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Atlanto-odontoid Dislocation or Fracture


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]
  • The oft-cited chapter on the principles of evidence-based decision-making in surgical practice is completely updated for the second edition, presenting the reader with a framework for the evidence-based practice of surgery.[books.google.com]
  • Conclusions We have presented a novel technique using C1 posterior arch screws for the fixation of a C1-C2 dislocation.[springerplus.springeropen.com]
Disability
  • After six weeks of immobilization with three weeks each in a Miami-J-collar and a soft collar, the boy had regained good range of motion and was free of pain with no neurologic disabilities.[medcraveonline.com]
  • Spine. 2009;9(1):31-8) and leave the patient permanently disabled in terms of neck range of motion.[spineuniverse.com]
  • Verification of the origin of pain by intra-articular blocks is recommended. [8] Neck Disability Index Neck Bournemouth Questionnaire Neck Pain and Disability Scale Numeric Pain Rating Scale Pain Catastrophizing Scale Visual Analogue Scale The examination[physio-pedia.com]
  • Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity.[elsevier.es]
  • A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability. Brain 1994;117:133-48. 14. List CF.[ijri.org]
Respiratory Insufficiency
  • Besides respiratory insufficiency, cardiac arrhythmia is a typical postoperative complication in patients with neurological deficits.[trauma-acute-care.imedpub.com]
Pneumonia
  • During the rehabilitation process the neurological status did not improve and recurrent pneumonias were treated with antibiotics.[trauma-acute-care.imedpub.com]

Workup

  • Mechanism of injury is an important determinant for further workup in this category of patients.[clinicalgate.com]
Third Degree Atrioventricular Block
  • Due to severe cardiac arrhythmia and a third degree atrioventricular block on the fifth day after the operation a cardiac pacemaker was implanted. For comfortable long-term ventilation a tracheotomy was performed.[trauma-acute-care.imedpub.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]
  • The Brook’s procedure of wiring C1 and C2 here was a safe and sound surgical treatment.[medcraveonline.com]
  • Wenger and Pring provide a uniquely practical, readable overview of children's fractures, emphasizing diagnosis, treatment, common pitfalls, and communication with parents and other healthcare professionals.[books.google.com]
  • Conservative treatment consisting of reduction and fixation with a halo vest was tried initially.[springerplus.springeropen.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]

Prognosis

  • Neurophysiological assessments are indicative of the prognosis. General treatment principles.[mauriziopiredda.it]
  • […] 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]

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]
  • (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]
  • 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]
  • 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]
  • Fratture osteoporotiche Maggiori informazioni sulla chirurgia vertebrale Maggiori informazioni sul chirurgo vertebrale Piredda Maurizio Versione in Italiano Epidemiology.[mauriziopiredda.it]
  • 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]
Sex distribution
Age distribution

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]
  • 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]
  • 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]

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