Pediatric congenital atlantoaxial dislocation: differences between the irreducible and reducible varieties

Salunke, Pravin; Behari, Sanjay; Kirankumar, Markani V.; Sharma, Manish; Jaiswal, Awadesh K.; Jain, Vibha

doi:10.3171/ped.2006.104.2.115

Cited by 35 publications

(34 citation statements)

References 30 publications

(24 reference statements)

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“…The clinical outcomes in this series are consistent with observation in experimental models that axons subjected to strain recover rapidly, both anatomically and functionally [30][31][32], and with neurosurgical series where anatomical alignment has been restored, and which show that even profound clinical deficits are recoverable [5,12,14,17,[33][34][35][36][37][38][39][40]. Improvement in pain, bulbar symptoms, ASIA index, Karnofsky index and quality of life assessment support the concept that restoration of the neutral position of the cervical spine and craniospinal junction with a neck brace decreases the deleterious effects of flexion in the setting of erstwhile abnormal movement and anatomical abnormality.…”

Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 72%

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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Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 72%

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

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“…There are several variations of posterior approaches bone fusion and stabilization [4][5][6][7][8] or the transoral approach release combined with the posterior approaches bone fusion and stabilization for the malformation of the upper cervical spine [9][10][11][12]. Os odontoideum can lead to reducible or irreducible atlantoaxial dislocation.…”

Section: Discussionmentioning

confidence: 99%

The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation

2009

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We report a 52-year-old female patient with a 2-year history of local neck pain, decreased cervical spine rotation, progressive numbness and weakness of both arms. Preoperative, dynamic X-rays, computed tomography, three-dimensional computed tomography demonstrated a displaced Os odontoideum with irreducible Subluxation of C1/2. We used a single transoral approach release, reduction using an assistance of skull traction, bone fusion and stabilization in the treatment of Os odontoideum with irreducible alantoaxial dislocation. Postoperative, the patient was free of all symptoms and X-rays taken showed a stable fusion of C1/2 at 6th postoperative month. This technique in the treatment of Os odontoideum with irreducible alantoaxial dislocation is atraumatic and effective. And preoperative dynamic X-rays, computed tomography, three-dimensional computed tomography and MRI scans provided an invaluable aid to select this operative procedure.

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“…This has been described by Olerud 125 It should be noted that, since, there is an observed asymmetry of the facet joints among a large number of patients with OO, this might make transarticular C1-C2 stabilization difficult in this pathology, necessitating an alternative method on the abnormal side. 126 About 15 years after the introduction of transarticular C1-C2 technique, posterior C1 lateral mass and C2 pars instrumentation by means of screw-plate was introduced by Goel and Laheri in 1994. 127 Thereafter, Harms modified this technique with the application of the polyaxial screw-rod system, which eased and increased stabilization and significantly improved the outcome.…”

Section: Management Of Reducible Atlantoaxial Instability In Oomentioning

confidence: 99%

“…3 This remained the procedure of choice for many authors such as Salunke et al who have reported their experience in 2005. 126 However, to avoid any complication of this corridor, a retropharyngeal route was proposed. Later, Leng et al described the endoscopic endonasal resection of OO with fewer complications in comparison to the former route.…”

Section: History Of Surgical Intervention In Iaadmentioning

confidence: 99%

“…134 Salunke et al have proposed starting with 7% of the body weight and its gradual increment upto 5 kg. 126 In adults, conscious traction allows the gradual reduction of C1-C2 subluxation with fewer neurological dysfunctions. If neural impairment occurs, the release of the weight results in a faster resolution of the neurological deficit.…”

Section: Management Of Irreducible Atlantoaxial Instability In Oo (Iaad)mentioning

confidence: 99%

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Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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Pediatric congenital atlantoaxial dislocation: differences between the irreducible and reducible varieties

Cited by 35 publications

References 30 publications

Clinical and Finite Element Analysis of Acute Whiplash

Clinical and Finite Element Analysis of Acute Whiplash

The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation

Os Odontoideum: Review Article

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