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1.
Medicine (Baltimore) ; 99(12): e19550, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195963

RESUMO

The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF).295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2-C7, range of motion for C2-C7, C2-C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups.The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ±â€Š10.1), angle of C2-C7 (18.0 ±â€Š4.6), range of motion of C2-C7 (32.5 ±â€Š7.7), C2-C7 sagittal vertical axis (17.9 ±â€Š4.3) and T1 slope (22.1 ±â€Š5.3) were higher in NG than these (59.4 ±â€Š9.2, 16.2 ±â€Š4.5, 30.2 ±â€Š6.9,16.1 ±â€Š4.0, 20.9 ±â€Š4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis.Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Discotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Pescoço/cirurgia , Osteoporose/epidemiologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Fatores de Risco , Espondilose/diagnóstico por imagem , Escala Visual Analógica
2.
Med Sci Monit ; 26: e921507, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196483

RESUMO

BACKGROUND We compared the clinical and radiographic outcomes between interface fixation using absorbable screws and plate fixation in anterior cervical corpectomy and fusion (ACCF) to evaluate the effectiveness of these 2 fixation methods for the treatment of 2-level cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS From January 2014 to December 2016, a total of 220 patients who received 2-level ACCF were retrospectively collected. Among them, 108 patients were treated with interface fixation using absorbable screws (Group A) and 112 patients underwent plate fixation (Group B). Japanese Orthopedic Association (JOA) score and Neck Disability Index (NDI) score were employed to compare the clinical improvement. Operative time, blood loss, surgical cost, cervical lordosis, complications, and fusion rate were also evaluated. RESULTS The average follow-up time were 35.2±4.5 months in Group A and 35.9±3.9 months in Group B. There was no difference in operative time and blood loss for both groups. The JOA scores and NDI scores were similar in each follow-up (p>0.05 in all). Group A cost an average of 30% less than Group B for the operation. Both groups achieved 100% in the fusion rate with the same conditions in cervical lordosis. Group A (5/108) had a significantly lower complication rate than Group B (17/112) (p<0.05). CONCLUSIONS ACCF with interface fixation using absorbable screws achieved similar clinical outcomes compared to ACCF with plate fixation for 2-level CSM. Moreover, the interface fixation using absorbable screws presented far fewer complications and cost less for the operation.


Assuntos
Parafusos Ósseos , Discotomia/instrumentação , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Vertebroplastia/instrumentação , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fusão Vertebral/métodos , Espondilose/diagnóstico por imagem , Vertebroplastia/métodos
4.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(2): 98-103, 2020 Feb 09.
Artigo em Chinês | MEDLINE | ID: mdl-32074670

