Treatment of severe retromastoid pain secondary to C1–2 arthrosis by using cervical fusion

Holly, Langsto T.; Batzdorf, Ulrich; Foley, Kevin T.

doi:10.3171/spi.2000.92.2.0162

Cited by 7 publications

(28 citation statements)

References 24 publications

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“…Literature [20,26,31,35,39,40,52,66] and our current results demonstrate that the C1-2 facet joints can be a meaningful source of pain. Thirty-one percent of our patients had at least one lateral C1-2 joint displaying advanced AAOA, more than half had signs of C2-nerve root conferred radiculopathy and motion induced suboccipital pain.…”

Section: Clinical Outcomesupporting

confidence: 59%

“…AAOA can disrupt the smooth, gliding joint motions [60] and a clinical hallmark of AAOA is known to be the significantly reduced ROT C1-2 [20,31,35,66]. Accordingly, our patients with AAOA (preexisting and new onset Type B joints) had significantly decreased total ROT C1-2 and %ROT C1-2 .…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 72%

“…The pain was not caused by nerve root or C2-ganglion compression, as there was no abnormal interlaminar space at C1-2 [6] in any patient. Facet joint pain is likely to be transmitted by unencapsulated receptors and free nerve endings in the joint capsule and synovial lining [35]. With aging or posttraumatic changes, degeneration with capsular laxity and synovitis can occur and finally AAOA can arise with a mechanical nature of pain [35,36].…”

Section: Clinical Outcomementioning

confidence: 99%

“…Facet joint pain is likely to be transmitted by unencapsulated receptors and free nerve endings in the joint capsule and synovial lining [35]. With aging or posttraumatic changes, degeneration with capsular laxity and synovitis can occur and finally AAOA can arise with a mechanical nature of pain [35,36]. As in our sample, pain derived from the C1-2 facet joints is frequently described in nonneuropathic terms such as 'pressurelike', 'deep boring', 'dull', and 'heavy' [20,35] and located almost exclusively at the ipsilateral retromastoid and occipital region [14,20,22,28,31,35,66].…”

Section: Clinical Outcomementioning

confidence: 99%

“…With aging or posttraumatic changes, degeneration with capsular laxity and synovitis can occur and finally AAOA can arise with a mechanical nature of pain [35,36]. As in our sample, pain derived from the C1-2 facet joints is frequently described in nonneuropathic terms such as 'pressurelike', 'deep boring', 'dull', and 'heavy' [20,35] and located almost exclusively at the ipsilateral retromastoid and occipital region [14,20,22,28,31,35,66]. As in the current study the main manifestations of C1-2 degeneration and AAOA are pain with significantly restricted ROM [22,31], elicited or exacerbated by ipsilateral neck rotation [20,22,28,35,66].…”

Section: Clinical Outcomementioning

confidence: 99%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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Section: Clinical Outcomesupporting

confidence: 59%

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 72%

Section: Clinical Outcomementioning

confidence: 99%

Section: Clinical Outcomementioning

confidence: 99%

Section: Clinical Outcomementioning

confidence: 99%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Osseous and vascular anatomical variations within the C1–C2 complex: a radiographical study using computed tomography angiography

Moftakhar

Gonzalez

Khoo

et al. 2008

Robotics Computer Surgery

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C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

et al. 2009

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Pertinent literature exists concerning indications, techniques, complications of treatment, and risk factors for nonunion in axis and odontoid fractures; however, there are scarce data regarding the incidence and definition of malunion in these fractures. As a prerequisite for the study of anatomical alignment following surgical and nonsurgical treatment of C2-fractures, an understanding of normal C2 anatomy is essential. Therefore, the authors intended to evaluate morphometrical dimensions of the C2 vertebra. The purpose was to provide normalized quantitative data to enable assessment of malalignment following the treatment of C2-fractures within a classification system. Using digitized cervical spine lateral and transoral odontoid radiographs of 100 consecutive patients without any evidence of traumatic or neoplastic disorders, the authors performed measurements on distinct anatomical structures and investigated morphometrical dimensions of the normal axis vertebra. The incidence of atlantoaxial arthritis was also evaluated. In addition, with the assessment of twenty arbitrarily chosen sets of radiographs by three different observers we calculated the interobserver reliability in terms of intraclass correlation coefficients for each parameter. With calculation of SD and 95% confidence limits, pathological cut-offs were reconstructed from measurements performed resembling non-physiological and pathological limits. Distinct parameters were selected to form a new classification system for radiographical follow-up that focuses on the quantitative C1-2 vertebral alignment. The measurement process resulted in 2,400 data points. Distinct morphometrical parameters, such as a quantitative characterization of the sagittal atlantoaxial congruency, the lateral mass inclination and the type of degenerative changes at the atlantoaxial joint could be demonstrated to be valuable and reliably used within a proposed classification for C2-malunions following C2-fractures. The current study offers a template including recommended radiological measurements for further research on the study of clinical outcome and posttraumatic alignment following C2-fractures.

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Treatment of severe retromastoid pain secondary to C1–2 arthrosis by using cervical fusion

Cited by 7 publications

References 24 publications

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Osseous and vascular anatomical variations within the C1–C2 complex: a radiographical study using computed tomography angiography

C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

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