Transarticular screw fixation for osteoarthritis of the atlanto axial segment

Grob, Dieter; Bremerich, Friedrich H.; Dvořák, Jiří; Mannion, Anne F.

doi:10.1007/s00586-005-0963-x

Cited by 46 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Literature [20,26,31,35,39,40,52,66] and our current results demonstrate that the C1-2 facet joints can be a meaningful source of pain. Thirty-one percent of our patients had at least one lateral C1-2 joint displaying advanced AAOA, more than half had signs of C2-nerve root conferred radiculopathy and motion induced suboccipital pain.…”

Section: Clinical Outcomesupporting

confidence: 60%

“…When motion is eliminated in the joint, the irritation within ceases and pain generation is halted [22]. Therefore, immobilization and definite posterior fusion C1-2 relieves pain in patients with sequelae of AAOA [22,28,31,35,55] like in one of our cases with intractable pain resulting from a C2-vertebral body fracture with a burst pattern at the lateral mass (Fig. 3, 4).…”

Section: Clinical Outcomementioning

confidence: 52%

“…As in our sample, pain derived from the C1-2 facet joints is frequently described in nonneuropathic terms such as 'pressurelike', 'deep boring', 'dull', and 'heavy' [20,35] and located almost exclusively at the ipsilateral retromastoid and occipital region [14,20,22,28,31,35,66]. As in the current study the main manifestations of C1-2 degeneration and AAOA are pain with significantly restricted ROM [22,31], elicited or exacerbated by ipsilateral neck rotation [20,22,28,35,66]. Our current findings are in line with previous authors' symptoms predominating on the side of the more significant lateral mass arthropathy, some patients even reporting crepitation [22,45].…”

Section: Clinical Outcomementioning

confidence: 65%

“…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%

“…It seemed that the restriction of rotation was perceived by the patients to be an acceptable 'price' to pay causing less disability if they did not perceive motion induced pain. Likewise, Grob [31] reported the residual neck rotation in 35 fusions of C1-2 for AAOA with a mean of 58°. Notably, rotation was not different between the patients reporting a 'good' or a 'poor' outcome.…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 96%

See 4 more Smart Citations

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

et al. 2009

View full text Add to dashboard Cite

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

show abstract