1/561. Transoral fusion with internal fixation in a displaced hangman's fracture.STUDY DESIGN: A case is reported in which late displacement of a "hangman's fracture" was managed by transoral C2-C3 fusion by using bicortical iliac crest graft and a titanium cervical locking plate. OBJECTIVES: To review the management of unstable fractures of the axis and to study other reports of transoral instrumentation of the cervical spine. SUMMARY OF BACKGROUND DATA: Undisplaced fractures of the axis are considered to be stable injuries. Although late displacement is unusual, it can lead to fracture nonunion with persisting instability and spinal cord dysfunction. In this situation, an anterior fusion of the second and third cervical vertebrae is preferred to a posterior fusion from the atlas to the third cervical vertebra, which would abolish lateral rotation between C1 and C2. methods: The literature on hangman's fractures was reviewed. Clinical and radiographic details of a case of C2 instability were recorded, and the particular problems posed by late displacement were considered. RESULTS: There are no other reports of transoral instrumentation of the cervical spine. A sound fusion of C2-C3 was obtained without infection or other complications. Good neck movement returned by 6 months after surgery. CONCLUSION: Undisplaced fractures of the axis are not always stable. The transoral route allows good access for stabilization of displaced hangman's fractures. In special circumstances, a locking plate may prove useful in securing the bone graft. The cervical spine locking plate can be inserted transorally with no complications and by using standard instrumentation.- - - - - - - - - - ranking = 1keywords = spinal, spine (Clic here for more details about this article) |
2/561. Extension of phenotype associated with structural mutations in type I collagen: siblings with juvenile osteoporosis have an alpha2(I)Gly436 --> Arg substitution.Mutations in the type I collagen genes have been identified as the cause of all four types of osteogenesis imperfecta (OI). We now report a mutation that extends the phenotype associated with structural abnormalities in type I collagen. Two siblings presented with a history of back pain and were diagnosed with juvenile osteoporosis, based on clinical and radiological examination. Radiographs showed decreased lumbar bone density and multiple compression fractures throughout the thoracic and lumbar spines of both patients. One child has moderate short stature and mild neurosensory hearing loss. However, neither child has incurred the long bone fractures characteristic of OI. Protein studies demonstrated electrophoretically abnormal type I collagen in samples from both children. Enzymatic cleavage of rna:rna hybrids identified a mismatch in type I collagen alpha2 (COL1A2) mRNA. dna sequencing of COL1A2 cDNA subclones defined the mismatch as a single-base mutation (1715G --> A) in both children. This mutation predicts the substitution of arginine for glycine at position 436 (G436R) in the helical domain of the alpha2(I) chain. Analysis of genomic dna identified the mutation in the asymptomatic father, who is presumably a germ-line mosaic carrier. The presence of the same heterozygous mutation in two siblings strongly suggests that the probands display the full phenotype. Taken together, the clinical, biochemical, and molecular findings of this study extend the phenotype associated with type I collagen mutations to cases with only spine manifestations and variable short stature into adolescence.- - - - - - - - - - ranking = 0.420878814481keywords = spine (Clic here for more details about this article) |
3/561. Lumbar intraspinal synovial cysts of different etiologies: diagnosis by CT and MR imaging.Intraspinal synovial cysts arises from a facet joint and may cause radicular symptoms due to nerve root compression. In the present study, three surgically and histologically proved cases of synovial cyst of the lumbar spine with different etiology are described. The purpose of this report is to illustrate the imaging features of various etiologies of intraspinal synovial cysts allowing a correct preoperative diagnosis. review of the literature enables us to say that to our knowledge, there is no reported article collecting the imaging findings of intraspinal synovial cysts with different etiologies. Only single cases with rheumatoid arthritic or traumatic origin have been reported to date. We believe that computed tomography and particularly magnetic resonance imaging are the methods of choice which provide the most valuable diagnostic information.- - - - - - - - - - ranking = 2.79121185519keywords = spinal, spine (Clic here for more details about this article) |
4/561. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures.PURPOSE: To describe the presentation and management of complete upper airway obstruction with life threatening arterial oxygen desaturation that occurred during attempted awake fibreoptic intubation in two patients presenting with unstable C-spine injury. CLINICAL FEATURE: Complete upper airway obstruction occurred during awake fibreoptic intubation of two men (ASA II; 68 & 55 yr old) presenting with unstable C-spine fractures. In both cases, bag and mask ventilation with CPAP failed to relieve the progressive hypoxemia. A surgical airway was established urgently to oxygenate the two patients who were suffering progressive life-threatening oxygen desaturation. One patient had trans-cricothyroid jet ventilation performed through a 16G intravenous cannula prior to an urgent tracheostomy. In the other patient, an emergency tracheostomy was inserted. Interestingly, both patients had been sedated in the Neurosurgical intensive care Unit with morphine and benzodiazepines before their scheduled surgeries. The most likely etiology for the complete upper airway obstruction was laryngospasm due to inadequate topicalization of the airway and additional sedation given in the operating room. Neither patients suffered any new neurological deficits following these events. They went on to have uneventful surgeries. CONCLUSION: This case report suggest that prior to awake fibreoptic intubation, oxygenation, adequate topicalization with testing to verify the lack of pharyngeal and laryngeal responses and careful assessment of sedation levels in the operating room are prudent for a safe endoscopic intubation.- - - - - - - - - - ranking = 1.262636443443keywords = spine (Clic here for more details about this article) |
5/561. Type I osteogenesis imperfecta: diagnostic difficulties.A 65-year-old woman presented with vertebral fractures of the lumbar spine and a history of pathological fractures following minor trauma, which had occurred before the onset of menopause. Her past medical history was significant for intermittent low back pain since childhood, which was attributed to thoracolumbar scoliosis. A diagnosis of unclassifiable osteoporosis was made until invasive diagnostic procedures suggested a mild form of type I osteogenesis imperfecta (OI). In unclear or atypical perimenopausal osteoporosis and diagnosis of OI should be considered.- - - - - - - - - - ranking = 0.2104394072405keywords = spine (Clic here for more details about this article) |
6/561. Bochdalek hernia in adulthood: a case report and review of recent literature.A 37-year-old Filipino woman presented with a post road-traffic accident fracture of dorsal spine 12. Chest radiograph revealed evidence of loops of small bowel in the left lung field. She admitted to symptoms of respiratory insufficiency since birth and treatment for tuberculosis in childhood. A pre-operative diagnosis of left traumatic diaphragmatic hernia was not confirmed at laparotomy which revealed typical left congenital Bochdalek hernia with smooth edges and herniation of small bowel and spleen into the left pleural cavity. Following reduction and repair of the hernia, the patient made an uneventful recovery. Chest radiograph remains normal till now, eight years post-operatively.- - - - - - - - - - ranking = 0.2104394072405keywords = spine (Clic here for more details about this article) |
7/561. Fatty infiltration of osseous structures: a long-term complication of oleothorax--case report.Thoracic imaging of a patient treated for pulmonary tuberculosis with oleothorax therapy before the antibiotic era demonstrated a rare complication. Gross invasion by lipid with subsequent pathologic fracture of the adjacent thoracic vertebra may give rise to symptomatic spinal cord compression. magnetic resonance imaging is a useful modality for help in diagnosing treatment complications of oleothorax.- - - - - - - - - - ranking = 0.36868177827849keywords = spinal (Clic here for more details about this article) |
8/561. Detection of vertebral artery injury after cervical spine trauma using magnetic resonance angiography.BACKGROUND: We prospectively describe the incidence, magnetic resonance-based diagnosis, and treatment of vertebral artery (VA) injury resulting from closed cervical spine trauma. methods: patients with fracture or dislocation on plain radiographic studies underwent computed tomography. Among these patients, the subset with computed tomographic evidence of foramen transversarium (FT) fracture underwent magnetic resonance angiography as early as possible. RESULTS: During a 16-month period, 38 patients with closed cervical trauma were treated. Twelve patients demonstrated fracture extension through at least one FT by computed tomography. Among these patients, four showed unilateral VA injury by magnetic resonance angiography, all ipsilateral to the fractured FT. Three cases of VA occlusion and one of focal narrowing were demonstrated. All four patients were initially treated with aspirin, and two were systemically anticoagulated. None developed irreversible neurologic deficits from the VA compromise. CONCLUSION: Our data suggest that the incidence of VA injury in closed cervical spine trauma is significant and that FT fractures warrant flow-sensitive magnetic resonance imaging.- - - - - - - - - - ranking = 1.262636443443keywords = spine (Clic here for more details about this article) |
9/561. 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 = 2.579121185519keywords = spinal, spine (Clic here for more details about this article) |
10/561. Bisegmental rotational fracture dislocation of the pediatric cervical spine. A case report.STUDY DESIGN: A case of a bisegmental rotational fracture dislocation in the pediatric cervical spine is presented. OBJECTIVES: To highlight the problems in the diagnostics and surgical management of this rare type of injury. SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine are relatively uncommon in childhood. To the authors' knowledge, this is the first reported case of a bisegmental rotational fracture dislocation in the pediatric cervical spine managed by a combined anteroposterior approach. methods: A 6-year-old girl was hit by a car as a pedestrian. In addition to an open fracture dislocation of the Lisfranc joint in the right foot, she sustained a bisegmental fracture dislocation at the lower cervical spine (C3-C5) with no neurologic deficit. The complete diagnosis of a locked rotational fracture dislocation could be established only by using computed tomography scans with three-dimensional reconstructions. The injury was managed with a combined anteroposterior open reduction and a bisegmental anterior fusion. RESULTS: Implant removal was performed after bony fusion 6 months after surgery. At follow-up assessment 2.5 years later, the girl had a good radiologic result and a full and pain-free functional recovery. CONCLUSIONS: Bisegmental rotational fracture dislocations in pediatric cervical spines are not easily diagnosed and may require three-dimensional computed tomography scan reconstructions for complete assessment. In such rare cases, a combined anteroposterior surgical procedure may be indicated, with a bisegmental anterior fusion providing a good functional result.- - - - - - - - - - ranking = 1.8939546651645keywords = spine (Clic here for more details about this article) |
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