RESUMEN
PURPOSE: Ponticulus Posticus, atlantooccipital ligament ossification-induced anomaly, surrounds the vertebral artery and the first cervical nerve root. It is believed to wrap around the first cervical nerve root and the vertebral artery, causing compression. We hypothesized that it would also reduce the diameter of the vertebral artery. METHODS: Between January 1, 2022, and December 31, 2022, cervical spine CT scans taken for any reason were retrospectively reviewed. The images of 1365 patients suitable for evaluation were evaluated by two expert radiologists in 3 dimensions. Among patients with PP, those who underwent cervical angiography were identified for vertebral artery diameter measurement. RESULTS: The average age of the 1365 individuals included in the study (732 males, 633 females) was 55.78 (± 18.85) with an age range of 1-96. Among this group, PP was detected in 288 individuals, resulting in a total prevalence of 21.1%. Right and left vertebral artery diameters were significantly lower in patients with complete PP compared to the absent group (p < 0,001, p < 0,001, respectively). Additionally, it was observed that width and height diameters and artery diameters were positively correlated in patients with Complete PP. CONCLUSIONS: Ponticulus posticus can cause vertebrobasilar insufficiency by reducing the diameter of the vertebral artery. Therefore, imaging and detailed evaluation of this region are important in symptomatic patients.
Asunto(s)
Arteria Vertebral , Humanos , Arteria Vertebral/anomalías , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/anatomía & histología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Adulto , Anciano de 80 o más Años , Adolescente , Niño , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Adulto Joven , Preescolar , Lactante , Tomografía Computarizada por Rayos X , Articulación Atlantooccipital/anomalías , Articulación Atlantooccipital/diagnóstico por imagen , Vértebras Cervicales/irrigación sanguínea , Vértebras Cervicales/diagnóstico por imagen , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/anatomía & histologíaRESUMEN
OBJECTIVE: Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children. METHODS: The outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates. RESULTS: All surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3-6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications. CONCLUSION: Autologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.
Asunto(s)
Trasplante Óseo , Costillas , Fusión Vertebral , Trasplante Autólogo , Humanos , Niño , Masculino , Femenino , Estudios Retrospectivos , Fusión Vertebral/métodos , Trasplante Óseo/métodos , Costillas/trasplante , Costillas/cirugía , Trasplante Autólogo/métodos , Resultado del Tratamiento , Preescolar , Adolescente , Articulación Atlantoaxoidea/cirugía , Articulación Atlantoaxoidea/diagnóstico por imagen , Estudios de Seguimiento , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Articulación Atlantooccipital/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
AIM: To provide a comprehensive analysis for accurate screw size selection and insertion angle during surgical procedures. MATERIAL AND METHODS: In this retrospective study, a total of 120 patients participated, resulting in the analysis of 240 occipital condyles using coronal, sagittal, and axial planes on CT scans. Statistical evaluation was performed using the Wilcoxon rank-sum test, with p < 0.05 considered statistically significant. RESULTS: The mean sagittal length and height were measured at 17.2 ± 1.7 mm and 9.1 ± 1.5 mm, respectively. The average condyle angle, a crucial factor for screw insertion, was assessed at 38.0 ± 5.5 mm in length, 19.6 ± 2.6 mm in width, and 9.5 ± 1.0 mm in height. Condyle height in the anterior and posterior hypoglossal canals was measured at 10.8 ± 1.4 mm and 9.0 ± 1.4 mm, respectively. Screw angle and condyle width were statistically smaller in females compared to the male population. CONCLUSION: The OC is a significant anatomical structure in the craniovertebral junction, playing a crucial role in stability. The obtained morphological values are applicable to the Turkish population and offer statistically significant findings for preoperative planning involving occipital condyle screw instrumentation.
