Search Results (7)

Cervical spine injuries that impact young horses and foals can result in mild to severe neurological signs or even result in sudden death. There are only a few reports on conservative treatment options for this condition in the scientific literature. If the condition is left untreated, it can lead to the development of degenerative joint disease, resulting in chronic neurological symptoms and discomfort. We present the case of a two-day-old Arabian foal that showed signs of ataxia following a neck injury, being the result of cervical spine subluxation. Radiological examination revealed a dislocation between the second and third cervical vertebrae. At admission to the clinic on the seventh day of life, the foal’s clinical examination parameters were within physiological ranges. The head posture at the presentation was consistently low, the foal could not lift its head above the shoulder joint throughout the whole examination, the neck muscles were spastically tensed and clinical signs of ataxia were present. The foal underwent a closed reduction in the subluxation under general anesthesia and a fiberglass semicircular gutter was created to stabilize the neck in the desired position. The ataxia symptoms began to improve around day 12 post manipulation, and the fiberglass stabilizer was removed after 16 days post manipulation, followed by radiographs. The dislocation of C2/C3 was no longer visible on the radiographs, and the foal was able to assume a normal neck posture after the removal of the fixator. Full article

Background/Objectives: Occipital condyle fractures (OCFs) can be seen in around 4–19% of patients who suffer from cervical spine trauma. Anderson and Montesano system type III OCFs, which are avulsion fractures, are potentially unstable and operative. This study evaluates the management of type III OCFs at our institution over a 22-year period. Methods: This retrospective study reviewed all cases of type III OCFs at our institution from July 2001 to March 2023, identified via imaging reports. Using the in-house radiology imaging informatics system “Doris” (Dig Our Radiology Information System), reports containing the terms subluxation, avulsion, unstable, or type 3/III with occipital condyle, occipital condylar, occipital fx, or occipital fracture were collected. We also searched for Montesano type III/3 fracture. Electronic medical records were used to collect clinical and demographic data. Patients evaluated by the neurosurgical team with at least 1 month of follow-up were included in the analysis. Results: A total of 563 patients were identified with type III OCFs. A total of 56 patients met the inclusion criteria. The majority (91%, 51/56) were treated conservatively with cervical orthosis. A small subset (8.9%, 5/56) underwent occipito-cervical fusion. Three had concomitant unstable C1 fractures, while the other two had significant coronal deformity associated with their type III OCF. Conclusions: At our institution, type III OCFs are predominantly managed with cervical orthosis. Only those with an associated malalignment of the occipito-cervical joint underwent fusion. These findings suggest that most type III OCFs can be treated conservatively with orthosis once stability is confirmed with an upright radiograph. Full article

Background and Objectives: C-arm-free MIS techniques can offer significantly reduced rates of postoperative complications such as inadequate decompression, blood loss, and instrumentation misplacement. Another advantageous long-term aspect is the notably diminished exposure to radiation, which is known to cause malignant changes. This study emphasizes that, in some cases of spinal conditions that require a procedural intervention, C-arm-free MIS techniques hold stronger indications than open surgeries guided by image intensifiers. Materials and Methods: This study includes a retrospective analysis and review of various cervical and thoracic spinal procedures, performed in our hospital, applying C-arm-free techniques. The course of this study explains the basic steps of the procedures and demonstrates postoperative and intraoperative results. For anterior cervical surgery, we performed OPLL resection, while for posterior cervical surgery, we performed posterior fossa decompression for Chiari malformation, minimally invasive cervical pedicle screw fixation (MICEPS), and modified Goel technique with C1 lateral mass screw for atlantoaxial subluxation. Regarding the thoracic spine, we performed anterior correction for Lenke type 5 scoliosis and transdiscal screw fixation for diffuse idiopathic skeletal hyperostosis fractures. Results: C-arm-free techniques are safe procedures that provide precise and high-quality postoperative results by offering sufficient spine alignment and adequate decompression depending on the case. Navigation can offer significant assistance in the absence of normal anatomical landmarks, yet the surgeon should always appraise the quality of the information received from the software. Conclusions: Navigated C-arm-free techniques are safe and precise procedures implemented in the treatment of surgically demanding conditions. They can significantly increase accuracy while decreasing operative time. They represent the advancement in the field of spine surgery and are hailed as the future of the same. Full article