RESUMO

Objective: To analyze the correlation between the age and the cone-beam CT (CBCT) images of the third and fourth cervical vertebrae in female skeletal class Ⅰ patients aged between 9 and 17 years, and to establish a quantitative evaluation method for calculating the age. Methods: CBCT images of 108 female skeletal class Ⅰ patients aged between 9 and 17 years were collected from Qingdao Stomatological Hospital from September, 2017 to March, 2019. The two-dimensional linear values (AH: height of anterior edge of vertebral body; H: height of middle part of vertebral body; PH: height of posterior edge of vertebral body; AP: width of vertebral body), the two-dimensional linear ratio values (AH/PH, AH/AP, AH/H, H/AP, H/PH, PH/AP) and the three-dimensional volume values of the third vertical vertebrae (C3) and the fourth vertical vertebrae (C4) were measured. By Exponential transformation of measurements and multiple linear regression analysis, the optimal index for evaluating age were screened, and the fitting degree of multiple linear regression equation (R(2)) and the accuracy of age estimation (SEE) were compared. CBCT images of 27 female skeletal class Ⅰ patients aged from 9 to 17 years were added from Qingdao Stomatological Hospital between April, 2019 and July, 2019, by which the accuracy of the regression equation was verified. Results: Multiple linear regression equation for age estimation based on two-dimensional linear indexes was as follows: Y=-113.928+33.743×e(AH)(3)(/100)+58.844×e(PH)(4)(/100)+20.590×e(AP)(4)(/100)( "e" was a natural constant, e≈2.718), R(2)=0.745, SEE=1.31. Multiple linear regression equation for age estimation based on two-dimensional linear ratio indexes was as follows: Y=-0.076-2.284×e(A)H(3)/PH(3)+3.227×e(A)H(3)/AP(3)+2.149×e(A)H(3)/H(3)+1.961×e(A)H(4)/H(4), R(2)=0.576, SEE=1.70. Multiple linear regression equation of age estimation by the volume index was as follows: Y=-16.828+22.184×e(V)(3)(/10 000), R(2)=0.555, SEE=1.71. The data of 27 new patients were tested. The CBCT measurement index of C3 and C4 vertebral bodies inferred the fitting degree (R(2)) and accuracy (SEE) of the equation of the age estimation. The two-dimensional linear value was superior to the two-dimensional linear ratio and the latter was superior to the three-dimensional volume value. The standard error of the estimate about them was 1.74, 2.00 and 2.37, respectively. Conclusions: The two-dimensional linear index of CBCT images of C3 and C4 could be used to estimate the age of 9 to 17-year-old female skeletal class Ⅰ patients, and the accuracy of the method was higher than that of two-dimensional ratio index and three-dimensional volume index.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Adolescente , Criança , Feminino , Humanos , Análise Multivariada , Análise de Regressão
5.
Am J Orthod Dentofacial Orthop ; 157(2): 228-239, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005475

RESUMO

INTRODUCTION: The objective of this study was to assess the reproducibility of cervical vertebral maturation (CVM) method based on the type of radiographic image and the level of experience and level of training of the evaluator. METHODS: Ten evaluators (5 orthodontic residents and 5 faculty members) were randomly divided into 2 groups: trained and untrained. All participants evaluated 80 radiographic images previously acquired in 4 different formats: (1) 2-dimensional (2D) digital (2D-digital), (2) 2D digitized hard copy from the Iowa Facial Growth Study (American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection), (3) 2D digital reconstructed from a 3-dimensional (3D) radiograph (2D-from 3D), and (4) 3D cone-beam computerized tomographic (3D-CBCT) images. Agreement among evaluators on the morphology of the cervical vertebrae (CV) and the CVM stage of each radiographic image was assessed using Randolph's kappa statistic and Kendall's W coefficient of concordance. RESULTS: Interobserver agreement on the determination of a curvature on the inferior border of the CV was substantial to perfect, whereas agreement on shape was fair to moderate. Overall, the level training in all image types, except 3D-CBCTs, but not the level of experience affected the agreement for shape and curvature of the CVs. Interobserver agreement on CVM staging for all combined images was substantial at 0.72. Faculty had a higher level of agreement than residents except for 2D-digital and 3D-CBCT images, whereas trained evaluators had an overall higher level of agreement than untrained evaluators except for 3D-CBCT images. CONCLUSIONS: Interobserver agreement in determining CVM stage was substantial for all images evaluated; experience and training resulted in higher level of agreement for some image types. The 3D-CBCT images did not provide increased interobserver agreement over current 2D-digital lateral cephalograms in determining CVM staging or shape of the CV. The highest agreement in CVM staging was obtained on 2D-digital lateral cephalograms with training.


Assuntos
Cefalometria , Vértebras Cervicais , Tomografia Computadorizada de Feixe Cônico , Ortodontia/educação , Vértebras Cervicais/diagnóstico por imagem , Competência Clínica , Humanos , Imagem Tridimensional , Iowa , Variações Dependentes do Observador , Reprodutibilidade dos Testes
7.
Medicine (Baltimore) ; 99(1): e18597, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895809

