Recurring Atlo-Axial Dislocation With Repeated Involvement of the Cord and Recovery

Kamman, Gordon R.

doi:10.1001/jama.1939.02800200016004

Cited by 5 publications

(2 citation statements)

References 2 publications

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“…Any motor signs and symptom combination can result, ranging from unilateral monoparesis, progressing to cruciate paralysis, tetraplegia and respiratory failure (30%). The pathogenesis of the neurological deficit though not clear, seems to be due to repeated microtrauma to the cord (which occurs due to repetitive early dislocation), which leads to cord degeneration [40][41][42] .…”

Section: Craniovertebral Junction Injuries In Children a Reviewmentioning

confidence: 99%

Craniovertebral junction injuries in children. A Review

Wani

Dar

Ramzan

et al. 2007

IJNT

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The craniovertebral junction (CVJ) is the most complex and dynamic region of the cervical spine. The wide range of movements possible at this region makes it vulnerable to injury and instability. The special anatomical features make children more prone to injuries of CVJ than adults where lower cervical spine is involved more frequently. The classical clinical manifestation in CVJ injury patients are pyramidal signs including weakness and spasticity, stigmata of CVJ anomalies (short neck, low hair line, facial or hand asymmetry, high arched palate, ), torticolis and neck movement restriction. The history of transient loss of consciousness or sudden neurological deterioration following minor trauma may be elicited. Most authors advocate conservative management (in form of immobilization) of CVJ injuries in children as is true in adults. Halo vest provides superior immobilization in upper cervical and CVJ injuries and can be used in a child as young as 1 year of age with minimal difficulty. Early surgical intervention, i.e. within 2 weeks of injury include is indicated in injuries that cannot be reduced and stabilized by external means, partial spinal cord injury with progressive neurological deficit and in children with extradural hematoma.

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Section: Craniovertebral Junction Injuries In Children a Reviewmentioning

confidence: 99%

Craniovertebral junction injuries in children. A Review

Wani

Dar

Ramzan

et al. 2007

IJNT

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“…Nach Jeanneret [46] genügt auch bei straffen Pseudarthrosen ein relativ geringfügi-ges Trauma, um eine Lockerung der fibrösen Verbindung mit Verschiebung des Dens herbeizuführen. Myelopathien bei mobilen Pseudarthrosen wurden häufig beschrieben [50,60,76] nach Paradis und Janes weisen bis zu 76 % der Patienten mit Denspseudarthrose neurologische Ausfälle auf [64].…”

Section: Postoperative Denspseudarthrosenunclassified

Operative oder konservative Behandlung der Pseudarthrose des Dens axis Wie gefährlich ist es, eine Denspseudarthrose nicht zu stabilisieren?

Blauth

Richter

Kiesewetter

et al. 1999

Chirurg

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Therapeutical recommendations need to be differentiated. Unstable non unions are most often responsible for persistent pain, may result in acute or chronic myelopathy++ and therefore - as well as ossa odontoidea - need operative fixation. In considerably displaced non unions a closed reduction manoeuver with long term traction should be tried. The operative treatment of choice is the posterior transarticular screw fixation C1/C2 desirably in a percutaneous technique. Tight, "stable" pseudarthroses in the sense of a persisting fracture gap in painfree patients should first be controlled radiologically. If the odontoid position remains unchanged, non operative treatment may be continued.

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Fractured Odontoid: The Management of Delayed Neurological Symptoms

1996

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Undiagnosed and untreated odontoid fractures are relatively common in developing countries where treatment for minor injuries is not considered. As a result, patients frequently present with neurological deterioration secondary to delayed odontoid dislocation. Fifty-one consecutive patients with this problem were entered into a management protocol and reviewed for this report. After diagnosis, reducibility was analyzed by extension films, and all patients who could not be reduced were initially managed in cranial long traction. Thirty-seven were reduced spontaneously or by traction alone, and 12 required transoral decompression. All underwent posterior C1-C2 fusion. Postoperatively, all were treated in external orthoses. The neurological recovery was excellent in 34 patients. Seven patients could function but had some disability, three patients had disabling spasticity, and three remained bedridden. Four deaths occurred as a result of respirator-dependent patients being taken home for social and financial reasons. As a result of this case-controlled study, we recommend that the treatment protocol first analyze reducibility by extension x-rays and then try traction for as long as 14 days to attempt reduction in patients who did not reduce in extension. Failure of reduction is indication for transoral decompression, and all patients require C1-C2 fusion. The neurological recovery is related to initial impairement but can be satisfactory in > 75% of patients.

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Recurring Atlo-Axial Dislocation With Repeated Involvement of the Cord and Recovery

Cited by 5 publications

References 2 publications

Craniovertebral junction injuries in children. A Review

Craniovertebral junction injuries in children. A Review

Operative oder konservative Behandlung der Pseudarthrose des Dens axis Wie gefährlich ist es, eine Denspseudarthrose nicht zu stabilisieren?

Fractured Odontoid: The Management of Delayed Neurological Symptoms

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