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[PMID]:29390447
[Au] Autor:Xu JX; Wang CG; Zhou CW; Tang Q; Li JW; Xu HZ; Mao FM; Tian NF
[Ad] Endereço:Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
[Ti] Título:Cervical myelopathy caused by invaginated laminae of the axis associated with occipitalizaion of the atlas: Case report and literature review.
[So] Source:Medicine (Baltimore);96(51):e9156, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: In previous studies, few cases of cervical myelopathy caused by invaginated anomalous laminae of the axis have been reported, and none of them was combined with occipitalization of the atlas. PATIENT CONCERNS: A 28-year-old male was brought to our hospital with motor and sensory impairments of the extremities after a car accident. DIAGNOSES: MRI showed the spinal cord was markedly compressed at the C2/3 level. Reconstructed CT scans revealed an invaginated laminae of axis into the spinal canal as well as atlas assimilation. INTERVENTIONS: The patient was successfully managed with surgical treatment by removal of the anomalous osseous structure as well as fixation and fusion. OUTCOMES: The patient had a rapid recovery after the operation. He regained the normal strength of his 4 extremities and the numbness of his extremities disappeared. He returned to his normal work 3 months after the surgery without any symptoms. LESSONS: Invaginated laminae of axis combined with occipitalization of the atlas is a rare deformity. MRI and reconstructed CT scans are useful for both diagnosing and surgical planning of this case. Surgical removal of the laminae results in a satisfactory outcome. The pathogenesis of this anomaly could be the fusion sequence error of the 4 chondrification centers in the embryological term.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/anormalidades
Vértebra Cervical Áxis/diagnóstico por imagem
Compressão da Medula Espinal/diagnóstico por imagem
Doenças da Medula Espinal/etiologia
[Mh] Termos MeSH secundário: Adulto
Descompressão Cirúrgica
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Compressão da Medula Espinal/cirurgia
Doenças da Medula Espinal/diagnóstico por imagem
Doenças da Medula Espinal/cirurgia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009156


  2 / 1720 MEDLINE  
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[PMID]:29252633
[Au] Autor:Aggarwal RA; Srivastava S; Bhosale S; Roy K
[Ad] Endereço:Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India.
[Ti] Título:Congenital Agenesis of the Posterior Elements of the Axis (C2), Occipitalization of the Atlas (C1), and Basilar Invagination in an Adult Woman: A Case Report.
[So] Source:JBJS Case Connect;6(3):e56, 2016 Jul-Sep.
[Is] ISSN:2160-3251
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE: A 55-year-old woman presented with chronic neck pain. Physical and neurological examination results were normal. Radiographs revealed absence of the posterior elements of C2 with hypertrophy of the spinous process of C3. A computed tomography scan showed occipitalization of the atlas with basilar invagination. Magnetic resonance imaging did not reveal any soft-tissue abnormalities. The patient was treated with a short course of a nonsteroidal anti-inflammatory drug and physiotherapy. CONCLUSION: Agenesis of the posterior elements of C2 should be considered in patients with hypertrophy of the spinous process of C3. Patients may have a varied presentation ranging from neck pain to myelopathy. Dynamic (flexion and extension) lateral cervical spine radiographs should be obtained, as cases reported in the literature involved instability of the cervical spine.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/anormalidades
Atlas Cervical/anormalidades
Cervicalgia/etiologia
[Mh] Termos MeSH secundário: Vértebra Cervical Áxis/diagnóstico por imagem
Atlas Cervical/diagnóstico por imagem
Feminino
Seres Humanos
Meia-Idade
Cervicalgia/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.CC.15.00261


  3 / 1720 MEDLINE  
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[PMID]:29381931
[Au] Autor:Zheng Y; Wang J; Liao S; Zhang D; Zhang J; Ma L; Xia H
[Ad] Endereço:Southern Medical University, Guangzhou.
[Ti] Título:Biomechanical evaluation of a novel integrated artificial axis: A finite element study.
