Letter to the Editor

Koller, H; Waldenberger, Peter; Mayer, Gert; Ar, Rosenkranz; Lhotta, Karl

doi:10.1191/0961203305lu2166xx

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…The author identified several articles [47,49,68] reporting on miscellaneous C2-fractures included into cross-sectional outcome analysis or using nonvalidated instruments; most studies are reluctant to further delineate distinct fracture morphology and outcome variables in heterogenous samples [5, 25-27, 29, 62, 68]. Therefore, we intended to seek objective outcome data through assessment of validated outcome measures, functional outcome using dynamic CT-scanning, a detailed classification of fracture pattern and an analysis of posttreatment C2-alignment using a classification system based on valid measurements [44].…”

Section: Discussionmentioning

confidence: 99%

“…Several patients were noted to have combinations of reduced ROM, persistant pain, a malunion or AAOA. Müller [49] stressed the importance of anatomical alignment in C2-fractures and the findings of the current study give evidence that with an increasing number of C2-fragments, deformation of the C2 vertebral body and particularly fractures of the C2 lateral mass clinical outcome drops: Fractures involving the C2 articular pillar can be isolated articular or lateral mass fractures or extensions of vertebral body fractures [5,26] and were found to be prone to a high rate of nonanatomical union [21] frequently indicating secondary fusion of C1-2 [30,67,70]. Up to 50% of Hmfx involve the articular facets of C2 and in the largest sample regarding anterior fusion C2-3 for the treatment of unstable Hmfx, Koller [46] observed a decreased functional and clinical outcome with a subset of patients having reduced rotation C1-2 and motion induced C2-referred pain.…”

Section: Clinical Outcomementioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Clinical Outcomementioning

confidence: 99%

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

et al. 2009

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Hypertension in selected rheumatic diseases

Niklas¹,

Niklas²,

Hrycaj³

2012

Reumatologia

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Nadciśnienie tętnicze to poważny problem zdrowotny zarówno w Polsce, jak i na całym świecie. Około 10% stanowi nadciśnienie wtórne, do którego zalicza się nadciśnienie spowodowane przez choroby reumatyczne. W jego patogenezie decydującą rolę odgrywa uszkodzenie nerek lub naczyń krwionośnych prowadzące do wzrostu wolemii, wydzielania substancji wazoaktywnych czy zwiększenia oporu naczyń (ryc. 1), dlatego nadciśnienie tętnicze bardzo często towarzyszy toczniowi rumieniowatemu układowemu, zapaleniu naczyń lub twardzinie układowej. Dotyczy ono również znacznej liczby chorych na dnę moczanową. Należy także pamiętać, że część leków powszechnie stosowanych w reumatologii może wpływać na wzrost ciśnienia tętniczego czy interferować z lekami hipotensyjnymi. Z uwagi na poważne powikłania, które mogą wystąpić na skutek nadciśnienia, należy dążyć do jego wczesnego wykrycia i skutecznej terapii (tab. I).

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Letter to the Editor

Cited by 2 publications

References 10 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

Hypertension in selected rheumatic diseases

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