Cervical lateral mass screw length analysis in men versus women.

Posterior fixations with lateral mass screws have become popular. The Roy-Camille and the Magerl techniques have been established and screw length was identified as a particularly important element. Sex and ethnicity are significant factors in cervical spine morphology, but few studies have been performed for screw length. We performed measurements using computed tomography (CT) images of adult patients hospitalized for surgery of the cervical spine, with targeted 3D data analysis. The final number of patients was 47 (33 men, 14 women) and 235 vertebrae. With the Roy-Camille technique, the screw length was longest at C3 (men: 13.0 mm ± 1.9 mm, women: 13.0 mm ± 1.9 mm) and smallest at C7 (men: 10.8 mm ± 1.8 mm, women: 9.4 mm ± 1.2 mm). With the Magerl technique, the screw length was smallest at C3 (men: 14.8 mm ± 1.6 mm, women: 14.3 mm ± 1.6 mm) and longest at C7 for men (16.8 mm ± 2.8 mm), and at C6 for women (15.4 mm ± 3.0 mm). To differ from spinal canal or pedicle, cervical lateral mass showed no obvious morphological differences from that of subjects of other ethnicity. The placement of a standard lateral mass screw would not cause complications in Japanese patients, even with the use of devices designed in North America or Europe. However, the anatomical background is essential because it is important to optimize the selection for each patient to avoid complications considering sex and individual differences.

Craniovertebral anomalies associated with pituitary gland duplication.

BACKGROUND: An extremely rare occurrence of the pituitary gland duplication inspired us to examine in detail the accompanying craniovertebral congenital anomalies in a patient involved. MATERIALS AND METHODS: T1-wighted magnetic resonance imaging (MRI) was performed, as well as the multislice computerised tomography (MSCT) and MSCT angiography in our patient, as well as in a control group of 10 healthy subjects. RESULTS: In a 20-year-old male a double pituitary gland was identified, as well as hypothalamic enlargement, tuberomamillary fusion and hamartoma. In addition, the patient also showed a duplicated hypophyseal fossa and posterior clinoid processes, notch of the upper sphenoid, prominent inner relief of the skull, inverse shape of the foramen magnum, third occipital condyle, partial aplasia of the anterior and posterior arches of the atlas with a left arcuate foramen, duplication of the odontoid process and the C2 body, and fusion of the C2-C4 and T12-L1 vertebrae. The MSCT angiography presented a segmental dilatation of both vertebral arteries and the A2 segment of the anterior cerebral artery, as well as a duplication of the basilar artery. CONCLUSIONS: This patient is unique due to complex craniovertebral congenital anomalies associated with a duplication of the pituitary gland.

Klippel-Feil Syndrome With Isolated Facial Dysmorphism: A Clinical Conundrum With Resemblance to Adenoid Facies.

Klippel-Feil syndrome (KFS) is a triad comprising cervical spine fusion, a low posterior hairline, and constrained neck movement. This triad is not universally present. The most frequent accompaniment is Sprengel's scapula deformity. According to the Feil classification, Class 1 (C1) is an immense fusion of many cervical vertebrae, Class 2 (C2) is a fusion of one or two vertebrae only, and Class 3 (C3) is coupled with thoracic and lumbar spinal vertebral fusion in addition to the fusion of the cervical vertebrae. Clarke's categorization of KFS includes other associated anomalies. The different classification systems for KFS have been made by the different specialists to whom patients may present, which include orthopedic surgeons, neurosurgeons, orthodontists, faciomaxillary surgeons, cardiologists, and pediatricians. This anomaly being rare and the lack of universally accepted classification may lead to confusion regarding the identification of the syndrome, especially the Clarke Type 3 with isolated facial dysmorphism may go undiagnosed. We report a case with KFS-Clarke Type 3 with isolated facial dysmorphism and Feil Type 2 with the fusion of C2-C3 cervical vertebrae, detected as an incidental radiologic finding, and initial impression of adenoid facies. Hence, this case also highlights the contrasting features between the facial dysmorphism of Clarke Type 3 KFS and adenoid facies.

Cardiopulmonary Complications of Klippel-Feil Syndrome: A Case Report.

Klippel-Feil syndrome is characterized by the congenital synostosis of multiple cervical vertebrae and commonly presents with a multitude of congenital abnormalities, mainly including cardiac and respiratory defects. We present the case of a 39-year-old male with a prolonged history of cardiopulmonary symptoms whose investigations revealed restrictive lung disease, ventricular trigeminy and bigeminy, cervical vertebrae fusion, thoracic lumbar scoliosis, and mild-to-moderate pulmonary hypertension, all consistent with a diagnosis of Klippel-Feil syndrome. His management focused on preventing the progression of these findings while minimizing the effects of his extrinsic pulmonary restriction. Given the lack of guidelines in the management of such patients, this report highlights the role of early diagnosis and adequate management of such patients to reduce its progression and prevent the development of complications.

Automatic 3D analysis of the ex-vivo porcine lumbar interbody fusion based on X-ray micro computed tomography data.