[So] Source:Medicine (Baltimore);96(47):e8597, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Various modified instruments are used for the anterior reconstruction of the tumor lesion affecting the second cervical vertebra, but there have been no reports regarding individual integrated artificial axis (IAA) prosthesis fabricated by selective laser melting. In the present work, a new type of IAA prosthesis has been designed with a 3-dimensional (3D) finite element model of normal occiput-the fourth cervical vertebra being established to assess its biomechanics. For easy comparison, another 3D finite element model is also established for the T-shaped Harms cage and an additional posterior fixation was performed on each model. The models are tested under a preliminary loading of 40 N to simulate cervical physical action including flexion, extension, lateral bending, and rotation. Under various loads from 4 different directions, the maximum stress and displacement of the IAA are less than those of the modified T-shaped Harms cage. Except for flexion, the maximum stress of the third cervical vertebra endplate of the IAA is smaller than that of the modified T-shaped Harms cage. The new prosthesis with axis is a good choice for upper cervical operation, which not only can greatly increase the operation stability of the upper cervical segment but also could significantly reduce the risk of fixation failure due to Harms cage subsidence.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/cirurgia
Desenho de Prótese/métodos
Neoplasias da Coluna Vertebral/cirurgia
Substituição Total de Disco/instrumentação
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Simulação por Computador
Análise de Elementos Finitos
Seres Humanos
Imagem Tridimensional
Terapia a Laser/métodos
Teste de Materiais
Melhoria de Qualidade
Substituição Total de Disco/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008597


  4 / 1720 MEDLINE  
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[PMID]:28885370
[Au] Autor:Yang HS; Kim KW; Oh YM; Eun JP
[Ad] Endereço:Department of Neurosurgery, Biomedical Research Institute of Chonbuk National University Hospital, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.
[Ti] Título:Usefulness of titanium mesh cage for posterior C1-C2 fixation in patients with atlantoaxial instability.
[So] Source:Medicine (Baltimore);96(36):e8022, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to investigate the usefulness of titanium mesh cage as an interlaminar spacer combined with nitinol shape memory loop fixation in patients with atlantoaxial instability.From April 2009 to March 2017, among the patients with atlantoaxial instability, a total of 30 patients were treated by nitinol shape memory loop fixation combined with titanium mesh cage as a spacer. We retrospectively reviewed 30 enrolled patients. Successful fusion was determined as improvement of symptoms and radiologic findings of bone fusion. We also reviewed surgical complications, instrumentation failure, bony fusion rate, and posterior atlantodental interval (PADI).After surgery, the symptoms of all patients significantly improved. Successful fusion was documented throughout the follow-up period. Evidence of solid bridging bone was found, and no instability was seen on flexion-extension radiographs and callus formation on 3D cervical spine computed tomography (CT) 6 months postoperatively in all cases. No surgical complications were observed. No cases of instrumentation failure were observed. The mean PADI also improved significantly to 22.45 ±â€Š1.11 mm 6 months postoperatively compared with the preoperative value of 18.37 ±â€Š1.16 mm (P < .05).We obtained a good fusion rate by using titanium mesh cage spacer with nitinol shape memory alloy loop in patients with atlantoaxial instability. This technique can help surgeons in avoiding vertebral artery injury and reducing bleeding and operation time. Therefore, we suggest that titanium mesh cage spacer combined with nitinol shape memory alloy loop can be a good substitute of autograft for C1-C2 fusion in treating atlantoaxial instabilities.
[Mh] Termos MeSH primário: Articulação Atlantoaxial/cirurgia
Vértebra Cervical Áxis/cirurgia
Atlas Cervical/cirurgia
Fixadores Internos
Instabilidade Articular/cirurgia
Fusão Vertebral/instrumentação
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Articulação Atlantoaxial/diagnóstico por imagem
Vértebra Cervical Áxis/diagnóstico por imagem
Atlas Cervical/diagnóstico por imagem
Feminino
Seguimentos
Seres Humanos
Imagem Tridimensional
Instabilidade Articular/diagnóstico por imagem
Masculino
Meia-Idade
Titânio
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
D1JT611TNE (Titanium)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008022


  5 / 1720 MEDLINE  
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[PMID]:28820364
[Au] Autor:Radovanovic I; Urquhart JC; Rasoulinejad P; Gurr KR; Siddiqi F; Bailey CS
[Ad] Endereço:Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario.