Asunto(s)
Tornillos Óseos , Hueso Occipital , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/anatomía & histología , Hueso Occipital/cirugía , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano , Turquía , Adulto Joven , Adolescente , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Articulación Atlantooccipital/anatomía & histologíaRESUMEN
BACKGROUND: Nablus mask-like facial syndrome (NMFLS) is an extremely rare genetic syndrome characterized by facial dysmorphia as well as developmental delay. In the present report we describe a potential association between non-traumatic atlanto-occipital dislocation and NMFLS in an 11-year old female lacking typical facial features of NMFLS. CASE DESCRIPTION: An 11-year-old female with autism presented with symptoms of persistent headache and vomiting as well as neck stiffness. Further investigation and CT imaging revealed congenital malformation of the skull base and craniocervical junction with complete posterior subluxation of the left occipital condyle. MRI findings later corroborated the findings on CT. CONCLUSIONS: The patient was successfully treated with occipitocervical fusion. The findings in this case suggest the possibility that atlanto-occipital instability and generalized occipitocervical may be associated with NMFLS.
Asunto(s)
Articulación Atlantoaxoidea , Luxaciones Articulares , Humanos , Femenino , Luxaciones Articulares/patología , Luxaciones Articulares/diagnóstico por imagen , Niño , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/patología , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/anomalías , Articulación Atlantooccipital/patologíaRESUMEN
OBJECTIVE: Skull base chordomas are rare, locally osseo-destructive lesions that present unique surgical challenges due to their involvement of critical neurovascular and bony structures at the craniovertebral junction (CVJ). Radical cytoreductive surgery improves survival but also carries significant morbidity, including the potential for occipitocervical (OC) destabilization requiring instrumented fusion. The published experience on OC fusion after CVJ chordoma resection is limited, and the anatomical predictors of OC instability in this context remain unclear. METHODS: PubMed and Embase were systematically searched according to the PRISMA guidelines for studies describing skull base chordoma resection and OC fusion. The search strategy was predefined in the authors' PROSPERO protocol (CRD42024496158). RESULTS: The systematic review identified 11 surgical case series describing 209 skull base chordoma patients and 116 (55.5%) who underwent OC instrumented fusion. Most patients underwent lateral approaches (n = 82) for chordoma resection, followed by midline (n = 48) and combined (n = 6) approaches. OC fusion was most often performed as a second-stage procedure (n = 53), followed by single-stage resection and fusion (n = 38). The degree of occipital condyle resection associated with OC fusion was described in 9 studies: total unilateral condylectomy reliably predicted OC fusion regardless of surgical approach. After lateral transcranial approaches, 4 studies cited at least 50%-70% unilateral condylectomy as necessitating OC fusion. After midline approaches-most frequently the endoscopic endonasal approach (EEA)-at least 75% unilateral condylectomy (or 50% bilateral condylectomy) led to OC fusion. Additionally, resection of the medial atlantoaxial joint elements (the C1 anterior arch and tip of the dens), usually via EEA, reliably necessitated OC fusion. Two illustrative cases are subsequently presented, further exemplifying how the extent of CVJ bony elements removed via EEA to achieve complete chordoma resection predicts the need for OC fusion. CONCLUSIONS: Unilateral total condylectomy, 50% bilateral condylectomy, and resection of the medial atlantoaxial joint elements were the most frequently described independent predictors of OC fusion in skull base chordoma resection. Additionally, consistent with the occipital condyle harboring a significantly thicker joint capsule at its posterolateral aspect, an anterior midline approach seems to tolerate a greater degree of condylar resection (75%) than a lateral transcranial approach (50%-70%) prior to generating OC instability.
Asunto(s)
Vértebras Cervicales , Cordoma , Hueso Occipital , Neoplasias de la Base del Cráneo , Fusión Vertebral , Humanos , Cordoma/cirugía , Cordoma/diagnóstico por imagen , Neoplasias de la Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Hueso Occipital/cirugía , Hueso Occipital/diagnóstico por imagen , Fusión Vertebral/métodos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Femenino , Articulación Atlantooccipital/cirugía , Articulación Atlantooccipital/diagnóstico por imagen , Masculino , Adulto , Persona de Mediana EdadAsunto(s)
Articulación Atlantoaxoidea , Articulación Atlantooccipital , Enfermedades de los Perros , Perros , Animales , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/anomalías , Articulación Atlantooccipital/anomalías , Articulación Atlantooccipital/diagnóstico por imagen , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/congénito , Masculino , Tomografía Computarizada por Rayos X/veterinaria , FemeninoRESUMEN
OBJECTIVE: Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF). METHODS: The authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio. RESULTS: Clinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle-C2 sagittal vertical alignment (C-C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95). CONCLUSIONS: The authors' results indicate that the occipital condyle-atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.
Asunto(s)
Malformación de Arnold-Chiari , Articulación Atlantooccipital , Atlas Cervical , Hueso Occipital , Fusión Vertebral , Siringomielia , Humanos , Malformación de Arnold-Chiari/cirugía , Malformación de Arnold-Chiari/diagnóstico por imagen , Siringomielia/cirugía , Siringomielia/diagnóstico por imagen , Femenino , Masculino , Atlas Cervical/anomalías , Atlas Cervical/cirugía , Atlas Cervical/diagnóstico por imagen , Niño , Hueso Occipital/cirugía , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/anomalías , Fusión Vertebral/métodos , Adolescente , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Articulación Atlantooccipital/anomalías , Resultado del Tratamiento , Preescolar , Descompresión Quirúrgica/métodos , Estudios Retrospectivos , Vértebras Cervicales/cirugía , Vértebras Cervicales/anomalías , Vértebras Cervicales/diagnóstico por imagenRESUMEN
OBJECTIVE: Pediatric cervical spine injuries (CSI) can be devastating, and children < 8 years are particularly at risk for upper CSI given unique anatomical differences. Diagnosis of these injuries can be delayed due to variable clinical presentations and a paucity of existing literature. The authors aimed to characterize the spectrum of pediatric upper CSI. METHODS: This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics. RESULTS: In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well. CONCLUSIONS: Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.
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Vértebras Cervicales , Traumatismos Vertebrales , Humanos , Estudios Retrospectivos , Masculino , Niño , Femenino , Preescolar , Traumatismos Vertebrales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Vértebras Cervicales/diagnóstico por imagen , Adolescente , Articulación Atlantooccipital/lesiones , Articulación Atlantooccipital/diagnóstico por imagen , Lactante , Fracturas de la Columna Vertebral/diagnóstico por imagen , Articulación Atlantoaxoidea/lesiones , Articulación Atlantoaxoidea/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagenRESUMEN
BACKGROUND: The correct diagnosis and treatment of the atlanto-occipital dislocation (AOD) remains a major challenge. OBJECTIVE: To evaluate the different radiological diagnostic criteria for AOD and discuss potential treatment strategies based on a case with AOD and additional fracture of the atlas. MATERIAL AND METHODS: A 29-year-old male patient is presented who suffered from AOD with concomitant fracture of the anterior and posterior arches of the atlas with rotational atlantoaxial dislocation following an accident in forestry. The following parameters were evaluated for the diagnosis and assessment of postoperative reduction: Powers ratio, the Xlines-method, Wackenheim line, basion-dens interval (BDI), basion-axial interval (BAI) and occipital condyle-C1 interval (CCI). RESULTS: Stabilization was performed by occipitocervical spondylodesis from C0 to C2/3. For final reduction it was necessary to reduce the malrotation of the atlas. In the presented case, the revised CCI proved to be a sensitive and valid yet practical parameter. Powers' ratio and the BDI were less suited for assessing the diagnosis. The Xlines-method, Wackenheim line and the BAI did not adequately detect the pathological situation. DISCUSSION: The AOD is a severe injury requiring immediate correct diagnosis for later adequate treatment results. Among the published parameters, the revised CCI proved to be a practical and valid parameter to detect AOD. For definitive treatment, the operative occipitocervical stabilization is regarded as the method of choice.
Asunto(s)
Articulación Atlantooccipital , Luxaciones Articulares , Traumatismos Vertebrales , Masculino , Humanos , Adulto , Articulación Atlantooccipital/diagnóstico por imagen , Luxaciones Articulares/diagnóstico , Traumatismos Vertebrales/diagnóstico por imagen , Radiografía , Hueso Occipital/lesionesRESUMEN
A 39-year-old male pedestrian-hit-by-car was transferred to our institution with atlantooccipital dislocation (AOD) on outside computed tomography (CT) imaging. On arrival he had a rigid cervical collar in place. Given the reported AOD, we placed the patient flat, removed the cervical collar, and supported the head in neutral alignment with sandbags. Due to a technical issue uploading his prior imaging to our system, the patient underwent repeat CTs at our center. Subsequently, after the outside images were uploaded, we were able to compare his cervical spine CT images before and after removing his cervical collar. On comparison, we noted a substantial reduction in AOD after collar removal. We hope this serves as a reminder of this key step in managing a rare but deadly clinical entity and a small demonstration of the efficacy of this intervention.
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Articulación Atlantooccipital , Luxaciones Articulares , Masculino , Humanos , Adulto , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/etiología , Luxaciones Articulares/cirugía , Tomografía Computarizada por Rayos X/métodos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugíaRESUMEN
BACKGROUND AND PURPOSE: The purpose of this study was to identify and classify the different types of anterior atlanto-occipital membrane complex injuries on MRI and evaluate for the presence, size, and location of a prevertebral effusion on the preceding CT exams. MATERIALS AND METHODS: Patients who suffered an anterior atlanto-occipital membrane complex injury were identified retrospectively utilizing Nuance mPower software. An anatomic-based description of the location of the anterior atlanto-occipital membrane complex injury was recorded along with any additional osteoligamentous trauma of the craniocervical junction. The preceding cervical CT exams for these patients were reviewed for the presence and location of a prevertebral effusion. RESULTS: Fifty patients were identified with an acute, post-traumatic anterior atlanto-occipital membrane complex injury. Three distinct patterns of anterior atlanto-occipital membrane complex injury were observed. Nineteen patients demonstrated increased STIR signal with disruption of the anterior atlanto-occipital membrane, ten patients demonstrated increased STIR signal with disruption of the anterior atlanto-axial membrane, and twenty-one patients demonstrated increased STIR signal with disruption of both the anterior atlanto-occipital membrane and anterior atlanto-axial membrane. An effusion at the C1-C2 level was present in greater than 90% of patients with anterior atlanto-occipital membrane complex injury. CONCLUSIONS: The presence of a craniocervical prevertebral effusion on CT in trauma patients may raise suspicion for an injury to the anterior atlanto-occipital membrane complex and potentially trigger additional investigation with cervical MRI.
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Articulación Atlantoaxoidea , Articulación Atlantooccipital , Luxaciones Articulares , Humanos , Estudios Retrospectivos , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/lesiones , Luxaciones Articulares/diagnóstico por imagen , Cuello , Imagen por Resonancia Magnética , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesionesRESUMEN
STUDY DESIGN: Retrospective radiographic analysis. OBJECTIVES: Evaluation of the anatomic features of the craniovertebral junction in patients with occipitalization with and without atlantoaxial dislocation (AAD). SUMMARY OF BACKGROUND DATA: Atlas occipitalization is a common feature of congenital AAD and usually requires surgical intervention. However, not all instances of occipitalization necessarily lead to AAD. No study has specifically examined and compared the craniovertebral bony morphology in occipitalization with, and without, AAD. MATERIALS AND METHOD: We reviewed computed tomography (CT) scans of 2500 adult outpatients. Occipitalization cases without AAD (ON) were selected. Meanwhile, a series of 20 inpatient occipitalization cases with AAD (OD) were obtained in parallel. Another 20 control cases without occipitalization were also included. Multi-directional reconstructed CT images of all cases were analyzed. RESULTS: A total of 18 adults with ON were found in all 2500 outpatients (0.7%). Both anterior height and posterior height of C1 lateral mass in the control group were significantly larger than those in both the ON and OD groups, whereas posterior height in the OD group was significantly less than that in the ON group. Three morphologic types of the occipitalized atlas posterior arch were identified: Type I, bilateral sides were unfused with opisthion; Type II, unilateral side was unfused with opisthion, whereas the other side was fused; and Type III, bilateral sides were fused with opisthion. In the ON group, three cases were type I (17%), six cases were type II (33%), and nine cases were type III (50%). In the OD group, all 20 cases were type III (100%). CONCLUSIONS: Atlas occipitalization with, and without, AAD results from a distinctly different bony morphology at the craniovertebral junction. The novel classification system based on reconstructed CT images may be useful in prognosticating AAD in the setting of atlas occipitalization.
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Articulación Atlantoaxoidea , Articulación Atlantooccipital , Atlas Cervical , Luxaciones Articulares , Anomalías Musculoesqueléticas , Adulto , Humanos , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Atlas Cervical/diagnóstico por imagen , Atlas Cervical/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature. METHODS: Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients. RESULTS: Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD. CONCLUSIONS: Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
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Articulación Atlantooccipital , Lesiones Traumáticas del Encéfalo , Luxaciones Articulares , Humanos , Adolescente , Estudios Retrospectivos , Centros Traumatológicos , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesiones , Tomografía Computarizada por Rayos X/métodos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/epidemiología , Luxaciones Articulares/etiología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/epidemiologíaRESUMEN
BACKGROUND: Our previous study suggested that atlanto-occipital instability (AOI) is common in patients with type II basilar invagination (II-BI). OBJECTIVE: To further understand the pathogenesis of AOI in Chiari malformations (CM) and CM + II-BI through systematic measurements of the bone structure surrounding the craniocervical junction. METHODS: Computed tomography data from 185 adults (80 controls, 63 CM, and 42 CM + II-BI) were collected, and geometric models were established for parameter measurement. Canonical correlation analysis was used to evaluate the morphological and positional relationships of the atlanto-occipital joint (AOJ). RESULTS: Among the 3 groups, the length and height of the condyle and superior portion of the lateral masses of the atlas (C1-LM) were smallest in CM + II-BI cases; the AOJ had the shallowest depth and the lowest curvature in the same group. AOJs were divided into 3 morphological types: type I, the typical ball-and-socket joint, mainly in the control group (100%); type II, the shallower joint, mainly in the CM group (92.9%); and type III, the abnormal flat-tilt joint, mainly in the CM + II-BI group (89.3%). Kinematic computed tomography revealed AOI in all III-AOJs (100%) and some II-AOJs (1.5%) but not in type I-AOJs (0%). Morphological parameters of the superior portion of C1-LM positively correlated with those of C0 and the clivus and significantly correlated with AOI. CONCLUSION: Dysplasia of the condyle and superior portion of C1-LM exists in both CM and II-BI cases yet is more obvious in type II-BI. Unstable movement caused by AOJ deformation is another pathogenic factor in patients with CM + II-BI.
Asunto(s)
Malformación de Arnold-Chiari , Articulación Atlantoaxoidea , Articulación Atlantooccipital , Inestabilidad de la Articulación , Adulto , Humanos , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/anomalías , Malformación de Arnold-Chiari/complicaciones , Malformación de Arnold-Chiari/diagnóstico por imagen , Malformación de Arnold-Chiari/patología , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Tomografía Computarizada por Rayos X , Fosa Craneal Posterior , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/patologíaRESUMEN
A 15-year-old pony was presented for acute neurological signs. Neurological examination suggested a brainstem lesion, blood laboratory tests detected an active inflammatory process, and upper respiratory endoscopy identified a suppurative lesion at the dorsal aspect of the right guttural pouch. Computed tomography was performed and findings were consistent with pituitary abscess, meningitis, and atlanto-occipital joint septic arthritis. Imaging findings were confirmed based on cerebrospinal and synovial fluid cultures and necropsy. Computed tomography provided important information for identifying the cause of the patient's neurological signs and helped the owner make a final decision for euthanasia.
