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Atlantooccipital Fusion or Occipitalization of Atlas

September 6, 2011 By Leave a Comment

Atlantooccipital fusion or Occipitalization of atlas is the most common congenital abnormality of upper cervical spine. It means partial or complete congenital fusion between the atlas and the base of the occiput.

The severity ranges from a complete bony fusion to a bony bridge or even a fibrous band. Occipitalization occurs because of failure of segmentation between the fourth occipital sclerotome and the first spinal sclerotome.

The incidence has been reported to be 1.4 to 2.5 per 1000 children. It affects both sexes equally. and affects males and females equally.

In 70% of the cases atlantooccipital fusion is associated with congenital fusion between C2 and C3. Other associated congenital anomalies are

  • Kyphosis and scoliosis
  • Anomalies of the jaw
  • Incomplete cleft of the nasal cartilage
  • Cleft palate
  • External ear deformities
  • Cervical ribs
  • Urinary tract anomalies

Clinical Findings

These patients have [Read more...]

Filed Under: Cervical Spine, Spine Tagged With: , ,

Congenital Abnormalities of Odontoid

August 20, 2011 By Leave a Comment

Congenital anomalies of the odontoid can be divided into three groups

  • Aplasia – Complete absence of odontoid.
  • Hypoplasia – Partial development of odontoid
  • Os odontoideum – In os odontoideum, the odontoid is an oval or round separated from the axis vertebra by a transverse gap. The lesion is mostly discovered as an incidental finding,

Odontoid anomalies are more common in patients of

  • Down syndrome
  • Klippel-Feil syndrome
  • Morquio syndrome
  • spondyloepiphyseal dysplasia.

Diagnosis

A number of patients may be asymptomatic. Others may have neck pain, torticollis, or headaches along with neurological symptoms may accompany. Proprioceptive and sphincter disturbances are common findings. Vertebral artery compression may cause cervical and brainstem ischemia of brainstem andcervical spine resulting in seizures, syncope, vertigo, and visual disturbances. [Read more...]

Filed Under: Cervical Spine, Pediatric Disorders, Spine Tagged With: , , ,

MRI Image Of Dislocation of C4 Vertebrae Over C5 Showing Compression Of Cord

July 23, 2011 By Leave a Comment

45 years old male got struck by a pole that fell on it while he was working in his fields. He came to emergency with complaints of weakness in all four limbs and pain in the neck.

THe xray showed C4-C5 dislocation and MRI revealed a compression on the cord by disc between these two vertebrae.

Here is MRI picture.

Disclocation of C4 vertebrae over C5 and disc compression of the cord
MRI SHowing Cord Compression By Disc Following C4 C5 Dislocation

The patient was treated by anterior decompression and fusion of C4 and C5 vertebrae

Filed Under: Cervical Spine, Musculoskeletal Radiology, Orthopaedic Images, Spine, Spine Injuries Tagged With: , , , , ,

Atlanto Axial Joint

March 11, 2011 By Leave a Comment

The Atlas or C1 is the first bone in the neck,  is simply a ring, with facets above and below to articulate with occiput above, and the Axis (C2) below.

The Axis (C2) too is quite unique. There is a pivot articulation between the odontoid process of the axis and the ring formed by the anterior arch and the transverse ligament of the atlas.

Atlas and Axis Vertebrae

Image Credit: http://www.chiropractic-help.com/Atlanto-axial-joint-anatomy.html

 

 

There are two atlanto-axial joints: median and lateral. [Read more...]

Filed Under: A-D, Cervical Spine, Definitions, Musculoskeletal Anatomy Tagged With: , ,

Xray Of Kyphosis At C3-C4 Cervical Vertebrae Due To Cervical Spine Instabilty

December 30, 2010 By Leave a Comment

The woman was 40 years old and had been admitted for hypertension and neckpain. She was apparently well about 3 days back when she started feeling pain in neck.

There were occasional episodes of vertigo.

Examination revealed tenderness at c4 level and there was mild loss of strength in her right hand grip.

The xray revealed reversal of lordosis and exaggereted kyphus at C3 C4 level.

The xray as shown above is an indicator of  severe cervical spine instability.

The patient was given a collar and sounded for need for operative intervention in form of fixation and fusion of C3-C4 vertebrae.