[Ti] Título:Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types.
[So] Source:J Neurosurg Spine;27(5):494-500, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Previous studies have focused on Type II odontoid fractures and have failed to report on the effect of other C-2 fracture types on treatment and outcome. The purpose of this study was to compare patient characteristics, cause of injury, predisposing factors to fracture, treatments, and mortality rates among C-2 fracture types in a cohort of elderly patients 70 years of age and older. METHODS A retrospective cohort study design was used. Patients who sustained a C-2 fracture between 2002 and 2011 and who were admitted to the authors' Level 1 trauma center were identified using the Discharge Abstract Database and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S12.1. Fractures were classified as odontoid Type I, II, or III; hangman's; C-2 complex (hangman's appearance on sagittal images, Type III odontoid on coronal cuts); and other (miscellaneous). Age, sex, predisposing factors to falls, cause of injury, treatment, presence of autofusion in the subaxial cervical spine, and mortality rates were compared between fracture patterns. RESULTS One hundred forty-one patients were included; their mean age was 82 years. Fractures included Type II odontoid (57%), complex (19%), Type III odontoid (11%), hangman's (8%), and other (5%). Falls from a standing height accounted for 47% of injuries, and 65% of patients had ≥ 3 risk factors for falls. Subaxial autofusion was more common in odontoid fractures (p = 0.002). Treatment was mainly nonoperative (p < 0.0001). The 1-year mortality rate was 27%. Four patients died of spinal cord injury. CONCLUSIONS Although not as common as Type II odontoid fractures, other C-2 fractures including hangman's, complex, and Type III odontoid fractures accounted for close to half of the injuries in the study cohort. There were few differences between the fracture types with respect to cause of injury, predisposing factors, or mortality rate. However, surgical treatment was more common for Type II odontoid fractures.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/lesões
Fraturas da Coluna Vertebral/mortalidade
Fraturas da Coluna Vertebral/terapia
[Mh] Termos MeSH secundário: Acidentes por Quedas
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Vértebra Cervical Áxis/diagnóstico por imagem
Vértebra Cervical Áxis/cirurgia
Feminino
Seguimentos
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores Sexuais
Traumatismos da Medula Espinal/etiologia
Traumatismos da Medula Espinal/mortalidade
Traumatismos da Medula Espinal/terapia
Fraturas da Coluna Vertebral/classificação
Fraturas da Coluna Vertebral/etiologia
Fusão Vertebral
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.3171/2017.3.SPINE161176


  6 / 1720 MEDLINE  
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[PMID]:28708041
[Au] Autor:Minamide A; Yoshida M; Simpson AK; Yamada H; Hashizume H; Nakagawa Y; Iwasaki H; Tsutsui S; Okada M; Takami M; Nakao SI
[Ad] Endereço:Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.
[Ti] Título:Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study.
