1/22. Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.STUDY DESIGN: This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES: A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA: review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. methods: A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS: An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS: The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/22. Occult ligamentous injury of the cervical spine.Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or "distracting" injuries. In such cases, cervical spine injury that is not apparent on radiographs may be missed. This case report illustrates a purely ligamentous cervical spine injury resulting in cervical instability. We describe our method of screening for and evaluating these types of injuries using physician-controlled stretch, flexion, and extension examination under fluoroscopy.- - - - - - - - - - ranking = 2.5keywords = ligament (Clic here for more details about this article) |
3/22. Traumatic atlantoaxial distraction injury: a case report.STUDY DESIGN: Case report. OBJECTIVES: Description of a rarely reported variant of traumatic C1-C2 dislocation and discussion of a favorable outcome in a nonsurgical treatment approach. SUMMARY OF BACKGROUND DATA: Atlantoaxial dislocation most commonly involves an anterior movement of C1 in relation to C2. Often, the integrity of the transverse ligament or odontoid process is compromised, and the atlantodental interval changed. The described patient sustained a purely craniocaudal atlantoaxial distractive lesion secondary to injury sustained in a high-speed motor vehicle accident. RESULTS: The initial treatment plan involved surgical stabilization subsequent to healing of a C1 ring fracture. After 12 weeks of external stabilization, ligamentous damage appeared well resolved. That there was no gross instability delayed using a surgical option. At periodic checkup, the patient was without symptoms. CONCLUSION: In this case, conservative management of a ligamentous C1-C2 injury was effective. At 5 years after trauma the patient was without sequelae. This outcome is in contrast to previous management of injuries of this type, all of which involved surgical intervention.- - - - - - - - - - ranking = 1.5keywords = ligament (Clic here for more details about this article) |
4/22. Traumatic occipitoatlantal dislocation.BACKGROUND: Traumatic occipitoatlantal dislocation (OAD) is a severe ligamentous injury resulting in instantaneous death or severe neurological deficit. However, survivors of OAD, both short and long term, have been increasingly reported; this may be because of improved prehospital care, more rapid transportation, a high index of suspicion, and new radiological techniques. methods: The medical records and film of three patients who had traumatic OAD were retrospectively reviewed. diagnosis was made by lateral cervical spine radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Treatment consisted of early respiratory support and subsequent posterior surgical fusion. RESULTS: The three survivors of traumatic OAD represent 3.1% of all cervical spine injuries in our service. Two were children and the other was a 64-year-old man, all of whom suffered from severe neurological deficits. Lateral cervical spine radiographs led to the diagnosis of OAD. Two were longitudinal, and one was anterior. Two patients died within 2 weeks after injury. The remaining patient, who had anterior OAD, survived longer, which allowed posterior fusion with a U-shape Steinman pin and wiring to be performed. However, she died 5 months after injury because of septicemia. CONCLUSION: Early recognition and treatment may improve the outcome of this injury. Treatment consists of early respiratory support and subsequent surgical fusion.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
5/22. airway management after upper cervical spine injury: what have we learned?PURPOSE: survival after atlanto-axial-occipital ligamentous injury is uncommon and experience with the immediate clinical management of these patients is similarly low. There has been considerable work published recently with respect to airway management in similar patients and a review of this material was undertaken. methods: medline searches were performed to seek out the English language literature using the key words and phrases: cervical spinal injury; atlanto-occipital dislocation; atlanto-occipital disarticulation; and airway management after spinal injury. The titles were culled for materials relevant particularly to upper cervical spinal injury, these were obtained and reviewed. The bibliographies of these articles were searched to ensure that the review would be complete. RELEVANT FINDINGS: The majority of cervical spinal movement occurring during direct laryngoscopy is concentrated in the upper cervical spine. The magnitude of movement during airway management rarely exceeds the physiological limits of the spine. movement is reduced by in-line immobilization but traction forces cause clinically important distraction and should be avoided. Indirect techniques for tracheal intubation cause less cervical movement than does the direct laryngoscope. survival after severe upper ligamentous injury is uncommon but intact survival occurs. Missed diagnosis is common and associated with a high incidence of severe secondary injury. Failure to immobilize the spine is deemed to be the most relevant factor in secondary injury. CONCLUSIONS: patients who survive severe upper cervical ligamentous injury and present to hospital are uncommon. However, of those who do, both intact survival and survival with limited neurological sequelae do occur. Meticulous airway care with maintenance of alignment and provision of continuous cervical immobilization are an integral component of care in these patients.- - - - - - - - - - ranking = 1.5keywords = ligament (Clic here for more details about this article) |
