One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation

Crockard, H A; Calder, Ian; Ransford, A. O.

doi:10.1302/0301-620x.72b4.2380227

Cited by 139 publications

(47 citation statements)

References 2 publications

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“…However, the technical intricacy of the trans-oral anterior approach to the spinal cord at the cranio-vertebral junction may not always result in optimal decompression. [22][23][24][25] Thus, an additional posterior decompression, either through one or two sessions, may be required, as in our cases. However, long-term conservative treatment without surgery together with prolonged palsy should have a negative effect on neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

Cruciate paralysis and hemiplegia cruciata: report of three cases

et al. 2005

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Study design: Report of three cases of cruciate paralysis and hemiplegia cruciata. Objective: To stress the importance of upper cervical spine lesions causing neurological symptoms and signs. Setting: Neuro-orthopedic service, Fukui University Hospital, Japan. Results: Three patients (all females; one with congenital anomaly at the occiput-atlas level, one with assimilation of the atlas, and one with rheumatoid arthritis-related proliferative synovium) had clinical features of cruciate paralysis and hemiplegia cruciata. All three cases underwent decompressive surgeries. Conclusion: Neurological symptoms and signs of cruciate paralysis and hemiplegia cruciata should be carefully assessed, and surgical therapy should be based on the pathological condition.

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Section: Discussionmentioning

confidence: 99%

Cruciate paralysis and hemiplegia cruciata: report of three cases

et al. 2005

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“…According to the authors, rod-and-wire techniques normally require several, sometimes very large, burr holes. Moreover, they are often placed into the region of the fossa cerebellaris [5,9,24,28], where the bone offers a thickness of only about 3 mm (see Fig. 3 and Table 1).…”

Section: Authormentioning

confidence: 99%

“…These can be divided in three groups: (1) simple onlay techniques [4,8,10,31], (2) wiring techniques [1,13,16,20,21,29,45] and (3) hook and rod [5,9,24,26,28,35,37,40] or plate [2,14,17,19,22,36,38,39,43,44] fixation. All these methods can be combined with the use of polymethylmethacrylate.…”

Section: Introductionmentioning

confidence: 99%

In vivo and in vitro CT analysis of the occiput

Hertel

Hirschfelder

1999

European Spine Journal

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“…Recently, the use of transpedicular screw fixation has been reported in the subaxial cervical spine as well [1,2]. Systems based on rods and wires/cables, such as the Ransford loop, allow multisegmental cervical and occipitocervical fixation [11,32]. Occipitocervical fusion, with or without [28] fixation, has been used in instabilities of the upper cervical spine since the description by Foerster in 1927 [14].…”

Section: Introductionmentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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IntroductionSince Hadra first described the time-honored technique of cervical wiring, several alternative fixation techniques have been developed, all with inherent limitations and risks.In atlanto-axial surgical stabilization, the Gallie wiring technique is still the gold standard, but it has several limitations [15,26]. Its mechanical stabilizing potential is limited, it does not result in rotational or translational sagittal stability and additional external fixation is needed, which is a great disadvantage, particularly in rheumatoid arthritis (RA) and metastatic disease. Transarticular C2-1 screws with additional Gallie type wire fixation is biomechanically attractive, offering rotational and translational stability, but is technically demanding, with a risk of vertebral artery injury [8,29,40].Wiring is also a traditional method of subaxial spine fixation [33]. Techniques based on wires through the Abstract There are today several techniques available for cervical fixation -all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17-84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre-and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.

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One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation

Cited by 139 publications

References 2 publications

Cruciate paralysis and hemiplegia cruciata: report of three cases

Cruciate paralysis and hemiplegia cruciata: report of three cases

In vivo and in vitro CT analysis of the occiput

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

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