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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-six patients underwent C1-2 posterior wiring and fusion procedures over a 5-year period for unstable C-2 fractures (eight cases), unstable atlas-axis combination fractures (six cases), rheumatoid C1-2 instability (14 cases), os odontoideum (four cases), traumatic C1-2 ligamentous instability (three cases), or instability secondary to a C-2 tumor (one case). In each case, the atlantoaxial arthrodesis utilized sublaminar wire at C-1 and incorporated an iliac-crest strut-graft positioned between the posterior arches of C-1 and C-2, held in place by securing wire around the base of the spinous process of the axis. Follow-up examination was performed in all patients after a mean postoperative duration of 33.7 months. The technical aspects and clinical merits of this fusion procedure, which led to a 97% union rate (one nonunion) and minimal morbidity and mortality rates, are presented.
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PMID:The interspinous method of posterior atlantoaxial arthrodesis. 198 87

Fifty consecutive patients requiring posterior cervical fusion for various pathologies were treated with Halifax interlaminar clamps for internal spinal fixation. Fusion involved the C1-2 level in 17 cases, the C1-3 level in one, and the lower cervical area (C2-7) in 32. No patient was lost to follow-up review, which varied from 6 to 40 months (average 21 months). Fusion failed in five patients, three at the C1-2 level, one at the C1-3 level, and one at the C2-3 level. Screw loosening was the cause of failure in four patients, and in one the arch of C-1 fractured. No other complications occurred. Because of the lack of complications, avoidance of the hazards of sublaminar instrumentation, and an excellent fusion rate, this technique is highly recommended for posterior cervical fusion in the lower cervical spine. Atlantoaxial arthrodesis was achieved in only 14 (82%) of 17 patients, however, which might be due to the higher mobility at this multiaxial level. Improved results in this region may be possible by using a new modified interlaminar clamp, by performing adequate bone fusions, and by postoperative external halo immobilization in high-risk patients.
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PMID:Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review. 846 99

The authors placed titanium mesh cages to achieve posterior atlantoaxial fixation in five patients with atlantoaxial instability caused by rheumatoid arthritis or os odontoideum. A mesh cage packed with autologous cancellous bone was placed between the C-1 posterior arch and the C-2 lamina and was tightly connected with titanium wires. Combined with the use of transarticular screws, this procedure provided very rigid fixation. Solid fusion was achieved in all patients without major complications. The advantages of this method include more stable fixation, better control of the atlantoaxial fixation angle, and reduced donor-site morbidity compared with a conventional atlantoaxial arthrodesis in which an autologous iliac crest graft is used.
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PMID:Use of a titanium mesh cage for posterior atlantoaxial arthrodesis. Technical note. 1179 1

Os odontoideum is an uncommon craniovertebral junction (CVJ) abnormality that exists as a separate ossicle apart from a hypoplastic dens. It usually moves with the clivus or the anterior arch of C-1 (dystopic) or rarely with the dens (orthotopic). Its genesis and natural history have been debated, and its proper treatment remains uncertain. Two hundred and sixty patients, with symptomatic os odontoideum, were evaluated by the author over a 20-year period; the author performed surgery in 134 of these patients. In a prospective study the author evaluated the early childhood history of trauma, the dynamic studies of motion, and the effects of traction by using pleuridirectional tomography, computerized tomography (CT), CT myelography and magnetic resonance (MR) imaging. Operative findings were documented. Early childhood trauma to the CVJ was recorded in 74 patients, in 30 of whom normal odontoid processes were documented at initial examination prior to the patient reaching age 4 years. Acute neurological deterioration following trauma occurred in 63 of 134 patients. Symptoms were insidious in 71 of 134 patients. In six patients, who presented with acute neurological deterioration after trauma and in whom an abnormal spinal cord signal in the cervicomedullary junction was demonstrated on MR imaging, normal CVJ motion dynamics were shown. Motion dynamics varied and were unique to each patient. Irreducible ventral CVJ disease causing cervicomedullary compromise occurred in 28 patients in whom a transpharyngeal ventral decompressive procedure was necessitated. During the transoral operation, the transverse portion of the cruciate ligament was found to be located anterior to the axis body. All patients required dorsal CVJ arthrodesis, which, in 46, was limited to the C1-2 segment. Instability at the C1-2 joints was always multidirectional, as demonstrated on preoperative neuroimaging studies as well as at operation. Sixteen patients presented after completed primary C1-2 dorsal fusion and with worsening deficits. They improved when the range of the fusion was extended to the occiput or if the ventrally located lesion was excised. Os odontoideum is associated with early childhood trauma and is an acquired phenomenon. The presence of abnormal motion dynamics necessitates surgical intervention as do associated neurological deficits. Asymptomatic patients in whom os odontoideum is incidentally discovered and in whom no abnormal motion dynamics are demonstrated should be followed closely.
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PMID:Pathogenesis, dynamics, and management of os odontoideum. 1697 48