[So] Source:J Neurosurg Spine;27(4):403-409, 2017 Oct.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE The goal of this study was to characterize the long-term clinical and radiological results of articular segmental decompression surgery using endoscopy (cervical microendoscopic laminotomy [CMEL]) for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). METHODS Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n = 78) underwent CMEL or ELAP. All patients were followed postoperatively for more than 5 years. The preoperative and 5-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), JOA recovery rates, axial neck pain (using a visual analog scale), the SF-36, and cervical sagittal alignment (C2-7 subaxial cervical angle). RESULTS Sixty-one patients were included for analysis, 31 in the CMEL group and 30 in the ELAP group. The mean preoperative JOA score was 10.1 points in the CMEL group and 10.9 points in the ELAP group (p > 0.05). The JOA recovery rates were similar, 57.6% in the CMEL group and 55.4% in the ELAP group (p > 0.05). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (p < 0.01). At the 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.6° gain in lordosis (versus 1.2° loss of lordosis in the ELAP group [p < 0.05]) and lower incidence of postoperative kyphosis. CONCLUSIONS CMEL is a novel, less invasive technique that allows for multilevel posterior cervical decompression for the treatment of CSM. This 5-year follow-up data demonstrates that after undergoing CMEL, patients have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional ELAP counterparts.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/cirurgia
Endoscopia
Laminectomia
Laminoplastia
Microcirurgia
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Vértebra Cervical Áxis/diagnóstico por imagem
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Espondilose/diagnóstico por imagem
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.3171/2017.2.SPINE16939


  7 / 1720 MEDLINE  
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[PMID]:28700494
[Au] Autor:Li G; Zhong D; Wang Q
[Ad] Endereço:Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, China.
[Ti] Título:A novel classification for atypical Hangman fractures and its application: A retrospective observational study.
[So] Source:Medicine (Baltimore);96(28):e7492, 2017 Jul.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Atypical Hangman fractures (AHF) were first formally reported and considered to be more often associated with neurologic deficit in 1993. However, there is a paucity of literature focusing on these fractures. The purpose of the retrospective study was to introduce a new classification scheme for AHF and its application.Sixty-two patients with Hangman fractures were identified. There were 46 (74.2%, 46/62) AHF patients, including 29 type I, 9 type II, 5 type IIa, and 3 type III fractures (Levine-Edwards classification). Based on fracture patterns, incidence, and their impact on neurologic status, a primary classification for AHF was devised. The clinical features of AHF were observed, and a new classification was introduced. The appropriate treatment strategy of AHF was discussed.Of 46 AHF patients, 27 underwent surgical treatment (24 with posterior approach with screw-rod fixation and fusion, 1 with anterior approach by C2/3 discectomy and fusion, and 2 with anterior and posterior approach), and the remaining 19 patients underwent nonoperative treatment. No patient complained severe neck pain at final follow-up. Neurologic status improved 1 to 2 grade in 12 cases with neurologic deficit. All patients achieved bony fusion within the follow-up period.AHF should be recognized as a distinct fracture subtype. The new classification for AHF is based on the feature of fracture patterns, injury mechanism, incidence, and their impact on neurologic deficit. And the new classification is complementary to Levine-Edwards.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/lesões
Fraturas da Coluna Vertebral/classificação
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Vértebra Cervical Áxis/diagnóstico por imagem
Vértebra Cervical Áxis/cirurgia
Discotomia
Feminino
Seguimentos
Fixação Interna de Fraturas
Seres Humanos
Incidência
Instabilidade Articular/diagnóstico por imagem
Instabilidade Articular/epidemiologia
Instabilidade Articular/etiologia
Instabilidade Articular/cirurgia
Masculino
Meia-Idade
Estudos Retrospectivos
Fraturas da Coluna Vertebral/diagnóstico por imagem
Fraturas da Coluna Vertebral/epidemiologia
Fraturas da Coluna Vertebral/cirurgia
Fusão Vertebral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170730
[Lr] Data última revisão:
170730
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007492


  8 / 1720 MEDLINE  
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[PMID]:28408260
[Au] Autor:Ren C; Song Y; Xue Y; Yang X; Zhou C
[Ad] Endereço:Department of Orthopedics, Lianyungang No.1 People' s Hospital, Xuzhou Academy of Medical Sciences, Lianyungang, China.
[Ti] Título:Evaluation of Bioabsorbable Multiamino Acid Copolymer/Nanohydroxyapatite/Calcium Sulfate Cage in a Goat Spine Model.