RESUMO

To explore the impact of Modic changes (MCs) on bone fusion after single-level anterior cervical discectomy and fusion (ACDF) with a zero-profile implant (the Zero-P implant system).From November 2014 to November 2017, a total of 116 patients who underwent single-level ACDF with the Zero-P implant were divided into two groups according to MRI showing type 2 MCs (MC2) or no MCs (i.e., the MC2 group and the NMC group, respectively). A total of 92 (79.3%) patients were classified into the NMC group, and 24 (20.7%) patients were classified into the MC2 group. The clinical outcomes and fusion rates were retrospectively evaluated between the 2 groups preoperatively and postoperatively at 3, 6, and 12 months, and the final follow-up.The Japanese Orthopedic Association (JOA) scores and the visual analogue scale (VAS) scores of neck pain were significantly improved compared to the preoperative scores in both the NMC and MC2 groups (P < .05). However, there were no differences in JOA or VAS scores between the 2 groups (P > .05). The fusion rates of the NMC and MC2 groups at 3, 6, and 12 months postoperatively, and the final follow-up were 33.7% and 12.5%, 77.2% and 54.2%, 89.1% and 87.5%, and 97.8% and 95.8%, respectively. The fusion rates were significantly lower at 3 and 6 months after surgery in the MC2 group than in the NMC group (P < .05).The presence of MC2 did not affect the clinical outcome but delayed the fusion time following ACDF with the Zero-P implant system.Level of Evidence is Level 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Discotomia , Fusão Vertebral , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
World Neurosurg ; 133: 90-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568901

RESUMO

BACKGROUND: Although adjacent segment disease (ASD) following anterior cervical fusion has been well described in the literature, there is relative paucity of data on this pathology after posterior cervical fusion. To our knowledge, there have been no reported cases of proximal ASD following posterior fusion to C2. CASE DESCRIPTION: We present 2 cases of proximal ASD presenting as retroodontoid pseudotumors following posterior fusion to C2, both in middle-aged females without history of rheumatologic disease. The first occurred in a patient with Klippel-Feil deformity 13 years after C2-6 posterior cervical fusion, the second in a patient 3 and a half years following revisional circumferential C2-T2 fusion. Both were successfully treated with proximal extension of laminectomy and fusion to the occiput, supplemented in the first patient by transdural decompression of retroodontoid mass. CONCLUSIONS: Proximal ASD can manifest as retroodontoid pseudotumor at variable time intervals following posterior fusion to C2. Clinicians must account for this possibility in their decision making.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Cervicalgia/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Síndrome de Klippel-Feil/diagnóstico por imagem , Síndrome de Klippel-Feil/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Cervicalgia/cirurgia , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Resultado do Tratamento
9.
World Neurosurg ; 133: e233-e240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518735

RESUMO

BACKGROUND: Compensatory mechanisms for cervical kyphosis are unclear. Few alignment analyses have targeted ongoing cervical kyphosis and detailed the effects of compensatory alignment changes. METHODS: We analyzed the radiographic alignment parameters of 31 patients (21 men and 10 women) with postoperative kyphotic changes after anterior cervical corpectomy and fusion (ACCF) between 2006 and 2015. This analysis included lordotic angle of the fusion area, fusion area length, cervical lordosis angle (CL), O-C7 angle (O-C7a), and cervical sagittal vertical axis (cSVA) as basic parameters and occipito-C2 angle (O-C2a), adjacent cranial angle, adjacent caudal angle, and T1 slope as compensatory parameters at 2 time points after surgery. RESULTS: Alignment analysis revealed that CL was significantly decreased by 5.0 ± 7.7° (P < 0.01) and O-C7a was changed by only -0.2 ± 6.8° (P = 0.75). An inverse correlation was found between ΔCL and ΔO-C2a (ρ = -0.40), with a nearly 1:1 relationship in the scatter diagram. ΔT1 slope had no direct compensatory correlation with ΔCL (P = 0.28) but was strongly correlated with ΔcSVA (ρ = 0.78). The scatter diagram of ΔcSVA and ΔT1 slope showed compensatory relevance and a shifted point to its collapse as the T1 slope lost control of cSVA; thereafter, both parameters incessantly increased, and ΔT1 and ΔcSVA became positive. CONCLUSIONS: When CL decreased after ACCF, ΔO-C2 immediately compensated for the CL loss that could lead to failure to obtain horizontal gaze. If cSVA increased, Δcaudal adjacent angle and ΔT1 slope (extension below the kyphosis) compensated for the horizontal offset translation. The noncompensatory status (ΔcSVA and ΔT1 positive) may necessitate further correction surgery in which the caudal fused level is beyond T1.


