An unusual presentation of Paget disease: pathological fracture of the odontoid

Sawardekar, Umayal G.; Nadimpalli, Surya Prakash Rao; Weisenberg, Elliot; Kranzler, Leonard

doi:10.3171/spi.2008.9.10.343

Cited by 6 publications

(2 citation statements)

References 6 publications

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“…Deformative stress is evident in multiple diseases and disorders such as achondroplasia [85][86][87][88][89], platybasia [84,90,91], acquired bone-softening conditions (e.g. rickets), hyperparathyroidism, spondyloepiphyseal dysplasia, acroosteolysis, achondrolmalacia, osteomalacia, Hurler's Syndrome, degenerative conditions, renal osteodystrophy, Paget's disease [35,51,72,[92][93][94][95][96][97][98][99] and osteogenesis imperfecta [100,101]. The horizontally tipped odontoid may deform the brainstem, especially in flexion [18,102].…”

Section: Cranio-cervical Anatomical Abnormalities That May Give Rise To Increased Neurological Deficit With Acute Whiplash Injurymentioning

confidence: 99%

Acute Whiplash: Clinical and Finite Element Analysis

Tannoury¹,

Giacomo²,

Rihn

et al. 2013

TOSPINEJ

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Study Design: A prospective 1-year study of whiplash patients presenting with either isolated neck pain (WADI/II), or neck pain with neurological signs/or symptoms (WADIII).Objective: We hypothesize that WADI/II and WADIII are distinct entities with significant differences in clinical presentation, pathoanatomy, and prognosis.Summary of Background Data: Whiplash associated disorders (WAD) are disparate and can range from mild neck pain (WADI/II), to insults associated with neurologic sequellae (WADIII), and even fracture/dislocations (WADIV). To date, literature considers post whiplash syndrome a single clinical and pathologic entity along a spectrum with escalating grades of severity (WADI-IV). However, a diverse pathogenesis may underlie the different grades of WAD, and these distinctive pathoanatomies may better portray the prognosis of these entities.Methods: Thirty one subjects were divided into a WADI/II control group and a WADIII study group. All subjects underwent H&P, radiographic evaluations, and clinical outcome measures (collected at 3, 6, and 12 months). A finite element analysis (FEA) technology (SCOSIA©) was used to predict stresses within the neuraxis. Statistical analysis was performed (Student T-test, Wilcoxon Signed-Rank test) with significance set at p=0.05.Results: At presentation, WADI/II group demonstrated better neurologic assessments, functional performances, and higher quality-of-life measurements in comparison to WADIII cohort. Yet VAS scores were comparable between the two groups. At final follow-up, both groups reported improvements in neurologic status and disability symptoms. However, functional recovery and quality-of-life measures significantly improved in WADIII, and conversely deteriorated in WADI/II. Additionally, WADI/II also portrayed notable worsening of pain symptoms. Litigation claims were comparable between the two groups. FEA predicted higher stress within the neuraxis of WADIII, most notably in subjects with preexisting stenosis and odontoid retroflexion. Conclusion:WADI/II and WADIII are distinct entities with different pathoanatomy and outcomes. Musculoskeletal injury precipitates WADI/II pain symptoms while neuronal stretching leads to WADIII neurologic injuries. Notably, most of the neurologic injuries in WADIII are recoverable.

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Section: Cranio-cervical Anatomical Abnormalities That May Give Rise To Increased Neurological Deficit With Acute Whiplash Injurymentioning

confidence: 99%

Acute Whiplash: Clinical and Finite Element Analysis

Tannoury¹,

Giacomo²,

Rihn

et al. 2013

TOSPINEJ

View full text Add to dashboard Cite

show abstract

“…Deformative stress due to chronic flexion extension injuries were noted in patients with angulation of the brainstem [76,78,79,84] and attributed to the fulcrum effect of the medullo-spinal junction draped over the odontoid [17]. Deformative stress is evident in achondroplasia [85][86][87][88][89], platybasia [84,90,91], acquired bonesoftening conditions such as rickets, hyperparathyroidism, spondyloepiphyseal dysplasia, acroosteolysis, Hurler's Syndrome, osteomalacia, achondromalacia, renal osteodystrophy, Paget's disease, and degenerative conditions such as rheumatoid arthritis [35,51,72,[92][93][94][95][96][97][98][99] and osteogenesis imperfecta [100,101]. The horizontally tipped odontoid may deform the brainstem, especially in flexion [18,102].…”

Section: Cranio-cervical Anatomical Abnormalities That May Give Rise mentioning

confidence: 99%

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

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Study Design:A prospective 1-year follow-up study of whiplash patients presenting with neurological signs/or symptoms (WADIII), and whiplash patients with neck pain but no neurologic findings (WADI/II). Objective:We hypothesize that WADI/II and WADIII are distinct entities, with regards to clinical presentation, pathoanatomy, and prognosis.Summary of Background Data: symptoms associated with whiplash injury range from mild neck pain (WADI/II), to injuries associated with neurologic sequellae (WADIII). To date, literature considers whiplash associated disorders (WAD) a single clinical and pathologic entity, with different grades of severity (WADI-IV).Methods: Thirty one subjects were divided into a WADIII study group and a WADI/II comparison group. All subjects underwent H&P, radiographic evaluations, and clinical outcome measures (collected at 3, 6, and 12 months). Statistical analysis was performed (Student T-test, Wilcoxon Signed-Rank test) with significance set at p=0.05. A finite element analysis (FEA) technology (SCOSIA©) was used to predict stresses within the neuraxis.Results: At day 0: Better neurologic assessments, functional performances, and higher quality-of-life measurements were noted in WADI/II compared to WADIII. VAS scores were comparable.At 12 months: Both groups reported improvements in neurologic status and disability symptoms. However functional recovery and quality-of-life measures significantly improved in WADIII, and conversely deteriorated in WADI/II along with notable worsening of pain symptoms. Litigation claims were comparable. FEA predicted higher stress within the neuraxis of WADIII, notably in subjects with preexisting stenosis and odontoid retroflexion. Conclusion:WADI/II and WADIII are distinct entities. Musculoskeletal injury precipitates WADI/II pain symptoms while neuronal stretching leads to WADIII neurologic injuries, which are mostly recoverable.

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Consecutive multilevel vertebral Paget’s disease of the lumbar spine: a rare Asian case and the differential diagnosis

Long

Lin

et al. 2013

Journal of Orthopaedic Science

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An unusual presentation of Paget disease: pathological fracture of the odontoid

Cited by 6 publications

References 6 publications

Acute Whiplash: Clinical and Finite Element Analysis

Acute Whiplash: Clinical and Finite Element Analysis

Clinical and Finite Element Analysis of Acute Whiplash

Consecutive multilevel vertebral Paget’s disease of the lumbar spine: a rare Asian case and the differential diagnosis

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