In cadaveric studies and recently in one adult patient the occipital condyle has been studied as an option to allow bone purchase by fixation devices. In the current case the authors describe the use of occipital condyle screws in a child undergoing occipitocervical fixation. To the best of the authors' knowledge this case is the first reported instance of this technique in a pediatric patient. This girl had a history of posterior fossa decompression for Chiari malformation Type I when she was 22 months of age. When she was 6 years old she presented with neck pain on flexion and extension of her head. Magnetic resonance imaging in flexion and extension revealed occipitocervical instability. She underwent an occiput to C-2 posterior arthrodesis with bilateral screw placement in the occipital condyles, C-2 lamina, and C-1 lateral masses. Postoperatively, she was neurologically intact. Computed tomography demonstrated a stable construct, and her cervical pain had resolved on follow-up.
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PMID:Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation. 2067 39

The surgical management of craniovertebral junction (CVJ) instability in pediatric patients presents unique challenges. As compared with the adult patient, the anatomical variations of the CVJ in the pediatric patient are significant, complicate the approach, and limit the use of internal fixation. Diminutive osseous and ligamentous structures and syndromic craniovertebral abnormalities complicate the issue. Advances in imaging analysis and instrumentation have improved the armamentarium for managing the pediatric patient who requires craniocervical stabilization. In this paper, the author's experience of performing more than 850 pediatric CVJ fusions is reviewed. This work includes the indications for atlantoaxial arthrodesis and occipitocervical fusion. Early atlantoaxial fusions were performed using interlaminar rib graft fusion, and more recently using either transarticular screw fixation in the older patient, or lateral mass screws at C-1 and rod fixation with either C-2 pars interarticular screw fixation or pedicle screw fixation. A C-2 translaminar screw fixation is also described. Occipitocervical fusions are performed with rib grafts in patients younger than 6 years of age. Subsequently, above that age, contoured loop fixation was performed, and in the past 8-10 years, screw and rod fixation was used. Abnormal spine growth was not observed in children who underwent craniocervical stabilization below the age of 5 years (clearly the bone grew with the patient). However, no deleterious effects were noted in the children treated with rigid instrumentation. The success rate for bone fusion alone was 98%. The author's success rate with rigid instrumentation is nearly 100%. A detailed review of the technique of fusion is presented, as well as the indications and means of avoidance of complications, their prevention, and management.
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PMID:Craniocervical fusions in children. 2265 46

OBJECTIVE Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion. MATERIALS Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail. RESULTS Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1-2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case. CONCLUSIONS Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.
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PMID:Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases. 2742 Mar 96

The authors report the case of a patient who suffered a Jefferson fracture during a professional football game. The C-1 (atlas) fracture was widely displaced anteriorly, but the transverse ligament was intact. In an effort to enable a return to play and avoid intersegmental (C1-2) fusion, the patient underwent a transoral approach for open reduction and internal fixation of the fracture. The associated posterior ring fracture displacement widened after this procedure, and a subsequent posterior arthrodesis and fixation of the fracture site was performed 6 months later when the fracture failed to heal with rigid collar immobilization. The approach maintained the normal range of motion at the atlantoaxial and atlantooccipital joints, which would have been sacrificed by an atlantoaxial or occipitocervical fusion, as is traditionally performed. Ultimately, the patient decided not to return to the football field, but this approach could avoid the more significant loss of motion associated with atlantoaxial or occipitocervical fusion for unstable Jefferson fractures.
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PMID:Motion-preserving, 2-stage transoral and posterior treatment of an unstable Jefferson fracture in a professional football player. 2919 78