Craniocervical Junction and Cervical Spine Anatomy

Offiah, Curtis

doi:10.1016/j.nic.2022.07.012

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…1,2 Es estabilizada principalmente por tejidos blandos, dentro de los cuales se encuentran las estructuras capsulo-ligamentarias, por ello el riesgo de inestabilidad; principalmente por patologías de tipo inflamatorias, degenerativas, infecciones y traumatismos. [1][2][3][4][5][6] Aun en la actualidad, los tratamientos quirúrgicos de reconstrucción de la unión occipitocervical son procedimientos poco comunes y la mayoría se ha estudiado como tratamiento de patologías degenerativas y reumáticas. 7,8 De acuerdo a lo anterior, el estudio de las lesiones por inestabilidad secundaria a traumatismos, es poco reportado como una entidad individual; casi siempre asociada a complicaciones con alto índice de mortalidad, y cuando se presenta de forma combinada es excepcional.…”

Section: Introductionunclassified

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Trujillo-Franco,

Gutiérrez-Herrera,

Bautista-Sandoval

2024

Ortho-Tips

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Introducción: las lesiones de la unión cráneo-cervical con inestabilidad secundaria a traumatismos son poco frecuentes; con complicaciones con un alto índice de mortalidad. Cuando ambas lesiones están presentes, el pronóstico de supervivencia y recuperación del paciente suele ser muy pobre. El tratamiento quirúrgico de reconstrucción de la unión occipitocervical es un procedimiento complejo y poco común; en la mayoría de las ocasiones se ha estudiado en tratamiento de patologías degenerativas y reumáticas. Caso clínico: paciente femenino de 27 años, con inestabilidad occipitoatloidea-atlantoaxoidea combinada, secundaria a accidente en vehículo tipo motocicleta; la cual presenta múltiples lesiones. Diagnóstico: clínica con déficit neurológico; estudios radiológicos de trauma, y tomografía axial de cráneo y columna vertebral evidencian datos de inestabilidad a nivel de C0-C1 y C1-C2. Intervenciones: manejo multidisciplinario y posteriormente reducción y fijación occipitocervical con técnica Harms de las lesiones por inestabilidad vertebral traumática, C0-C1, C1-C2 y C2-C3. Seguimiento: a nueve meses de la intervención, con adecuada evolución clínica. Conclusiones: aunque existen pocas publicaciones y guías sobre el diagnóstico, momento ideal de intervención y método de estabilización óptimo en casos de inestabilidad por trauma, recomendamos un abordaje multidisciplinario. El diagnóstico y tratamiento precoz influye directamente en el pronóstico final y calidad de vida de estos pacientes.

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Section: Introductionunclassified

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Trujillo-Franco,

Gutiérrez-Herrera,

Bautista-Sandoval

2024

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“…The craniocervical junction (CCJ) is a complex bony region ( 1 ). Arteriovenous fistulas (AVFs) are arteriovenous shunting diseases without a nidus that rarely occur in the CCJ region, accounting for 1–2% of all cerebrospinal AVFs ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment of high cervical arteriovenous fistulas in the craniocervical junction region

2023

Front. Neurol.

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The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.

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“…The alar ligaments, with help from the transverse ligament and tectorial membrane, are responsible for the bulk of craniocervical junction (CCJ) stability. 1 Strain or rupture of the alar ligaments is often seen following upper cervical trauma, most commonly alongside concomitant injuries such as condylar fracture, atlantooccipital dislocation, atlantoaxial subluxation, or other ligamentous disruption. [2][3][4][5][6] Such injuries can result in high cervical instability and often warrant urgent surgical intervention to prevent or abate severe spinal cord damage.…”

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confidence: 99%

Isolated unilateral alar ligamentous injury: illustrative cases

Reeves,

Valcarce-Aspegren,

Robert

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Isolated unilateral alar ligament injury (IUALI) is a rare and likely underreported occurrence after upper cervical trauma, with only 16 cases documented in the literature to date. Patients generally present with neck pain, and definitive diagnosis is typically made by magnetic resonance imaging (MRI). Unfortunately, likely due in part to its rarity, there are no formal guidelines for the treatment of an IUALI. Furthermore, there is a limited understanding of the long-term consequences associated with its inadequate treatment. OBSERVATIONS Here, the authors report on three pediatric patients, each found to have an IUALI after significant trauma. All patients presented with neck tenderness, and two of the three had associated pain-limited range of neck motion. Imaging revealed either a laterally deviated odontoid process on cervical radiographs and/or MRI evidence of ligamentous strain or discontinuity. Each patient was placed in a hard cervical collar for 1 to 2 months with excellent resolution of symptoms. A comprehensive review of the literature showed that all patients with IUALI who had undergone external immobilization with either rigid cervical collar or halo fixation had favorable outcomes at follow-up. LESSONS For patients with IUALI, a moderate course of nonsurgical management with rigid external immobilization appears to be an adequate first-line treatment.

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Craniocervical Junction and Cervical Spine Anatomy

Cited by 6 publications

References 31 publications

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Treatment of high cervical arteriovenous fistulas in the craniocervical junction region

Isolated unilateral alar ligamentous injury: illustrative cases

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