Spinal fusion is a surgical procedure used to join two or more vertebrae to prevent movement between them. This surgical procedure is considered in patients suffering from a wide range of degenerative spinal diseases or vertebral fractures. The success rate of spinal fusion is frequently evaluated subjectively using X-ray computed tomography. The pig was chosen as an animal model for spinal fusion, since its spinal structure is similar to the human spine. Our paper presents an automatic approach for pig's spinal fusion evaluation in 3D. The proposed approach is based on the determination of the vertebral fused area, which reflects the fusion quality. The approach was applied and tested on microCT (µCT) data of fused porcine vertebrae ex-vivo. In our study, three types of implants were used to perform spinal fusion: the iliac crest bone graft used as the gold standard, and two types of novel scaffold implants based on the polymer/ceramic porous foam involving either growth factors or polyphosphates. The evaluation worked automatically for all three types of used implants, and the fusion quality was determined quantitatively. The calculation is based on the detection of the fused area and area of facies intervertebralis, so the percentual representation of the vertebral joint can be determined. Since this approach is versatile and is described in detail as a guide for image processing the data of vertebrae fusion, this methodology has the potential to establish a standard approach for evaluating the fusion quality in ex-vivo samples that can be tested on clinical data.

The Clinical Significance of Lumbosacral Transitional Vertebrae on the Surgical Outcomes of Lumbar Discectomy: A Retrospective Cohort Study of Young Adults.

OBJECTIVE: To evaluate whether the presence of lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of microdiscectomy (MD) in young adults with lumbar disc herniation. METHODS: We retrospectively included 398 patients who were followed-up for at least 2 years after MD for lumbar disc herniation at L4/5 (disc above the LSTV). The patients were divided into 2 groups. Group A was made up of 31 patients in whom LSTV was detected. Group B, in contrast, was made up of 35 patients in whom LSTV was not detected. The LSTV were classified using plain radiographs and three-dimensional computed tomography by Castellvi et al. The primary outcome measure was pain intensity at each follow-up visit assessed with visual analog scale for back and leg. Secondary outcome measures included the Oswestry Disability Index, a 12-item short-form health survey for quality of life, complications, and recurrence rate. RESULTS: After surgery, the visual analog scale scores for the back and leg decreased significantly in both groups. However, the back pain intensity in group A worsened at 12 and 24 months postoperatively. The Oswestry Disability Index scores and 12-item short-form health survey (both mental and physical) worsened at 12 and 24 months postoperatively in group A. Two cases of reherniation (6.5 %) were observed in group A, who required reoperation. CONCLUSIONS: LSTV can limit a patient's clinical improvement after MD with regard to pain intensity and recurrence. Caution must be taken when a patient is scheduled to undergo surgery.

Complex phenotype associated with 17q21.31 microdeletion.

We report on a patient carrying a 17q21.31 microdeletion and exhibiting many common syndrome features, together with other clinical signs which have rarely or never been described to date. The detected 695-kb 17q21.31 deletion is larger than in most previously reported cases but is still probably the result of recombination between flanking low-copy repeats. Due to the complexity of the patient's clinical condition, together with the presence of 3 previously unreported symptoms, namely chronic anemia, cervical vertebrae arthrosis and vertebrae fusion, this case is an important addition to the existing knowledge about the 17q21.31 microdeletion syndrome.

Asociación de paladar fisurado y sindrome de Klippel-Feil / Cleft palate and Klippel-Feil syndrome: a case report

El síndrome de Klippel-Fiel, Distrofia Brevicollis Congénita, Sinostósis Congénito Cervical o Fusión de las Vértebras Cervicales, consiste en la fusión de, al menos, dos de las siete vértebras del cuello. Se caracteriza por la presencia de una tríada clásica compuesta por cuello corto, baja inserción de la línea del cabello y limitación de los movimientos del cuello. Pero además se puede acompañar de una serie de condiciones tales como: escoliosis, tortícolis, deformidad de Sprengel, malformaciones cardiovasculares, renales, auditivas y paladar fisurado entre otros. La aparición del paladar fisurado en pacientes con el síndrome de Klippel-Feil se presenta entre el 5 y el 10 de los casos. Como posibles causas primarias de la falta de fusión del paladar se han reportado las anomalías de la columna cervical superior y alteraciones en la base del cráneo, defectos que impiden la fusión de las dos apófisis horizontales de los maxilares. Con este artículo se reporta el caso de una niña de una niña de 10 años que presenta Síndrome de Klippel-Feil asociado con la deformidad de Sprengel y Paladar fisurado.

Kippel-Feil syndrome is a condition characterized by shortness of the neck resulting from reduction in the number of vertebrae or the fusion of multiple hemivertebrae into one osseous mass. It is characterized by a classic triad: short neck, low hair insertion line and limited neck movements. There are some associated conditions that could be presents like scoliosis, wryneck, Sprengel deformation, cardiovascular, kidney, hearing troubles and fissured palate. Kippel-Feil syndrome had been reported as an important cause of about 5 to 10 of fissured palate because skull basal lesions and spine cervical upper alterations could be the primary troubles for the tow part of the palate bone union. This article presents a case of Klippel-Feil syndrome, Sprengel deformity and clef palate associated in a ten years old girl.