[So] Source:World Neurosurg;103:341-347, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Currently, polylactide is the most popular material used to made bioabsorbable cages but too-quick degradation and osteolysis around the cage have been reported in the literature. This study evaluated the fusion effect, biomechanical stability, and histologic characteristics of a novel bioabsorbable multiamino acid copolymer/nanohydroxyapatite/calcium sulfate (MAACP/n-HA/CS) interbody cage in a goat model of anterior cervical discectomy and fusion. METHODS: A total of 24 goats underwent C3/C4 discectomy and fusion with 3 groups of intervertebral implants: MAACP/n-HA/CS cage group (n = 8), titanium cage group (n = 8), and autologous tricortical iliac crest bone group (n = 8). Disc space height and lordosis angle were measured pre- and postoperatively and after 4, 12, and 24 weeks. Range of motion (ROM) was evaluated through biomechanical testing. Histologic analysis was performed to evaluate fusion status and to detect any foreign body reactions associated with the bioabsorbable cages. RESULTS: At 12 and 24 weeks, disc space height in MAACP/n-HA/CS cage group was greater than that of titanium cage group and tricortical iliac crest group (P < 0.05). Lordosis angle in MAACP/n-HA/CS cage group and titanium cage group were lower than that of tricortical iliac crest group (P < 0.05). Biomechanical test showed that ROM did not differ significantly between MAACP/n-HA/CS cage group and titanium cage group, whereas the value of ROM in bone graft group was the largest. Histologic evaluation showed a better interbody fusion in the MAACP/n-HA/CS cage group than in the other 2 groups. MAACP/n-HA/CS cage surface degraded and was absorbed at 24 weeks. All MAACP/n-HA/CS cages showed excellent biocompatibility. CONCLUSIONS: MAACP/n-HA/CS cages can provide good fusion effect, enough biomechanical stability, and integrate closely with the surrounding bone.
[Mh] Termos MeSH primário: Implantes Absorvíveis
Sulfato de Cálcio/uso terapêutico
Fusão Vertebral/instrumentação
[Mh] Termos MeSH secundário: Aminoácidos/uso terapêutico
Animais
Vértebra Cervical Áxis/fisiologia
Vértebra Cervical Áxis/cirurgia
Fenômenos Biomecânicos
Discotomia/métodos
Durapatita/uso terapêutico
Cabras
Nanoestruturas/uso terapêutico
Polímeros/uso terapêutico
Distribuição Aleatória
Amplitude de Movimento Articular/fisiologia
Fusão Vertebral/métodos
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amino Acids); 0 (Polymers); 91D9GV0Z28 (Durapatite); WAT0DDB505 (Calcium Sulfate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE


  9 / 1720 MEDLINE  
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[PMID]:28387614
[Au] Autor:Dlouhy BJ; Policeni BA; Menezes AH
[Ad] Endereço:Departments of 1 Neurosurgery and.
[Ti] Título:Reduction of atlantoaxial dislocation prevented by pathological position of the transverse ligament in fixed, irreducible os odontoideum: operative illustrations and radiographic correlates in 41 patients.
