AtlantoAxial Rotatory Fixation: Part 3—A Prospective Study of the Clinical Manifestation, Diagnosis, Management, and Outcome of Children with AlantoAxial Rotatory Fixation

Pang, Dachling; Li, Veetai

doi:10.1227/01.neu.0000180052.81699.81

Cited by 111 publications

(139 citation statements)

References 39 publications

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“…3j). Concerning the loss of rotation, our findings echo previous observations describing significantly reduced rotation C1-2 after prolonged immobilization, e.g., with temporary Magerl fixation [7,71], after ligamentous and capsular injuries to the C1-2 joints [60] and after intraarticular or malunited fractures of C2 [52,57]. In addition to articular surface deformities, distortion of the rotational axis of C1 and C2 in terms of deviated instantaneous center of rotation (ICR C1-2 ), e.g.…”

Section: Functional Outcome and Atlantoaxial Rotationsupporting

confidence: 89%

“…We did not observe a significantly increased C0-1 rotation in case of reduced ROT C1-2 as it was in children with pathological stickiness C1-2 [58,60]. We had a mean ROT C0-C1 of 2.6°and 2.7°to the right and left suggesting a normal coupling between C0 and C1 [58].…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 49%

“…AAOA can disrupt the smooth, gliding joint motions [60] and a clinical hallmark of AAOA is known to be the significantly reduced ROT C1-2 [20,31,35,66]. Accordingly, our patients with AAOA (preexisting and new onset Type B joints) had significantly decreased total ROT C1-2 and %ROT C1-2 .…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 72%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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Section: Functional Outcome and Atlantoaxial Rotationsupporting

confidence: 89%

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 49%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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“…If the injury onset was longer than 3 months, the satisfactory outcome can be expected by an operation. 1,[8][9][10] It is known that the early diagnosis is essential for the successful non-invasive reduction in adult atlantoaxial rotatory subluxation and the need for the invasive reduction increases when the reduction is delayed for several months 5,11) like the pediatric atlantoaxial rotatory subluxation. However, there aren' t enough systemic studies regarding adult atlantoaxial rotatory subluxation based on Fielding type 1, 2 and 3, and only there are several reports of bilateral atlantoaxial rotatory subluxation cases caused by trauma to date.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

Kim

Ahn

Yang

et al. 2011

J Korean Soc Spine Surg

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“…The optimal treatment is yet to be defined Suppress [2,6,[10][11][12][13][14]. Goals of treatment are reduction of rotationally fixed Atlantoaxial joint, restoring stability at C1-C2, protection of nerve tissue from (further) damage, facilitating recovery.Although C1-C2 transarticular screw fixation had proven to be the best biomechanical construct, it has few disadvantages like the risk for injury of vertebral arteries, a learning curve, needs skilled surgeons, specific surgical armamentarium, and is challenging as a procedure; conditions rarely achieved in Sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 99%

Atlantoaxial transarticular screw fixation: a technique never reported from (sub-saharan) Africa?

Ndoumbe¹,

Guifo²,

Amougou³

et al. 2013

Neurosci Discov

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Background: Atlantoaxial transarticular screw fixation is considered to be the "gold standard" for treating atlantoaxial instabilities. This challenging surgical procedure requires high skills and appropriate surgical armamentarium. Such conditions are rarely met in sub-Saharan Africa. After a thorough review of medical literature, we did not find a single report on atlantoaxial transarticular screwing from Africa. For this reason, we decided to report on a case we operated on at our institution. Methods: We retrospectively reviewed a case of post-traumatic acute atlantoaxial rotatory fixation (AARF) associated with C5-C6 left facet joint dislocation that we managed in our hospital with posterior atlantoaxial/transarticular screw fixation and C5-C6 lateral masses plating. Results: A 56 years old female was admitted to our service for head and cervical spine trauma following a road traffic accident. She had asymmetrical quadriplegia and urinary retention. Computed tomography (CT) scans revealed a type II atlantoaxial rotatory fixation of left atlantoaxial joint along with stage II distractive-flexion injury of left C5-C6 facet joint. Transcranial traction with Gardner-Wells tongs was performed and patient subsequently underwent surgical stabilization with modified Magerl's technique and C5-C6 lateral masses plating. Fourthy-five days after surgery, the patient was able to walk alone without any help. Conclusions: "State-of-the art" procedures like atlantoaxial transarticular screwing are rarely performed in Sub-Saharan Africa where surgical equipment is very insufficient. But, even in these compelling conditions, such operations can be done successfully by skilled surgeons for patients'benefit.

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AtlantoAxial Rotatory Fixation: Part 3—A Prospective Study of the Clinical Manifestation, Diagnosis, Management, and Outcome of Children with AlantoAxial Rotatory Fixation

Cited by 111 publications

References 39 publications

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

Atlantoaxial transarticular screw fixation: a technique never reported from (sub-saharan) Africa?

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