Medullospinal Compression Due to Atlanto-Axial Dislocation and Sudden Haematomyelia During Decompression

Dastur, Darab K.; Wadia, N. H.; Desai, Anil D.; Sinh, Gajendra

doi:10.1093/brain/88.5.897

Cited by 74 publications

(31 citation statements)

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“…Post-mortem examination showed evidence of recent as well as old haemorrhages in the medulla and upper cervical cord along with degenerative changes. Similar experiences have been described by Dastur et al (1965).…”

Section: Mortalitysupporting

confidence: 84%

Atlanto-axial dislocations

Masalawala¹

1977

Spinal Cord

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Abstract. The clinical problems, treatment and results are discussed in 23 cases of atlanto-axial dislocation.Key words: Atlanto-axial dislocation.INTEREST in the subject of atlanto-axia1 injuries and affections has grown over the years. A large number of papers have been published in the last 50 years. Ac cording to Washington (1959), Bell (1830) first described a case of infective aetiology while Block1ey and Purser (1956) attributed the earliest description of traumatic cases to Corner (1907), Fritzche (1912) and Jefferson (1927). Reports of a series of cases have been published more recently by Block1ey and Purser (1956), Lipscomb (1957), Sherk andNicholson (1970), and Wadia (1967). AnatomyThe most important features are: 1. The relationship between skull and the axis with the weak atlas lying be tween the two stronger bones. The stability of atlas on axis is dependent on transverse ligament aided by the alar ligaments.2. The ossification of the odontoid process of axis may be incomplete with a plate of cartilage persisting at the base and acting as a weak point. The tip may also remain separate.3. Congenital anomalies at this level are well known and may take the form of absence or hypoplasia of odontoid process, and poor formation transverse ligaments. Both these predispose to a dislocation at slight injury.4. The position of oro-and naso-pharynx in front of vertebrae result in infective processes affecting these vertebrae. Patho g enesisCases of atlanto-axia1 dislocations can be grouped in three groups: (1) trau matic; (2) infective; and (3) rheumatoid.At the J.J. Group of Hospitals we have studied 40 cases in the last 20 years. Their age and sex distributions are shown in Table I. As only one case of rheuma toid variety-anky10sing spondylitis was seen, it has not been separately tabled. Traumatic GroupThere were 23 cases in this group subdivided into four groups (Table II). Burst fractures were produced by forces acting vertically with a double break in the ring of atlas bilaterally. As the fragments tended to move outwards, the chances of cord affection were less. The other three groups were classical flexion injuries with forces acting from above and behind, forwards and downwards. No case of extension injury has been recorded in our series. Where there was a congenital absence of odontoid or weakness of ligaments, the force required to produce the dislocation was much less than where odontoid was fractured. These occurred mainly in children. The following case histories illustrate these points. Cases 2 and 3: Dislocation of atlas with fracture odontoid process. Case 2. A I4-year-old boy with history of a fall from 3 ft, 2-3 years earlier and progressive weakness in last 4 months. Examination showed spasticity, motor weakness and exaggerated jerk. Radio grams showed dislocation of atlas with fracture of odontoid and moderate mobility.Case 3. A 22-year-old man who complained of pain and stiffness in his neck for 4 months following a fall from a swing but no neurological deficit.Case 4: Dislocation o...

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Section: Mortalitysupporting

confidence: 84%

Atlanto-axial dislocations

Masalawala¹

1977

Spinal Cord

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“…1,3,[5][6][7]12,14) This disorder is frequently associated with a complex of bony and neural anomalies in the craniovertebral region and spine including platybasia,`fixed' atlantoaxial dislocation, assimilation of the atlas, malformation of the occipital bone, C2-3 fusion, and a range of fusion defects of the other cervical vertebral bodies. High cervical disc prolapse is rare, probably due to the limited range of movements in the region and the strength of the ligaments.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of High Cervical Disc Prolapse Associated With Basilar Invagination-Two Case Reports-

Goel

Phalke

Cacciola

et al. 2004

Neurol. Med. Chir.(Tokyo)

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C3-4 cervical disc prolapse was associated with basilar invagination and short neck in a 21-year-old man and additionally with an extensive Klippel-Feil abnormality and fusion of multiple cervical vertebrae in a 32-year-old man. The transoral surgical route was adopted for cervical discectomy in the latter case and an additional odontoidectomy in the former case. Interbody plate and screw fixation was carried out in the patient with Klippel-Feil abnormality. Both the patients were relieved of symptoms and remained asymptomatic at follow up. Simultaneous fixation procedure is not mandatory after transoral surgery in patients with basilar invagination.

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“…At times a fusion was combined with the operation. The mor tality and morbidity of such procedures were high, espe cially when the indication was a ventrally situated abnor mality [3][4][5][6][7], Operative procedures based on an under standing of the surgical physiology of this region have been developed [1,5].…”

Section: Introductionmentioning

confidence: 99%

Complications of Surgery at the Craniovertebral Junction – Avoidance and Management

Menezes¹

1991

Pediatr Neurosurg

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The pathology encountered at the craniovertebral junction is extensive. It includes congenital, developmental and acquired abnormalities which ultimately compromise the cervicomedullary junction. The pediatric age group is particularly vulnerable as the muscular support is not fully developed. Numerous surgical approaches have been developed to relieve compression, as well as to stabilize this region. The complications described are from a review of the literature and the author’s personal experience.

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Medullospinal Compression Due to Atlanto-Axial Dislocation and Sudden Haematomyelia During Decompression

Cited by 74 publications

References 0 publications

Atlanto-axial dislocations

Atlanto-axial dislocations

Surgical Management of High Cervical Disc Prolapse Associated With Basilar Invagination-Two Case Reports-

Complications of Surgery at the Craniovertebral Junction – Avoidance and Management

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