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Artritis Infecciosa , Articulación Atlantooccipital , Enfermedades de los Caballos , Caballos , Animales , Absceso/patología , Absceso/veterinaria , Tomografía Computarizada por Rayos X/veterinaria , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/veterinaria , Artritis Infecciosa/patología , Articulación Atlantooccipital/diagnóstico por imagen , Autopsia/veterinaria , Enfermedades de los Caballos/diagnóstico por imagen , Enfermedades de los Caballos/patologíaAsunto(s)
Articulación Atlantoaxoidea , Articulación Atlantooccipital , Neoplasias , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/patología , Articulación Atlantoaxoidea/cirugía , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/cirugía , Humanos , Neoplasias/patologíaRESUMEN
BACKGROUND CONTEXT: Atlanto-occipital dissociation (AOD) has historically been considered a fatal injury. Recent small case series, however, have suggested that AOD injuries have become increasingly survivable. There has not been an adequately powered study that confirms this. PURPOSE: The aim of this study is to assess whether the survival rate for patients with AOD increased over time. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: Patients with traumatic AOD identified from our Level 1 Trauma Center database. OUTCOME MEASURES: Mortality following traumatic AOD. METHODS: Patients with traumatic AOD from 1996 to 2019 were retrospectively identified from our Level 1 Trauma Center database using International Classification of Diseases 9 and 10 codes. Patients were stratified into two cohorts- those diagnosed before August 1, 2015 and after. RESULTS: A total of 52 patients met our inclusion criteria and were analyzed. Mean age was 34.41 (11.71), with 34 (65.4) females, and 26 (50) Hispanics. Mean BMI was 28.13 (7.30), mean injury severity score was 40.79 (21.72), and mean Glasgow coma scale was 5.91 (4.72). Overall, 33 patients died (63.5%). The mortality rate before 2015 was 81.80%, this number dropped down to 50% for those who were treated post 2015 (p=.01). CONCLUSIONS: This study demonstrates that patients treated recently for AOD at a level 1 trauma center were more likely to survive than patients treated in the past at the same center. Possible reasons for the improved survival rate seen in this study include: increased awareness of AOD, improved diagnostic protocols with more uniform computed tomography based imaging, and advances in the care of these patients.
Asunto(s)
Articulación Atlantooccipital , Luxaciones Articulares , Adulto , Articulación Atlantooccipital/diagnóstico por imagen , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND AND PURPOSE: Craniocervical dissociation is a rare and life-threatening injury that results from a significant hyperflexion-hyperextension force. Occult craniocervical dissociation is defined as an unstable craniocervical injury in the absence of atlanto-occipital joint space widening or other skull base line abnormality. The early and accurate diagnosis of craniocervical dissociation is crucial since the early diagnosis and subsequent stabilization with occipital-cervical fusion has been shown to reduce neurologic morbidity and mortality. Several normative skull base lines have been developed to predict craniocervical dissociation. The purpose of our study was to measure the atlanto-occipital joint space and four other common skull base lines in patients who underwent occipital-cervical fusion for post-traumatic craniocervical instability. MATERIALS AND METHODS: Patients who underwent occipital-cervical fusion for craniocervical injury were identified retrospectively using a keyword search of radiology reports using Nuance mPower software. The cervical CT and MRI exams for these patients were reviewed and the atlanto-occipital joint space, Powers ratio, Wackenheim line, posterior axial line, and basion dens interval were measured. Detailed descriptions of craniocervical ligament injuries on MRI were recorded along with patient demographic information, clinical history, management, and outcome. RESULTS: Nine adult patients who underwent occipital-cervical fusion for an acute craniocervical injury were identified. Six patients demonstrated an atlanto-occipital joint space measuring 2 mm or less on cervical spine CT with no additional abnormality in the Powers ratio, Wackenheim line, posterior axial line, or basion-dens interval. Three patients demonstrated widening of the atlanto-occipital joint space with two patients demonstrating an abnormality in at least two additional skull base lines. Clinical outcomes were variable with nearly half of the patients demonstrating persistent neurologic deficits, including one quadriplegic patient. CONCLUSIONS: A normal atlanto-occipital joint space and skull base line measurements on cervical CT demonstrated a low predictive value for detecting unstable craniocervical injuries. Occult craniocervical dissociation was present in two-thirds of patients who underwent occipital cervical fusion for acute, craniocervical trauma. A high clinical and radiologic index of suspicion for craniocervical trauma with subsequent follow-up cervical MRI to directly evaluate ligamentous integrity is necessary to accurately diagnose and triage patients with high velocity trauma.
