Traumatic Lesions of the Atlas and Axis

Mixter, S. J.; Osgood, Robert B.

doi:10.1097/00000658-191002000-00004

Cited by 152 publications

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“…This can be compared to the 94% satisfactory results reported with the OPCD (one-piece cervical device) hook system used on less severely disabled patients [26]. The relatively high frequency of general complications must be interpreted in the light of the advanced age and the severe pathologies treated.…”

Section: Discussionmentioning

confidence: 91%

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 91%

“…

…”

mentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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“…Since 1909, when Mixter and Osgood [47] described the posterior approach for atlanto-axial joint stabilisation, various investigators have advocated different techniques to achieve C1/C2 spondylodesis [5, 18, 19, 21, 37, 46, 55, 56, 58]. Although Gallie [21] never published a detailed technique of surgical correction of C1/C2 instability, one of the standard operations bears his name.…”

Section: Discussionmentioning

confidence: 99%

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Kandziora

Mittlmeier

Kerschbaumer

1999

European Spine Journal

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Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre-and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 ± 19.3 months (range 21-96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P < 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3°± 7.8°for rotation; 7.8°± 5.6°for bending; average gain of motion in group II: 21.5°± 14.0°f or rotation; 17.2°± 5.5°for bending), while it decreased significantly in group III (10.7°± 18.1°for rotation; 6.7°± 18.5°for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.Key words Atlanto-axial instability · Transoral approach · Decompression · Rheumatoid arthritis · C1/C2 fusion ORIGINAL ARTICLE Eur Spine J (1999) 8 : 371-381

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“…Subsequently, Mixter and Osgood modified this technique by passing a braided silk soaked in compound tincture of benzoin under the posterior arch of the atlas and tying it about the hooked spinous process of the axis. 28 Later, Willard switched to the use of wire for C1-C2 fixation and subsequently its augmentation with iliac bone graft. Subsequently, Gallie modified this technique and described its thorough detail in 1939, which contributed to its popularity thereafter.…”

Section: Management Of Reducible Atlantoaxial Instability In Oomentioning

confidence: 99%

“…Although he could only partially reduce the subluxation, the ultimate outcome was satisfactory. 28 Later, the treatment for irreducible OO shifted to decompressive laminectomy of the atlas and enlargement of the foramen magnum. However, because of a continuous ventral cervicomedullary compression, this was less appreciated on account of high morbidity and mortality and was abandoned later.…”

Section: History Of Surgical Intervention In Iaadmentioning

confidence: 99%

Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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Traumatic Lesions of the Atlas and Axis

Cited by 152 publications

References 0 publications

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Os Odontoideum: Review Article

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