In vitro biomechanics of the craniocervical junction—a sequential sectioning of its stabilizing structures

Radcliff, Kris E.; Hussain, Mir; Moldavsky, Mark; Klocke, Noelle; Vaccaro, Alexander R.; Albert, Todd J.; Khalil, Saif; Bucklen, Brandon

doi:10.1016/j.spinee.2015.02.004

Cited by 34 publications

(18 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…None of the participants in the traumatic group had a diagnosis of alar ligament damage prior to high-field strength MRI. This would suggest that the diagnosis of an alar ligament lesion remains challenging [5,8,21,22], unless highly specialized MRI machines and protocols are followed.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

von¹,

Maloul²,

Hoffmann³

et al. 2018

Journal of Manual & Manipulative Therapy

View full text Add to dashboard Cite

Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI. Results: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%. Discussion: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

von¹,

Maloul²,

Hoffmann³

et al. 2018

Journal of Manual & Manipulative Therapy

View full text Add to dashboard Cite

show abstract

“…[13] Furthermore, anterior–posterior and cranial–caudal translations exist with motion of the atlantooccipital and atlantoaxial joints. [14] Thus, the C2 lesion is more likely to affect the stability of the atlantoaxial joint and lead to cervical deformity, and atlantoaxial subluxation or instability has already been observed on presentation in patients with EG. [2,7–10] Some of these patients have a history of immobilization with a collar, but the effect of this treatment was unsatisfactory.…”

Section: Discussionmentioning

confidence: 99%

The outcome of eosinophilic granuloma involving unilateral atlantoaxial joint

et al. 2017

View full text Add to dashboard Cite

Rationale:Solitary eosinophilic granuloma (EG), the most benign, common form of Langerhans cell histiocytosis, has a self-limiting process and is associated with a good prognosis. Immobilization is recommended as the first treatment strategy for solitary EG, although the treatment protocols are still controversial. Radiotherapy and surgery are secondary treatment choices. Lesions of the upper cervical spine react differently to treatment because of their specific anatomical and motor features.Patient concerns:We discuss the case of a 29-year-old man with axis EG who underwent immobilization, radiotherapy, and finally surgery.Diagnosis:Eosinophilic granuloma (EG).Interventions:An initial conservative protocol, including immobilization with a collar and radiotherapy, effectively relieved his neck pain, whereas torticollis secondary to atlantoaxial subluxation was not improved. Therefore, he underwent tumor resection through the anterior approach and spinal reconstruction, fixation, and fusion through the posterior approach.Outcomes:The deformity was well corrected and follow-up was satisfactory.Lessons:Upon review of the literature, we found that EG lesions affecting the axis have more risk factors for instability or deformity, and they have particular anatomical and motor characteristics; thus, they require more consideration and attention in terms of treatment, prognosis, and follow-up.

show abstract

“…The injury model in the current study involved axial drilling of the dens with all ligaments left intact, with the exception of apical and alar ligaments. This model is similar to that used in a previous biomechanical study performed to test craniocervical dislocations [ 18 19 ]. It might accurately mimic a type II odontoid fracture because the base of the dens can be properly fractured without affecting the ALL, the PLL, or the C1 vertebral body.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study

et al. 2017

Self Cite

View full text Add to dashboard Cite

Study DesignResearchers created a proper type II dens fracture (DF) and quantified a novel current posterior fixation technique with spacers at C1–C2. A clinical case study supplements this biomechanical analysis.PurposeResearchers explored their hypothesis that spacers combined with posterior instrumentation (PI) reduce range of motion significantly, possibly leading to better fusion outcomes.Overview of LiteratureLiterature shows that the atlantoaxial joint is unique in allowing segmental rotary motion, enabling head turning. With no intervertebral discs at these joints, multiple ligaments bind the axis to the skull base and to the atlas; an intact odontoid (dens) enhances stability. The most common traumatic injury at these strong ligaments is a type II odontoid fracture.MethodsEach of seven specimens (C0–C3) was tested on a custom-built six-degrees-of-freedom spine simulator with constructs of intact state, type II DF, C1–C2 PI, PI with joint capsulotomy (PIJC), PI with spacers (PIS) at C1–C2, and spacers alone (SA). A bending moment of 2.0 Nm (1.5°/sec) was applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). One-way analysis of variance with repeated measures was performed.ResultsDF increased motion to 320%, 429%, and 120% versus intact (FE, LB, and AR, respectively). PI significantly reduced motion to 41%, 21%, and 8%. PIJC showed negligible changes from PI. PIS reduced motion to 16%, 14%, and 3%. SA decreased motion to 64%, 24%, and 54%. Reduced motion facilitated solid fusion in an 89-year-old female patient within 1 year.ConclusionsType II odontoid fractures can lead to acute or chronic instability. Current fixation techniques use C1–C2 PI or an anterior dens screw. Addition of spacers alongside PI led to increased biomechanical rigidity over intact motion and may offer an alternative to established surgical fixation techniques.

show abstract

In vitro biomechanics of the craniocervical junction—a sequential sectioning of its stabilizing structures

Cited by 34 publications

References 32 publications

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

The outcome of eosinophilic granuloma involving unilateral atlantoaxial joint

Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study

Contact Info

Product

Resources

About