6/22. Spinal injury considerations in the competitive diver: a case report and review of the literature.BACKGROUND CONTEXT: Despite significant literature associated with spinal injuries and recreational diving, few articles exist regarding competitive diving injuries, with no reports pertaining specifically to spinal injuries. As a result, a case report of a collegiate diver with C5-C6 ligamentous instability requiring operative stabilization is currently presented in addition to a review of the literature. PURPOSE: Present a case report of cervical C5-C6 ligamentous instability in a collegiate diver. STUDY DESIGN: Case report and literature review. methods: Not applicable. RESULTS: Not applicable. CONCLUSIONS: diving injuries pertaining to competitive diving do occur but to a lesser extent than would be expected given the large forces the spine experiences. Training, experience and appropriate technique greatly minimize potential spinal hazards. Persistent complaints of neck pain after a competitive diving injury mandate aggressive evaluation and further workup.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/22. Minimally invasive lateral mass plating in the treatment of posterior cervical trauma: surgical technique.OBJECTIVE: The technique of lateral mass fixation restores the posterior tension band and provides effective stabilization in patients with many types of traumatic injuries. However, postoperative wound pain is not uncommon. The objective of this work is to describe a modified technique of minimally invasive lateral mass plating for cervical spine trauma. methods: Patient 1 was a 64-year-old woman who had been in a motor vehicle accident and sustained bilateral C5-C6 facet dislocation with posterior C5-C6 distraction. She was otherwise neurologically intact, and attempts at closed reduction were not successful. Patient 2 was a 16-year-old girl who had also been in a motor vehicle accident but had an incomplete spinal cord injury. She had an unstable burst fracture of C7 with posterior C5-C6 distraction. Both patients underwent anterior cervical fusion followed by staged minimally invasive posterior fusion with good results. A dilator tubular retractor system (METRX) was used to access the bilateral lateral masses through a small midline incision under fluoroscopic guidance. Lateral mass screws were then placed by using a modified Magerl technique, securing two-hole plates on each side onto the lateral masses, performed through the METRX system. We also successfully performed four-level lateral mass plating in a cadaveric cervical spine using a 2-cm skin incision. CONCLUSIONS: We describe successful placement of lateral mass screw and plate constructs with the use of a minimally invasive approach by means of a tubular dilator retractor system. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
8/22. A C1-2 locked facet in a child with atlantoaxial rotatory fixation. Case report.Conservative treatment is reported in a child with atlantoaxial rotatory fixation. Three-dimensional (3D) computerized tomography (CT) and magnetic resonance (MR) imaging demonstrated the degree of dislocation and alar ligament damage. A rigid cervical collar and muscle relaxant agents without any traction allowed full recovery. Control 3D CT scanning and MR imaging findings are reported.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
9/22. Infolding of the ligamentum flavum: a cause of spinal cord compression after reduction of cervical facet injuries.Controversy exists regarding management of cervical facet injuries. Previous literature has focused on associated disc herniations reported to cause neurologic injury upon reduction. Although rupture of the ligamentum flavum has been noted with these injuries, its clinical significance has not been examined. In this case report, we present two patients in whom neurologic deterioration occurred due to infolding of the torn ligamentum flavum with spinal cord compression after reduction of cervical facet subluxations. Both had large flaps of ligamentum flavum arising from the caudal lamina which infolded upon reduction and became trapped between the spinal cord and cephalad lamina. Both patients regained normal motor function after removal of the pathologically infolded ligamentum. Neither patient had a disc herniation, hypotensive/anemic/hypoxic event, or epidural hematoma that could have otherwise been causative of the neurologic deficit. Pathologic infolding of ligamentum flavum, in addition to extruded disc herniations, should be recognized as another potential cause for spinal cord compression with reduction of cervical facet injuries. In particular, if there is a long flap of flavum arising from the caudal lamina poised to become entrapped in the spinal canal with reduction and the patient has a congenitally narrow canal, the surgeon should consider removal of the ligamentum flavum prior to reduction.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
10/22. Unusual sciatica: traumatic rupture of the ligamentum flavum.We describe a case of acute traumatic rupture of the ligamentum flavum. A condition occurring where there had been histological evidence of previous ligamentous damage. The symptoms were extreme and the surgical treatment highly effective.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
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