2. There were no adverse events associated with MUA. 9/19 (47%) patients in group 1 resolved without need for further treatment compared with 10/14 (71%) in group 2 (p = 0.15). Of the 10 patients who failed group 1 treatment, four resolved after HBO. A total of ten patients (30%) failed treatment and required open surgery. Conclusions MUA is a safe procedure for AARF where initial conservative measures have failed. MUA followed by immobilisation avoids the need for open surgery in over two thirds of cases. Immobilisation by cervical collar appears equally effective to HBO as an initial management, and so a step-wise approach may be reasonable. Delayed presentation may be a risk factor for relapse and need for open surgery.
“…In many instances, AARF is managed with simple nonsurgical measures such as analgesia, muscle relaxants, and collars without manipulation under anesthesia (MUA). 24,53 However, where torticollis does not resolve promptly, escalation of treatment to include either nonsurgical reduction or surgical intervention is generally considered essential to avoid a poor long-term outcome. There was no consensus on the method of reduction among the different studies.…”
Section: Methods Of Initial Nonsurgical Reductionmentioning
OBJECTIVEAtlantoaxial rotatory fixation (AARF) is an acquired fixed abnormality of C1–2 joint rotation associated with torticollis in childhood. If the condition is left uncorrected, patients are at risk for developing C1–2 fusion with permanent limitation in the cervical range of movement, cosmetic deformity, and impact on quality of life. The management of AARF and the modality of nonsurgical treatment are poorly defined in both primary care and specialized care settings, and the optimal strategy is not clear. This systematic review aims to examine the available evidence to answer key questions relating to the nonsurgical management of AARF.METHODSA systematic review was performed using the following databases: PubMed, MEDLINE, Healthcare Management Information Consortium (HMIC), EMCare, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), and Allied and Complementary Medicine Database (AMED). Search criteria were created and checked independently among the authors. All articles with a radiological diagnosis of AARF and primary outcome data that met the study inclusion criteria were included and analyzed by the authors.RESULTSSearch results did not yield any level I evidence such as a meta-analysis or randomized controlled trial. The initial search yielded 724 articles, 228 of which were screened following application of the core exclusion criteria. A total of 37 studies met the full criteria for inclusion in this review, consisting of 4 prospective studies and 33 retrospective case reviews. No articles directly compared outcomes between modalities of nonsurgical management. Six studies compared the outcome of AARF based on duration of symptoms before initiation of treatment. Comparative analysis of studies was hindered by the wide variety of treatment modalities described and the heterogeneity of outcome data.CONCLUSIONSThe authors did not identify any level I evidence comparing different nonsurgical management approaches for AARF. There were few prospective studies, and most studies were uncontrolled, nonrandomized case series. Favorable outcomes were often reported regardless of treatment methods, with early treatment of AARF tending to yield better outcomes independent of the treatment modality. There is a lack of high-quality data, and further research is required to determine the optimal nonsurgical treatment strategy.
“…[ 4 , 8 , 35 , 87 ] Immobilization consisting of collar fixation or cervical traction can also be utilized. [ 6 , 88 ] Numerous reports have documented successful cases of long-term conservative management for patients with stable OO. [ 1 , 7 , 89 , 90 ] Conversely, cases of neurological deterioration and sudden death have also been documented.…”
Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients. A literature review was conducted using the PubMed, EMBASE, and Scopus databases. A search using the query “os odontoideum” yielded 4319 results, of which 112 articles were chosen and analyzed for insights on factors such as etiology, clinical presentation, and management of OO. The presentation of OO varies widely from asymptomatic cases to severe neurological deficits. Asymptomatic patients can be managed either conservatively or surgically, while symptomatic patients should undergo operative stabilization. Although multiple studies show different techniques for surgical management involving posterior fusion, the diversity of such cases illustrates how treatment must be tailored to the individual patient to prevent complications. Conflicting studies and the paucity of current literature on OO highlight poor comprehension of the condition. Further understanding of the natural history of OO is critical to form evidence-based guidelines for the management of OO patients. More large-center studies are thus needed to promote accurate management of OO patients with optimal outcomes.
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