Asunto(s)
Articulación Atlantooccipital , Luxaciones Articulares , Traumatismos del Sistema Nervioso , Adulto , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesiones , Articulación Atlantooccipital/cirugía , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Vértebras Cervicales/cirugía , Humanos , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The anatomical features of the atlanto-occipital joint can be potentially useful in re-associating or excluding crania to atlases in commingled remains. This study investigated whether linear measurements and the 3-dimensional (3D) surface of occipital condyles and articular facets of atlases can represent valid insights for this purpose. METHODS: The variations among eight corresponding linear distances were analyzed in a sample of 150 individuals through six supervised machine learning techniques attempting to develop classifiers able to identify elements belonging to the same individual. Furthermore, a 3D analysis was conducted on the articular surfaces through superimpositions of 3D models of corresponding and non-corresponding crania and atlases obtained by using respectively stereophotogrammetry and laser scanning. This analysis investigated differences in terms of point-to-point distances (Root Mean Square, RMS) of superimposed 3D surfaces. RESULTS: None of the six machine learning techniques were able to correctly detect a satisfying percentage of correspondent pairs in the overall sample by using the linear variables. The 3D analysis of the articular surfaces found RMS values over 0.53 mm only for superimposed non-corresponding surfaces, which sets a threshold value to identify 32% of incorrect pairs. DISCUSSION: The re-association of cranium to atlas proved to be challenging and hardly possible when considering only metric variables. However, the 3D geometry of the articular surfaces represents a valid variable for this purpose and 3D analyses pave the way for an initial exclusion of incorrect re-associations, thus should not be considered as a re-association method per se, but as an exclusionary screening technique.
Asunto(s)
Articulación Atlantooccipital , Humanos , Articulación Atlantooccipital/diagnóstico por imagen , Hueso Occipital/diagnóstico por imagen , FotogrametríaRESUMEN
ABSTRACT: The treatment of an atlas burst fracture depends on whether transverse atlantal ligament (TAL) injury is present. We compared the radiologic parameters associated with the presence of a TAL injury as detected using magnetic resonance imaging (MRI), and verified whether the lateral mass displacement (LMD) criteria currently used to diagnose TAL injuries in atlas burst fractures are reliable or need revision.Thirty patients who presented with isolated atlas burst fractures were included in this retrospective observational study. We measured radiologic parameters, including LMD, atlanto-dental interval, basion-dens interval, internal lateral mass displacement, and external lateral mass displacement, in each patient at the time of initial presentation. The presence of TAL injury was evaluated using MRI. We compared the radiologic parameters and characteristics of patients who presented with TAL injury. We also determined the sensitivity and specificity of an LMD test to accurately diagnose TAL injury based on MRI. Finally, we compared the radiologic parameters according to the presence of surgical treatment and patient union status.Twenty patients presented with an intact TAL, while 10 patients had a TAL injury on MRI. LMD was significantly higher in patients with TAL injury (9.61 vs 3.73âmm, Pâ<â.001). In multivariable logistic regression analysis, LMD was also significantly higher in patients with TAL injury. The sensitivity and specificity of LMD for diagnosing TAL injury based on MRI in patients with isolated C1 fractures were 90% and 100%, respectively. The incidence of an LMD greater than 8.1âmm was statistically higher in patients than in those without TAL injury (90% vs 0%, Pâ<â.001).Nine patients underwent surgery for isolated atlas burst fractures, and 21 did not. LMD (9.56 vs 4.03âmm, Pâ<â.001) and fracture gap (7.96 vs 4.01âmm, Pâ<â.001) were significantly higher in patients who underwent surgery.Among the various radiologic parameters, LMD closely correlated with the presence of TAL injury, as patients with an LMD greater than 8.1âmm were more likely to have a TAL injury in the case of atlas burst fractures. LMD is a good method for predicting the presence of TAL injury if MRI is not available.