Assuntos
Adaptação Fisiológica/fisiologia , Vértebras Cervicais/cirurgia , Cifose/etiologia , Complicações Pós-Operatórias/etiologia , Postura/fisiologia , Fusão Vertebral , Idoso , Antropometria , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem
10.
World Neurosurg ; 133: 275-277, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629145

RESUMO

We report a rare case of cervicothoracic intramedullary and extramedullary lipoma. Complete resection of the extramedullary lipoma and almost complete resection of the intramedullary lipoma were performed using a microscope, followed by posterior fusion and internal fixation from C4-T2 to maintain the stability of the cervicothoracic junction. Despite the high risk, it was still necessary to perform the decompression surgery and the surgical results were favorable.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral , Vértebras Torácicas/cirurgia , Resultado do Tratamento
11.
World Neurosurg ; 133: 248-252, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629148

RESUMO

BACKGROUND: Persistent idiopathic facial pain is characterized by persistent facial or oral pain in the absence of a neurologic deficit. This underexplored pain may be conducted by various nerves, including cranial nerves and upper cervical spinal roots, and its etiology is unclear. CASE DESCRIPTION: A patient presented with persistent idiopathic facial pain associated with occipital muscle stiffness after an improper neck massage. The patient achieved almost complete pain relief by coblation of right upper cervical nerves (C1 and C2 spinal roots) followed by continuous cervical epidural analgesia for a period of 3 weeks. The analgesic effect was stable during the 3-month follow-up period. CONCLUSIONS: Persistent idiopathic facial pain may be cervicogenic, and treatments focusing on cervical spinal roots may provide satisfactory pain control in patients with cervical abnormalities.


Assuntos
Técnicas de Ablação/métodos , Dor Facial/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Dor Facial/diagnóstico por imagem , Humanos , Masculino , Raízes Nervosas Espinhais/diagnóstico por imagem , Resultado do Tratamento
12.
World Neurosurg ; 133: e225-e232, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493599

RESUMO

OBJECTIVE: To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). METHODS: This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C2 and C5 spinous processes and in the scalp over the primary sensory area (C3'/4'). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. RESULTS: All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC2) was associated with CSM, but with low diagnostic accuracy (area under the curve = 0.199). At a dynamic position, the percentage change in amplitude of LMC2 and of left ulnar stimulus recorded at C2 spinous process (LUC2) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC2 and LUC2 were calculated as 10.2% and 19.25%, respectively. CONCLUSIONS: The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.


Assuntos
Vértebras Cervicais , Potenciais Somatossensoriais Evocados , Compressão da Medula Espinal/diagnóstico , Espondilose/complicações , Espondilose/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Discotomia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Tempo de Reação , Estudos Retrospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Espondilose/cirurgia
13.
Radiol Med ; 125(3): 272-279, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31784927

RESUMO

OBJECTIVE: The purpose of this study is to investigate the role of cervical radiography in the study of patients with vertigo and dizziness. PATIENTS: This is a retrospective single-institution case series study of 493 patients suffering from vertigo and dizziness who were referred (from January 2011 to December 2012) to the hospital to study those symptoms. METHODS: We studied cervical radiographies, CT and MRI of the cervical spine made in the sample and the radiological findings. We analyzed demographic characteristics, presence of psychiatric pathology and emergency assistance due to vertigo in patients who have undergone cervical study. RESULTS: A total of 57% of patients had cervical radiography made; this was more frequent in women, Spanish people, with psychiatric pathology and who have gone to the emergency department for vertigo (p < 0.05). Degenerative changes were found in 74.1% of the patients with radiography made, more frequently at an older age, osteophytes in 49.5% and abnormal cervical lordosis in 37.1%. CONCLUSIONS: There are sociodemographic factors that influence in the request for cervical radiographs in patients with vertigo and dizziness. Given the suspicion of cervical vertigo, we do not consider that the findings in the radiographs help in the diagnosis. In our opinion, an excessive use of cervical radiography is made in patients with vertigo and dizziness.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Tontura , Imagem por Ressonância Magnética/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Vertigem , Análise de Variância , Distribuição de Qui-Quadrado , Tontura/epidemiologia , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Espanha/epidemiologia , Vertigem/epidemiologia
14.
Clin Nucl Med ; 45(1): e29-e31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31652157

