Split atlas in a patient with odontoid fracture

We report the unusual association of a split atlas and an odontoid fracture in a case of a cervical trauma, thus mimicking a complex C1–C2 fracture. The normal embryology of C1 and the literature on this rare malformation are reviewed.     

Preliminary results for the treatment of a pain-causing osteoporotic vertebral compression fracture with a Sky Bone Expander

OBJECTIVE: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. MATERIALS AND METHODS: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. RESULTS: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. CONCLUSION: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.     

CT volumetry of intravertebral cement after kyphoplasty. Comparison of polymethylmethacrylate and calcium phosphate in a 12-month follow-up

This study was intended to measure the volume of intravertebral cement after balloon kyphoplasty with high resolution computed tomography (CT) and dedicated software. Volume changes of biocompatible calcium phosphate cement (CPC) were detected during a follow-up of 12 months. Measurements were compared with a control group of patients treated with polymethylmethacrylate (PMMA). Twenty-three vertebrae (14 CPC, 9 PMMA) of 12 patients were examined with CT using an identical imaging protocol. Dedicated software was used to quantify intravertebral cement volume in subvoxel resolution by analyzing each cement implant with a density-weighted algorithm. The mean volume reduction of CPC was 0.08 ml after 12 months, which corresponds to an absorption rate of 2 vol%. However, the difference did not reach significance level (P>0.05). The mean error estimate was 0.005 ml, indicating excellent precision of the method. CT volumetry appears a precise tool for measurement of intravertebral cement volume. CT volumetry offers the possibility of in vivo measurement of CPC resorption.     

Fusion of the anterior arch of the atlas and dens

Seven cases of fusion of the anterior arch of the atlas to the dens have been described in the English literature. This anomaly alone is stable. A new case of this rare anomaly incidentally discovered in a patient examined for trauma is presented.     

Vertebroplasty in the treatment of osteoporotic vertebral body fracture

During the last few years, vertebroplasty has gained a wide acceptance for the treatment of painful osteoporotic vertebral body fractures and osteolytic changes. However, new guidelines with significant changes in indications and technique were published recently in Europe. Therefore, the aim of this review is to highlight recent changes in indications for vertebroplasty, patient work-up and changes in procedural technique, and to give an overview of patient outcome and possible complications. Therefore, technical details like different types of fluoroscopy, needle placement, pain management during the intervention, recommended equipment, including bone cement, and the use of venography are discussed. Postprocedural issues are noted, including the risk of minor and major complications and the expected outcome of the treated patients.     

Elongation of the anterior tubercle of a cervical vertebral transverse process: An unusual variant

Elongation of the anterior tubercle of a transverse process of a cervical vertebra is a congenital anomaly that should be considered in a patient demonstrating a bony mass projecting anterior to the vertebral body on a lateral radiograph of the cervical spine. Reported is a case of elongation of the tubercles of the transverse processes of both C5 and C6 with the formation of an articulation. Computed tomography was used to definilation. Computed tomography was used to definitively differentiate this variant from a fracture fragment, bone tumor, or osteophyte. This anomaly is probably a form of supernumerary cervical rib developing at a level above the lowest cervical vertebra.     

颈椎钩突骨折的损伤机制与治疗

目的　探讨颈椎钩突骨折的损伤机制及诊治特点。　方法　回顾分析自 1976年 1月至 1999年 12月收治的 9例颈椎钩突骨折 ,其中男 4例 ,女 5例 ;年龄 18～ 31岁 ,平均 2 3.5岁。单侧颈椎钩突骨折 5例 ,双侧颈椎钩突骨折 2例 ,同侧 2个颈椎钩突骨折 2例。C5钩突骨折 4例次 ,C6 钩突骨折 7例次。非手术治疗 3例 ,手术治疗 6例。全组获随访 3～ 2 4年 ,平均 11年。结果　本组手术治疗患者效果优良 ;非手术治疗患者遗留不同程度颈痛、头晕、手麻等症状 ,其中 2例患者 30岁时有明显颈椎退变 ,3例患者 35岁时均诊断为颈椎病。　结论　本组颈椎钩突骨折的损伤机制是由于颈部的瞬时旋转和侧屈暴力造成 ,且有颈部侧屈和 (或 )旋转位受伤史。一旦颈椎左右侧屈正位片X线检查发现一侧椎间隙增宽 (>2mm) ,应行CT检查明确诊断 ,CT扫描层厚最好控制在 2mm。该种骨折如果治疗不当 ,将明显提前颈椎病发生时间     

Computed tomographic evaluation of C1–C2 in Pediatric cervical spine trauma

The supine open-mouth odontoid view required in most cervical spine trauma series often is difficult to obtain, especially in the pediatric or uncooperative patient. This retrospective study compared thin-section computed tomography with multiplanar reconstructions and the standard plain film cervical spine examination for evaluation of C1–C2 in a group of 31 pediatric patients age 6 years and under with combined craniocervical trauma. The plain film examination demonstrated adequate visualization of C1–C2 in only 58% of patients. The average number of anteroposterior odontoid films was 3.5 per examination (range, 1–6 films). Only 9% of anteroposterior open-mouth odontoid views were felt to be of adequate diagnostic quality vs. 60% of the Fuch’s odontoid view. The computed tomographic examination was diagnostic in 91% of examinations and could be acquired more rapidly.     