The patient does not want to undergo surgery and is satisfied with the collar for time being.

Filed Under: Cervical Spine, Spine Tagged With: , , , ,

Anteroposterior & Lateral Xrays Of Cervical Vertebrae Dislocation C5 Over C6

December 19, 2010 By Leave a Comment

A young male of 34 years was brought to casualty with history of fall from horse cart. He was quadriplegic [There was no power in any of the limbs]. On examination he was found to be in spinal shock.
c5-C6 dislocation of cervical vertebra

The xray showed dislocation of C5 over C6 vertebra. Vertebrae have been marked for better understanding.

The neck was stabilized with head halter traction and he was put on supportive treatment.

His MRI revealed a compression at C5-C6 level along with cord edema. [Read more...]

Filed Under: Cervical Spine, Spine Injuries Tagged With: , , , ,

Sternal Occipital Mandibular Immobilization Brace

August 15, 2010 By Leave a Comment

Image Credit: http://www.ketteringsurgical.co.uk/orthopaedics/orthotic-cervical-co/somi-brace-sternal-occipital-mandibular-immobilizer.71437.htm

The sterno-occipital-mandibular immobilizer (SOMI) cervical orthosis is a rigid cervico thoracic orthosis  used for supporting the ervical spine . SOMI does not provide complete immobilization though. It is somewhere between a Philadelphia collar and a halo brace.

Structurally, it has a chest plate that goes up to the notch where the collarbones meet in the front and metal, aluminum, or plastic bars that curve over the shoulder.

Straps from the bars go over the shoulder and cross to the opposite side of the anterior plate to hold it in place.

A removable chin piece attaches to the chest plate with an optional headpiece that can be used when the chin piece is removed for eating.

The SOMI works well to control flexion of the upper cervical spine (C1-3). It does not control extension that well.

The SOMI is used to immobilize an unstable neck due to fracture or ligamentous injury or disruption.

Filed Under: Cervical Spine, Definitions, S-Z, Traction-Aids-Appliances Tagged With: , ,

Minerva Brace

August 14, 2010 By 6 Comments
Minerva Brace

Image Credit: mattle.ch/upload/Minerva.jpg

The Minerva brace is a cervical and upper thoracic orthosis. It provides good orthotic control of the neck. There are many instances where Minerva brce can be used. For example severe whiplash injury or fracture of the vertebra or lower cervical fusion.

The Minerva orthosis has a rigid plastic posterior section that goes from the base of the skull down to the midtrunk. There is a solid chest piece in the front that is attached to the back along the sides with Velcro straps that can be adjusted.

Filed Under: Cervical Spine, Definitions, I-M, Traction-Aids-Appliances Tagged With: , ,

Fractures to the Axis Vertebra

August 3, 2010 By Leave a Comment

The axis vertebra has unique anatomy and despite  fractures to the odontoid or pars interarticularis, is subject to a variety of injuries similar to those found in the lower cervical spine. Several basic fracture types are recognized and can be divided  into distinct categories

Type I

The fractures resemble an extension-type teardrop fracture of the inferior anterior end plate. These fractures are usually stable.

Type II

Fractures are characterized by hear fracture line through the C-2 vertebral body that runs horizontally.

Type III

It is a burst fracture of  C-2 vertebral body.

Type IV

These fractures are sagittal cleavage fractures are usually be highly unstable.

Treatment

Stable fractures can be treated by conservative means but unstable fractures would require operative treatment.

Filed Under: Cervical Spine, Spine Injuries Tagged With: , ,

Cervical Injuries of the Ankylosed and Spondylotic Spine

July 31, 2010 By 4 Comments

Patients with ankylosed and spondylotic spine can suffer cervical injury even after minor trauma. Therefore, the patients who present with neck pain or neurologic deficit after major or minor trauma should be considered to have a cervical spine injury until proven otherwise.

Degenerative spondylotic changes, such as vertebral body osteophytes, fixed subluxations, and facet hypertrophy can make plain films difficult to interpret. Therefore unless the injury is severe, the plain x-rays may not be helpful in detecting a level of injury. [Read more...]

Filed Under: Cervical Spine, Spine Injuries Tagged With: , ,
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