RESUMO

We report FDG PET/CT images of a 63-year-old woman referred for characterization of osteolytic lesions of the cervical spine. This patient with chronic renal failure had a history of follicular thyroid carcinoma with undifferentiated cells, treated by a total thyroidectomy, completed by radioactive iodine in 2017. Because of cancer history, a FDG PET/CT was performed and showed multiple moderately hypermetabolic osteolytic lesions of the spine from C3 to T1, with joint erosion on CT. A laminectomy was performed for cervical spinal cord decompression and revealed a gouty tophus.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Fluordesoxiglucose F18 , Gota/complicações , Gota/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/complicações , Feminino , Humanos , Pessoa de Meia-Idade
15.
World Neurosurg ; 135: 241-244, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881343

RESUMO

BACKGROUND: To the best of our knowledge, the presence of Chiari formation and Hirayama disease in the same patient has not been previously reported. On the basis of the presented case, we have attempted to identify the common pathogenesis of both of these clinical entities. CASE DESCRIPTION: We have reported a case of a 23-year-old male patient who had presented with complaints of pain in the nape of neck and shoulders of 9 months' duration, weakness and stiffness in all 4 limbs, and wasting and weakness of muscles of both hands of 6 months' duration. The investigations showed Chiari formation and syringomyelia. Additional investigations depicted the characteristic radiological features associated with Hirayama disease. The patient was treated by atlantoaxial and multisegmental subaxial cervical spinal fixation. CONCLUSIONS: Spinal instability seems to be the nodal point of the pathogenesis of both Chiari formation and Hirayama disease.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Atrofias Musculares Espinais da Infância/diagnóstico por imagem , Siringomielia/diagnóstico por imagem , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Masculino , Fusão Vertebral , Atrofias Musculares Espinais da Infância/complicações , Atrofias Musculares Espinais da Infância/cirurgia , Siringomielia/complicações , Siringomielia/cirurgia , Adulto Jovem
17.
Am J Orthod Dentofacial Orthop ; 156(4): 502-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582122

RESUMO

INTRODUCTION: The aims of this study were to analyze differences in craniofacial and upper cervical spine morphology, including posterior cranial fossa and growth prediction signs between European and Asian skeletal Class III children, and to analyze associations between morphologic deviations in the upper cervical spine and craniofacial characteristics. METHODS: A total of 60 skeletal Class III children, 19 Danes and 41 Koreans, were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender. RESULTS: In the craniofacial morphology, the inclination of the maxilla (NSL/NL, P <0.05) and the shape of the posterior cranial fossa (s-d, d-p, p-iop; P <0.01 and P <0.0001, respectively) were significantly different between the 2 groups. There was no significant difference in upper cervical spine morphology and Atlas dimensions between the groups. Fusion was significantly associated with the sagittal jaw relationship (P <0.05), and the total upper spine deviations were significantly associated with some growth prediction signs (P <0.05, P <0.01). Atlas dimensions were significantly associated with the prognathia of the mandible (P <0.05), posterior cranial fossa (P <0.01, P <0.0001), and some growth prediction signs (P <0.05, P <0.01). CONCLUSIONS: Upper spine morphology and Atlas dimensions may provide valuable information for predicting jaw growth and craniofacial morphology in Class III malocclusion.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Cefalometria/métodos , Atlas Cervical/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Anormalidades Craniofaciais/diagnóstico por imagem , Anormalidades Craniofaciais/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/etnologia , Adolescente , Atlas Cervical/crescimento & desenvolvimento , Vértebras Cervicais/crescimento & desenvolvimento , Criança , Dinamarca , Feminino , Humanos , Masculino , República da Coreia
18.
BMC Musculoskelet Disord ; 20(1): 451, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615503

RESUMO

BACKGROUND: To compare the imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod. METHODS: Thirty-seven patients suffering from atlantoaxial dislocation underwent posterior reduction and internal fixation by pedicle screw and rod. We measured pre-operative and post-operative atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), sum of lateral mass interspace (SLMI) of the operation and the control group. ADI, CCA, CMA, and SLMI between the pre-operative and post-operative conditions of the operation group and the control group were compared. RESULTS: The ADI, CCA, CMA, and SLMI in the pre-operative condition of the operation group were 8.3 ± 4.3 mm, 130.2 ± 14.2°, 133.8 ± 16.7°, and 3.7 ± 1.3 mm, respectively, those in the post-operative condition of the operation group were 1.0 ± 0.9 mm, 148.5 ± 9.4°, 156.0 ± 8.2°, and 8.0 ± 2.7 mm, respectively, while those in the control group were 1.2 ± 0.3 mm, 152.7 ± 5.3°, 160.2 ± 6.3°, and 4.5 ± 1.0 mm respectively. Post-operative ADI, CCA, CMA, and SLMI were statistically different (p < 0.01) from pre-operative assessments. The SLMI has no significant difference between the pre-operative condition and the control group. Post-operative SLMI was statistically different from that of the control group. CONCLUSIONS: The lateral mass joints were widened after the anatomical reduction of atlantoaxial dislocation by pedicle screw and rod. Widening of the lateral mass exists in both atlantoaxial fusion and occipital-cervical fusion.


Assuntos
Articulação Atlantoaxial/lesões , Fixação Interna de Fraturas/instrumentação , Luxações Articulares/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Criança , Estudos Transversais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 238-242, sept.-oct. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183878

RESUMO

Spinal cord teratomas are rare. There are few reports of teratomas affecting the cervical spine and their association with spondylotic radiculopathy has not been described. A 59-year-old woman with history of fecal incontinence attended with cervical radicular pain radiating to upper limbs. Physical examination showed distal muscle hypotrophy and abolishment of bicipital, tricipital, and brachioradialis reflexes of the right arm, preserving proximal strength. Also, hiporreflexia and loss of proprioception in the right lower limb was observed. Magnetic resonance imaging showed an intramedullary mass at C7-T1, accompanied by intervertebral disk protrusions and dural sac compressions at the same level. One-stage posterior-anterior operative approach for tumor resection, decompression of the radiculopathy and replacement of intervertebral discs was performed. The histopathological diagnosis was for a mature teratoma. We described the first case of an intramedullary cervical teratoma associated with radiculopathy in an adult, providing evidence of rare long-lasting teratomas affecting the cervical spine


Los teratomas medulares son raros. La asociación de teratomas cervicales con radiculopatía espondilótica no ha sido descrita. Una mujer de 59 años con historia de incontinencia fecal acudió con dolor radicular cervical irradiado a miembros superiores. La exploración física reveló hipotrofia distal, arreflexia bicipital, tricipital y braquiorradial del brazo derecho, conservando la fuerza proximal. Se observó hiporreflexia y pérdida de la propiocepción en el miembro inferior derecho. La resonancia magnética reveló una masa intramedular en C7-T1, así como hernias discales y compresión del saco dural en dichos segmentos. Se realizó un doble abordaje posterior-anterior en un solo tiempo para resecar el tumor, descomprimir la radiculopatía y reemplazar los discos afectados. El diagnóstico histopatológico fue de un teratoma maduro. Describimos el primer caso de un teratoma intramedular cervical con radiculopatía espondilótica en un adulto, aportando evidencia sobre los teratomas raros de larga evolución que afectan a la columna cervical


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Neoplasias Ductais, Lobulares e Medulares/diagnóstico por imagem , Neoplasias Ductais, Lobulares e Medulares/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Cervicalgia/complicações , Cervicalgia/etiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Procedimentos Neurocirúrgicos
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