[So] Source:J Neurosurg Spine;27(1):20-28, 2017 Jul.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Os odontoideum (OO) is a craniovertebral junction (CVJ) abnormality in which an ossicle (small bone) is cranial to a hypoplastic dens by a variable gap. This abnormality can result in instability, which may be reducible or irreducible. What leads to irreducibility in OO is unclear. Therefore, the authors sought to better understand the causes of irreducibility in OO. METHODS A retrospective review was conducted, which identified more than 200 patients who had undergone surgical treatment for OO between 1978 and 2015 at the University of Iowa Hospitals and Clinics. Only the 41 patients who had irreducible OO were included in this study. All inpatient and outpatient records were retrospectively reviewed, and patient demographics, clinical presentation, radiographic findings, surgical treatment, and operative findings were recorded and analyzed. RESULTS The cohort of 41 patients who were found to have irreducible OO included both children and adults. A majority of patients were adults (61% were 18 years or older). Clinical presentation included neck pain and headache in the majority of patients (93%). Weakness, sensory disturbances, and myelopathy were invariably present in all 41 patients (100%). Down syndrome was much more common in the pediatric cohort than in the adult cohort; of the 16 pediatric patients, 6 had Down syndrome (38%), and none of the adults did. Of the 16 pediatric patients, 5 had segmentation failure (31%) in the subaxial spine, and none of the adults did. A form of atlantoaxial dislocation was seen in all cases. On CT imaging, atlantoaxial facets were dislocated in all 41 cases but did not have osseous changes that would have prevented reduction. On MRI, the transverse ligament was identified anterior and inferior to the ossicle and superior to the hypoplastic odontoid process in all cases in which these studies were available (i.e., post-MRI era; 36 of 36 cases). The ligament was hypointense on T2-weighted images but also had an associated hyperintense signal on T2 images. Intraoperatively, the transverse ligament was identified anterior and inferior to the ossicle and superior to the hypoplastic odontoid process in all 41 cases. CONCLUSIONS In the largest series to date of irreducible OO and the only study to examine variable factors that lead to irreducibility in OO, the authors found that the position of the transverse ligament anterior and inferior to the ossicle is the most common factor in the irreducibility of OO. The presence of granulation tissue and of the dystopic variant of OO is also associated with irreducibility. The presence of Down syndrome and segmentation failure probably leads to faster progression of ligamentous incompetence and therefore earlier presentation of instability and irreducibility. This is the first study in which intraoperative findings regarding the transverse ligament have been correlated with MRI.
[Mh] Termos MeSH primário: Articulação Atlantoaxial/lesões
Articulação Atlantoaxial/cirurgia
Vértebra Cervical Áxis/anormalidades
Vértebra Cervical Áxis/cirurgia
Luxações Articulares/cirurgia
Ligamentos Articulares/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Articulação Atlantoaxial/diagnóstico por imagem
Articulação Atlantoaxial/patologia
Vértebra Cervical Áxis/diagnóstico por imagem
Vértebra Cervical Áxis/patologia
Criança
Pré-Escolar
Feminino
Seres Humanos
Luxações Articulares/diagnóstico por imagem
Luxações Articulares/etiologia
Luxações Articulares/patologia
Ligamentos Articulares/diagnóstico por imagem
Ligamentos Articulares/patologia
Masculino
Meia-Idade
Procedimentos Ortopédicos
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE
[do] DOI:10.3171/2016.11.SPINE16733


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[PMID]:28319639
[Au] Autor:Muss L; Wilmskoetter J; Richter K; Fix C; Stanschus S; Pitzen T; Drumm J; Molfenter S
[Ad] Endereço:Bielefeld University, Bielefeld, GermanyMedical Park Loipl, Bischofswiesen, Germany.
[Ti] Título:Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison.
[So] Source:J Speech Lang Hear Res;60(4):785-793, 2017 04 14.
[Is] ISSN:1558-9102
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results: After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions: ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.
[Mh] Termos MeSH primário: Vértebra Cervical Áxis/cirurgia
Transtornos de Deglutição/etiologia
Deglutição
Discotomia
Complicações Pós-Operatórias/diagnóstico por imagem
Fusão Vertebral
[Mh] Termos MeSH secundário: Adulto
Idoso
Deglutição/fisiologia
Transtornos de Deglutição/diagnóstico por imagem
Transtornos de Deglutição/fisiopatologia
Feminino
Fluoroscopia
Seres Humanos
Osso Hioide/diagnóstico por imagem
Osso Hioide/fisiologia
Masculino
Meia-Idade
Variações Dependentes do Observador
Faringe/diagnóstico por imagem
Faringe/fisiologia
Complicações Pós-Operatórias/fisiopatologia
Reprodutibilidade dos Testes
Estudos Retrospectivos
Gravação em Vídeo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170321
[St] Status:MEDLINE
[do] DOI:10.1044/2016_JSLHR-S-16-0091



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