Presentation
[…] cant number with extensive head and thoracoabdominal injuries are presenting to the emergency room, posing dif?cult problems in the coor- nation of care and timing of selective aspects of management. Survival rates are improving. [books.google.com]
Conclusion: This rare case and presented management strategy underlines the significantly increased mortality rate with high cord injuries. [trauma-acute-care.imedpub.com]
Due to the extreme instability present with this fracture sub-type and the potential for neurological compromise, early recognition of this fracture pattern by the treating physician is imperative to prevent fatal spinal cord injury. [ncbi.nlm.nih.gov]
Symptoms / Presentation Patients generally present with a history of trauma and a symptom of pain in the neck. [scientificspine.com]
On initial presentation his neurologic exam was intact. Injury films are shown in Figure A and B. The patient was evaluated and surgical treatment was recommended. The patient left the hospital against medical advice. [orthobullets.com]
Entire Body System
- Falling
Injuries to the odontoid are common in motor vehicle accidents and falls. The base of the skull (occiput) and atlas (C1) create the atlanto-occipital joint which connects the skull and spine. [chop.edu]
Higher velocity, fall from a height, vertebral tenderness and neurological symptoms ( ASIA Form if neurological signs) are the more important indicators for x-ray. [emed.ie]
The management of this combination is a matter of debate. 1,8,9 Material and Methods: We present a case of a 78 years old woman who sustained a fall on the ground from a couch directly on her forehead, resulting in atlantoaxial dislocation with type II [thieme-connect.com]
[…] single cannulated screw 3 Anterior screw osteosynthesis with two cannulated screws 4 C1-C2 transarticular screws 5 Posterior C1-C2 wiring with autograft ML 4 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ06.263) A 36-year-old male falls [orthobullets.com]
Case 64M, s/p fall down stairs while intoxicated 3 days ago. No LOC. P/w persistent neck pain & right shoulder pain. PMH: EtOH abuse Neuro: AA&Ox3, FC, MAE 5/5, SILT 3. CT C Spine 4. [slideshare.net]
- Weakness
Although the patient experienced slight weakness when spreading his bilateral fingers, his overall condition was good. [springerplus.springeropen.com]
His neurologic status improved to a slight weakness of the right shoulder in abduction (Grade 4/5) after 4 months and his C2 fracture healed in an acceptable position. [journals.lww.com]
Enquire about pain - site, radiation, neurological symptoms, e.g. numbness and weakness. Perform a full neurological examination and include sacral reflexes if evidence of cord injury. [emed.ie]
He had immediate onset of upper and lower extremity weakness. First study the images. Then continue reading. [radiologyassistant.nl]
Patients who have neurologic compression or irritation may have numbness or weakness in the arms and/or legs. There may or may not be associated radiating pain symptoms. [uscspine.com]
Gastrointestinal
- Dysphagia
We present a case of a 30-year-old male with an atlantoaxial dislocation and type II odontoid fracture with a complete tetraplegia, dysphagia and his follow-up. [trauma-acute-care.imedpub.com]
Other findings may be Motor power loss ranging to quadriplegia Feeling of the instability of head on the spine Dysphagia may be present when associated with a large retropharyngeal hematoma Imaging Xrays AP, lateral, open-mouth odontoid view of the cervical [boneandspine.com]
- Nausea
[…] encountered a 17% prevalence in patients after trauma. 5 Clinical Presentation: Patients will present with the following symptoms: Severe muscle spasm, unwilling to move head into flexion, lump in throat, Lip or facial paresthesia, severe headache, dizziness, nausea [morphopedics.wikidot.com]
- Vomiting
[…] prevalence in patients after trauma. 5 Clinical Presentation: Patients will present with the following symptoms: Severe muscle spasm, unwilling to move head into flexion, lump in throat, Lip or facial paresthesia, severe headache, dizziness, nausea, vomiting [morphopedics.wikidot.com]
Musculoskeletal
- Osteoporosis
However, screw fixation is associated with an increased risk for vertebral artery (VA) injury in patients whose VA is found in an anomalous location, or who display abnormal bone morphology or have osteoporosis. [springerplus.springeropen.com]
Odontoid process osteoporosis, angulation, or fracture may also occur. Osteophyte formation is not seen due to deficient osteogenesis. Hook-like appearance of the odontoid due to erosions by pannus is characteristic of RA. [ijri.org]
Skin
Neurologic
- Headache
Atlanto occipital joint is a common cause of headache which chiropractors treat. Atlanto occipital Joint. Meaning of atlantooccipital medical term. What is lateral atlantooccipital ligament? What does atlantooccipital mean? Fractură de odontoidă. [eqeloluyulovuh.cf]
[…] fixation method encountered a 17% prevalence in patients after trauma. 5 Clinical Presentation: Patients will present with the following symptoms: Severe muscle spasm, unwilling to move head into flexion, lump in throat, Lip or facial paresthesia, severe headache [morphopedics.wikidot.com]
Rare, high risk of neurologic deficit Clinical Findings: Cock-robin head position (rotation and contralateral tilt of the head in relation to the lateral mass of C1) Neck pain (increased with attempted passive correction in acute cases) Headache Sternocleidomastoid [posna.org]
[…] manual therapy and exercise may be useful in treatment of mechanical neck disorders. [9] (Level of Evidence 1A) Mobilization and/or manipulation used in combination with exercise are beneficial for persistent mechanical neck disorders with or without headache [physio-pedia.com]
This can be either a vague neck pain or a headache. However, this pain is an extremely nonspecific finding, and these patients will require further evaluation to determine its source. [emedicine.medscape.com]
- Dizziness
[…] encountered a 17% prevalence in patients after trauma. 5 Clinical Presentation: Patients will present with the following symptoms: Severe muscle spasm, unwilling to move head into flexion, lump in throat, Lip or facial paresthesia, severe headache, dizziness [morphopedics.wikidot.com]
- Agitation
On physical examination, he was alert and oriented but agitated. A series of laboratory tests revealed no remarkable findings. Radiographs of the cervical spine showed normal curvature, and no obvious fractures. [pulsus.com]
- Paresthesia
[…] screw and endplate fixation method encountered a 17% prevalence in patients after trauma. 5 Clinical Presentation: Patients will present with the following symptoms: Severe muscle spasm, unwilling to move head into flexion, lump in throat, Lip or facial paresthesia [morphopedics.wikidot.com]
Workup
Mechanism of injury is an important determinant for further workup in this category of patients. [clinicalgate.com]
Treatment
However, a treatment algorithm has not yet been established. The type of treatment should be based on the expected neurological outcome and the severity of dislocation. [trauma-acute-care.imedpub.com]
However, its treatment is complex and dangerous. [healio.com]
Suggest Treatment Indicate how you would treat this patient by completing the following brief survey. Your response will be added to our survey results below. Selected Treatment We elected a posterior occiput-cervical fixation (O-C3). [spineuniverse.com]
Nonoperative treatments include brace (orthotic) treatment and medications. [uscspine.com]
Prognosis
[…] lateral tilt; - it can occur spontaneously or after trauma; - complete C1-C2 dislocation is a known complication of football spearing; - pts complain of neck pain, occipital neuralgia, and occassionally symptoms of vertebrobasilar artery insufficiency; - prognosis [wheelessonline.com]
Pathognomonic radiological signs for predicting prognosis in patients with chronic atlantoaxial rotatory fixation. Journal of neurosurgery. Spine. Nov 2006;5(5):385-391. Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. [posna.org]
Good prognosis. Complete spinal cord injury Total absence of sensation and motor function caudal to the level of injury. [radiologyassistant.nl]
Prognosis Prognosis is good for patients with symptomatic AAI in whom posterior spinal fusion is successful and function returns. [emedicine.medscape.com]
This system assists in determining prognosis and making treatment decisions. 18 The type I fracture is rare, seen in only 2 of 49 cases in the original series and 2 of 340 in the largest series published to date. 10,18 The proposed etiology is avulsion [appliedradiology.com]
Etiology
Etiology congenital os odontoideum Down syndrome (20%) Morquio syndrome spondyloepiphyseal dysplasia osteogenesis imperfecta Marfan disease neurofibromatosis type 1 (NF1) arthritides rheumatoid arthritis psoriatic arthritis Reiter syndrome (reactive arthritis [radiopaedia.org]
The regional anatomy and etiology of os odontoideum are discussed here. [pulsus.com]
The same etiology may also have different clinical manifestations. This study proposed a new clinical classification with the intension of clarifying the clinical manifestations of dislocation. [healio.com]
(Ishii, 2006) MRI Provides soft tissue detail Possible findings: Spinal cord compression Disruption of tranverse atlantal ligament Bone or soft-tissue infection Etiology: Grisel Syndrome Retropharyngeal irritation secondary to upper respiratory infection [posna.org]
This system assists in determining prognosis and making treatment decisions. 18 The type I fracture is rare, seen in only 2 of 49 cases in the original series and 2 of 340 in the largest series published to date. 10,18 The proposed etiology is avulsion [appliedradiology.com]
Epidemiology
New chapters cover casts and epidemiology and prevention of fractures. Elbow injuries are covered in greater detail in two chapters. New information on imaging and new MRI scans have been added. [books.google.com]
Epidemiology: Anatomy 50% rotation of the cervical spine occurs at C1-C2. [posna.org]
The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury. 1992;21:38-40. Hadley MN, Dickman CA, Browner C, Sonntag VK. Acute axis fractures: A review of 229 cases. J Neurosurg. 1989;71:642-647. [appliedradiology.com]
Atlantoaxial instability in individuals with Down syndrome: epidemiologic, radiographic, and clinical studies. Pediatrics. 1987 Oct. 80(4):555-60. [Medline]. Evaniew N, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, et al. [emedicine.medscape.com]
Given the increasing utilization of side airbags in modern automobile production, an additional biomechanical investigation, using a different epidemiological database such as the National Automotive Sampling System, would be needed to better understand [jcvjs.com]
Pathophysiology
Mechanism / Pathophysiology Atlas fractures most commonly resulted from axial loading on the head through the occiput, leading to a burst-type fracture of C1. The mechanism may include hyperextension, lateral compression, and axial compression. [scientificspine.com]
Pathophysiology AAI may occur as a result of abnormalities or trauma associated with the C1-2 articulation, causing excessive movement around this joint. [emedicine.medscape.com]
Prevention
Due to the extreme instability present with this fracture sub-type and the potential for neurological compromise, early recognition of this fracture pattern by the treating physician is imperative to prevent fatal spinal cord injury. [ncbi.nlm.nih.gov]
New chapters cover casts and epidemiology and prevention of fractures. Elbow injuries are covered in greater detail in two chapters. New information on imaging and new MRI scans have been added. [books.google.com]
Particular attention was also paid to mouth care in order to prevent infection of the pharyngeal wound. Postoperative analgesia was provided with I/rn pethidine. [jpma.org.pk]
Stability of AA joint Alar ligaments - prevents excessive rotation - attaches to sides of dens and inserts at base of the occiput Transverse ligament – most important - prevents excessive anterior shift - attaches to anterior arch of C1 bilaterally via [slideshare.net]
To prevent injury to the underlying dura mater, a spatula was placed at the exit point of the drill, between the anterior side of the posterior arch and the dura mater. [springerplus.springeropen.com]