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease among children. In some patients, cervical spine arthritis remains a serious and chronic manifestation of JIA. The aim of this study was to assess the frequency of cervical spine lesions on radiographs and MRI in JIA patients with clinical signs of cervical spine involvement and to verify if with the addition of MRI, the use of radiographs could be abandoned. Methods: This retrospective study evaluated consecutive 34 children (25 girls; aged 6–18 years, median 15.5 years) with JIA and with clinical involvement of cervical spine. In each patient, both radiographs and MRI of the cervical spine were performed. Imaging findings were correlated with clinical and laboratory data. Results: The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxations (SAS; 24%), apophyseal joint ankylosis (9%), and C1/C2 joint lesions (9%). Anterior atlanto-axial subluxation (AAS) was diagnosed only by radiography, and most of the SAS were seen on radiography, whereas only a few on MRI. Reversely, C1/C2 soft tissue involvement were seen on MRI only. Cervical spine involvement was associated with raised ESR (p = 0.012) and CRP (p = 0.014). Conclusions: The cervical spine lesions are still frequent complication of JIA affecting up to 35% of JIA patients. Most of them develop serious complications, such as AAS and ankylosis. Despite advantages of MRI in terms of the imaging of the atlanto-axial region radiography shows superiority in diagnosis of AAS and SAS. Full article

Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: Overall, 240 consecutive patients with RA were referred for imaging by clinicians based on symptoms suggesting cervical spine involvement and/or long disease duration. In each patient, lateral radiographs and MRI of the cervical spine were performed. The imaging data were correlated with clinical records and laboratory data. Results: The cervical spine was affected in 179 patients (75%). The most common lesions were anterior atlanto-axial subluxation (AAS; 58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked to longer disease duration (p = 0.007), the presence of rheumatoid factor (RF; p = 0.010), elevated C-reactive protein (CRP) levels (p = 0.016), and accelerated erythrocyte sedimentation rate (ESR; p = 0.025). Longer disease duration was associated with anterior AAS (p = 0.005), subaxial subluxation (p = 0.005), and basilar settling (p = 0.003). Conclusions: As many as 75% of RA patients develop lesions that can be observed on radiographs and through MRI. The most frequent radiological findings include anterior AAS and subaxial subluxation. Long disease duration, RF seropositivity, and elevated inflammatory markers were risk factors for cervical spine involvement. Full article

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson–Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson–Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson–Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5–14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3–11 points) and SF-36 score (median: 91 points; range: 64–96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest. Full article

Cervical myelopathy occurs in approximately 2.5% of patients suffering from rheumatoid arthritis (RA) and is associated with notable morbidity and mortality. However, the surgical management of patients affected by cervical involvement in the setting of RA remains challenging and not well studied. To address this, we conducted a retrospective analysis of our clinical database between May 2007 and April 2017, and report on nine patients suffering from cervical myelopathy due to RA. We included patients treated surgically for cervical myelopathy on the basis of diagnosed RA. Clinical findings, treatment and outcome were assessed and reported. In addition, we conducted a narrative review of the literature. Four patients were male. Mean age was 64.8 ± 20.5 years. Underlying cervical pathology was anterior atlantoaxial instability (AAI) associated with retrodental pannus in four cases, anterior atlantoaxial subluxation (AAS) in two cases and basilar invagination in three cases. All patients received surgical treatment via posterior fixation, and in addition two of these cases were combined with a transnasal approach. Preoperative modified Japanese orthopaedic association scale (mJOA) improved from 12 ± 2.4 to 14.6 ± 1.89 at a mean follow-up at 18.8 ± 23.3 months (range 3–60 months) in five patients. In four patients, no follow up was available, and the mJOA of these patients at time of discharge was stable compared to the preoperative score. One patient died two days after surgery, where a pulmonary embolism was assumed to be the cause of mortality, and one patient sustained a temporary worsening of his neurological deficit postoperatively. Surgery is generally an effective treatment method in patients with inflammatory arthropathies of the cervical spine. Given the nature of the RA and potential instability, fixation in addition to cord decompression is generally required. Full article