Nontraumatic dens fracture in a patient with lymphangiomatosis: radiographic, CT, and MR findings

Lymphangiomatosis is a rare condition characterized by benign angiomatous growth of lymphatic tissue. Bone infiltration may result in lytic lesions surrounded by sclerotic margins of varying thickness. We report a nontraumatic fracture of the dens in a female patient. Conventional radiographs and computed tomographic and magnetic resonance images are shown. The use of computed tomography and magnetic resonance imaging is highly recommended for investigating bone lesions of lymphangiomatosis, since, as occurred with our patient, conventional radiographs may not reveal all bone lesions in this disorder.     

C2 rotation and spinous process deviation in migraine: cause or effect or coincidence?

Summary Previous reports have shown an association between the side of C2 spinous process deviation or asymmetrical prominence, or vertebral rotation, and the side of the headache in unilateral migraine. However, this study has found that such C2 appearances were present as frequently in the controls as in the migraine patients, and that there was no association between the side of the anomaly and the lateralisation of the headache. The results were comparable for the different sub-groups of migraine.     

经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的现状及问题

经皮椎体成形术作为介入放射学中有效、安全的微创治疗手段,对骨质疏松性椎体压缩骨折有较好的疗效和较少的并发症.本文综述了经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床应用现状及存在问题.     

Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures

The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury.     

Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas: report of 2 cases

We report two cases of acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas. In both cases significant improvement of symptoms was rapid. One patient was able to return to work.     

前外侧入路经皮椎体成形术治疗颈椎4～7肿瘤性病变

目的 研究前外侧入路经皮椎体成形术治疗中下段颈椎肿瘤的方法的可行性及临床疗效.方法 2004-2008年共治疗16例中下段颈椎肿瘤患者,其中转移瘤12例,骨髓瘤3例,嗜酸性肉芽肿1例.穿刺入路采用前外侧穿刺法,所有患者均在X线透视引导下完成穿刺和骨水泥注射.术后随访3个月.结果 共穿刺和注射21个C4～C7段椎体,穿刺和骨水泥注射技术成功率100%.16例疼痛都得到了明显缓解,视觉模拟评分(VAS)由术前平均7分,降低到术后平均1.7分,颈椎运动功能优良.结论 前外侧入路经皮椎体成形术是安全、有效的治疗中下段颈椎椎体肿瘤微创方法.     

Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta

Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta.     

骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折

目的探讨骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折的操作技术、临床疗效。方法2002～2004年间共计治疗了108例诉有严重疼痛的椎体压缩性骨折患者,其中骨质疏松性压缩性骨折85例,椎体恶性肿瘤31例。穿刺入路采用双侧椎弓根穿刺法,所有患者均在透视监视下双侧注射聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA),注射设备为骨水泥混合与注射一体化装置。术后随访患者6个月。结果共计注射116个椎体(腰椎69个,胸椎47个),双侧穿刺和骨水泥注射成功率100％,99例患者(91．7％)术后疼痛明显缓解,6个月内疼痛无复发95例(95．6％),9例患者(8．3％)术后疼痛无缓解。发生骨水泥外漏12例(11％),有临床症状5例(4．6％)。结论骨水泥混合与注射一体化装置行经皮椎体成形术创伤小、并发症少,而且止痛疗效显著,是一种非常有前景的治疗椎体压缩性骨折的介入手术方法。     

无骨折脱位型颈髓损伤手术与非手术治疗疗效对比观察

目的　比较无骨折脱位型颈髓损伤非手术与手术治疗后 ,脊髓功能恢复程度的差异。　方法　回顾性分析 2 4例无骨折脱位型颈髓损伤患者 ,其中 13例行手术治疗 ,11例行非手术治疗 ,根据损伤时日本骨科学会 (JOA)评分、治疗后随访JOA评分 ,比较治疗前后JOA评分增加幅度。　结果　治疗后 3个月JOA评分增加幅度 :非手术组为 1.6 4± 0 .5 8,手术组为 3.2 9±0 .90 ;治疗后 12个月JOA评分增加幅度 :非手术组为 2 .0 0± 0 .73,手术组为 4 .93± 0 .96。经t检验 ,两组差异均有非常显著性意义 (P <0 .0 1)。　结论　无骨折脱位型颈髓损伤手术治疗效果明显优于非手术治疗 ,无骨折脱位型颈髓损伤一旦确诊 ,应当积极争取早期手术。     

相邻椎体单节段椎弓根内固定椎间植骨融合治疗胸腰椎骨折

目的研究相邻椎体单节段椎弓根内固定椎间植骨融合治疗轻、中度胸腰椎骨折的可行性和临床疗效。方法回顾性研究32例应用相邻椎体单节段椎弓根内固定技术治疗的胸腰椎骨折的患者，观察复位及植骨融合情况，矫正丢失、腰痛、腰椎活动情况及融合椎体相邻椎间盘退变等并发症发生情况。结果平均随访4．6个月时达到骨性融合，所有患者均得到满意复位，复位率达96％，术后腰痛症状明显缓解，未出现顽固性腰痛、腰椎活动受限等并发症，融合节段相邻椎间盘退变率仅为6％，临床效果明显优于多节段内固定。结论只要适应证选择合适，相邻椎体单节段内固定不但可以达到骨性融合、满意复位、坚强骨性融合，而且较三椎体二节段固定可明显降低顽固性腰痛、腰椎活动受限、相邻椎间盘退变等并发症的发生。     

Quantification of C2 cervical spine rotatory fixation by X-ray,MRI and CT

Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5° up to 15° right and 15° left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5° led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62° mm^–1). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15° rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation.