1/268. Delayed dislocation of radial head following upper radial epiphysial injury.Injury to the upper radial epiphysis is mainly a radiological diagnosis. Delayed dislocation of the radial head following such injuries, where there is no evidence of primary subluxation or dislocation, has not been recorded in the literature. We have identified three such cases that needed open reduction. As long term results of delayed treatment of dislocation of any joint is not good, we advocate the awareness of this complication and also a longer period of routine follow-up (up to a year) of all upper radial epiphysial injuries, to avoid a catastrophe in an entirely preventable situation.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
2/268. Spontaneous regression of periodontoid pannus mass in psoriatic atlantoaxial subluxation. Case report.STUDY DESIGN: A case report of a 41-year-old man with psoriasis who had cervical myelopathy caused by atlantoaxial subluxation and periodontoid pannus mass. OBJECTIVE: To describe the possible mechanism underlying the periodontoid pannus formation and the optimal treatment for such cases. SUMMARY OF BACKGROUND DATA: Atlantoaxial subluxation causing spinal cord compression at the craniocervical junction may develop in patients with rheumatoid or psoriatic arthritis. Periodontoid pannus formation plays an important role in compromising the anteroposterior diameter of the spinal canal and in causing neurologic deficits. Transoral transpharyngeal excision of the pannus is sometimes thought necessary for anterior decompression of the spinal cord. Spontaneous resolution of the periodontoid pannus after posterior atlantoaxial fusion and fixation has been documented in rheumatoid arthritis, but not in psoriatic arthritis. methods: The patient underwent posterior atlantoaxial fusion and Halifax fixation. RESULTS: The patient experienced clinical improvement. Regression of the periodontoid pannus mass was observed on magnetic resonance imaging. CONCLUSIONS: Posterior fusion and instrumentation resulted in spontaneous regression of the pannus mass and symptomatic relief. This report provides evidence that atlantoaxial instability may be the sine qua non for the formation of periodontoid pannus, and that amelioration of such instability leads to spontaneous resolution of the pannus mass.- - - - - - - - - - ranking = 36.457609333738keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
3/268. Atlanto-occipital subluxation/dislocation: a "survivable" injury in children.Atlanto-occipital dislocation occurs more often in children due to the laxity of the ligamentous structures anchoring the occiput to the axial skeleton. The mechanism of action usually involves a sudden acceleration-deceleration force on the head of the child. The dislocation usually severs the spinal cord at the foramen magnum, resulting in acute respiratory arrest. We have managed four patients who sustained this injury and arrived at our trauma center with signs of life. Two patients were hemodynamically unstable, had positive diagnostic peritoneal lavage, and underwent splenectomy. Both patients had obvious separation of the occiput and C1 on lateral cervical spine films. Both remained very unstable and died soon after celiotomy. The other two patients were stabilized, and both met criteria for brain death; one family agreed to organ donation. A 5-year analysis revealed 57 pediatric deaths, with 10 patients sustaining atlanto-occipital dislocations (17.5%). Nine of 10 patients sustained other injuries, but in only 2 patients were the injuries immediately life-threatening. With continued improvement in emergency medical systems and pediatric trauma care, we can expect to see more pediatric patients with this injury arriving in trauma centers with signs of life. In our experience, 50 per cent of patients may meet organ donor criteria, and our incidence of this injury (17.5%) reveals atlanto-occipital dislocation as a major contributor to pediatric trauma mortality.- - - - - - - - - - ranking = 15.745879023313keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
4/268. Adjacent fracture-dislocations of the lumbosacral spine: case report.OBJECTIVE AND IMPORTANCE: Traumatic fracture-dislocations of the lumbosacral junction are rare, with all previously reported cases involving fracture-dislocations at a single level. No cases of multiple fracture-dislocations of contiguous spinal segments in the lumbosacral spine have been reported. A case of traumatic adjacent fracture-dislocations of the fifth lumbar segment is presented. CLINICAL PRESENTATION: An 18-year-old male patient sustained open lumbar spinal trauma after a motor vehicle accident. A neurological examination revealed an L4 level. Radiographic evaluation of the spine revealed a three-column injury at L5 with spondyloptosis of the L5 vertebral body. Aorto-ilio-femoral angiography revealed no evidence of vascular injury. INTERVENTION: The patient was treated with a combined anterior and posterior approach in a two-stage operation. Six months postoperatively, he was neurologically unchanged; however, he was able to walk with the aid of a cane. Plain films revealed normal alignment of the lumbosacral spine. CONCLUSION: The management of traumatic lumbosacral fracture-dislocations requires careful consideration of retroperitoneal structures and possible exploration of the iliac vessels in addition to spinal reconstruction.- - - - - - - - - - ranking = 14.897553861336keywords = spinal (Clic here for more details about this article) |
5/268. Vertical atlantoaxial dislocation.An unusual case of vertical atlantoaxial dislocation without medulla oblongata or spinal cord injury is reported. The pathogenic process suggested occipito-axial dislocation. The case was treated surgically with excellent results on mobility and pain.- - - - - - - - - - ranking = 15.745879023313keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
6/268. Craniocervical junction synovial cyst associated with atlanto-axial dislocation--case report.A 51-year-old female presented with a rare case of synovial cyst at the cruciate ligament of the odontoid process associated with atlanto-axial dislocation, manifesting as a history of headache and numbness in her left extremities for 5 months, and progressive motor weakness of her left leg. neuroimaging studies revealed a small cystic lesion behind the dens, which severely compressed the upper cervical cord, and atlanto-axial dislocation. The cyst was successfully removed via the transcondylar approach. C-1 laminectomy and foramen magnum decompression were also performed. Posterior craniocervical fusion was carried out to stabilize the atlanto-axial dislocation. The cyst contained mucinous material. Histological examination detected synovial cells lining the fibrocartilaginous capsule. Synovial cysts of this region do not have typical symptoms or characteristic radiographic features. Careful preoperative evaluation of the symptoms and a less invasive strategy for removal of the cyst are recommended.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
7/268. Conservative management of C5-C6 fracture-luxation in the elderly. Case report.The case of a 86-year-old female victim of cervical trauma with C5-C6 fracture-luxation and bilateral locked facets is hereinafter described. The case was reputed representative of the complexity in deciding between conservative and surgical treatment in spine surgery. Conservative management would have been dictated by the additional risks linked to the age of the patient, whereas the surgical treatment would have been favored by the easy access to the anterior cervical spine for reduction and fixation. On the way to plan the definitive treatment, the patient died by pulmonary embolism. The controversial aspects and the indication to anticoagulant therapy in spinal surgery, frequently faced in the treatment of spine trauma in patients of this age group, are discussed in this case report.- - - - - - - - - - ranking = 4.9658512871121keywords = spinal (Clic here for more details about this article) |
8/268. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 27.677581597537keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
9/268. Right sternoclavicular dislocation after traumatic delivery: a case report.Sternoclavicular (SC) dislocation is an injury that is very rare in the newborn. Thus far there have been no reports describing this in neonates after a traumatic birth injury. This condition can be difficult to differentiate from epiphyseal separation, which occurs more often in older children. For successful treatment, early diagnosis is essential. Timely surgical reposition and fixation with following immobilization is recommended in instances of complete (SC) dislocation. We report a trauma-induced case of SC dislocation in a neonate successfully managed by polydioxanon cord fixation.- - - - - - - - - - ranking = 1keywords = cord (Clic here for more details about this article) |
10/268. Atlantoaxial rotatory subluxation in patients with marfan syndrome. A report of three cases.STUDY DESIGN: This is a retrospective case series of three patients, ages 9 1/2, 13, and 20 years old, with marfan syndrome treated for atlantoaxial rotatory subluxation. In the first two cases, acute torticollis was noted postoperatively, following pectus excavatum repair. The diagnosis was made in the third patient after she presented to the emergency room with a week-long history of unresolved neck pain following minor trauma. OBJECTIVE: To report and discuss the courses and clinical sequelae of atlantoaxial subluxation in patients with marfan syndrome. SUMMARY OF BACKGROUND DATA: Radiographic analysis of patients with marfan syndrome has shown that increased atlantoaxial translation, larger odontoid height, and basilar impression are more prevalent in this population compared to age-matched controls. Despite these findings, there are sparse data on injuries secondary to cervical spine instability or abnormalities in this population. To the authors' best knowledge, no report of atlantoaxial rotatory subluxation in patients with marfan syndrome exists in the literature. methods: Case records of rotatory instability of the atlanto-axial level were reviewed and are presented in the following report. RESULTS: The first two patients described in this report were noted to have "cock robin" posturing of their necks following pectus excavatum repairs. The first patient's subluxation was partially reduced with halo traction, and he subsequently underwent posterior spinal fusion of C1-C2 with internal fixation. The patient was well aligned postoperatively, and had no neurologic deficits. The second patient's subluxation reduced after 20 days of halter and traction; he was immobilized in a collar following discharge and reduction was maintained. The third patient's subluxation failed to reduce with halo traction; further imaging studies revealed odontoid prominence in the foramen magnum. She underwent posterior spinal fusion, occiput to C3, with satisfactory result. CONCLUSIONS: The cervical bony and ligamentous abnormalities seen in patients with marfan syndrome may slightly increase their risk for atlantoaxial rotatory instability. Special attention to intubation and positioning, both intraoperatively and postoperatively, may be necessary in patients with marfan syndrome. Additionally, rotatory subluxation should be included in the differential diagnosis for Marfan patients with neck pain after injury.- - - - - - - - - - ranking = 10.931702574224keywords = spinal, cord (Clic here for more details about this article) |
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