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Evaluation and treatment of congenital and developmental anomalies of the cervical spine

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Arnold H. Menezes

region. 11 Advances in neurodiagnostic imaging have increased our understanding of the abnormal anatomy and the ongoing developmental changes—and thus, the natural history—of these congenital/developmental disorders. In this paper the practical classification of congenital cervical abnormalities, their evaluation, and their imaging features are discussed. A surgical approach to treatment of these abnormalities will be presented as a treatment algorithm. Classification of Congenital Anomalies of the Cervical Spine Table 1 provides a practical classification of

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Arnold H. Menezes

AH , VanGilder JC , Graf CJ , McDonnell DE : Craniocervical abnormalities. A comprehensive surgical approach . J Neurosurg 53 : 444 – 455 , 1980 25 Milhorat TH , Chou MW , Trinidad EM , Kula RW , Mandell M , Wolpert C , : Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients . Neurosurgery 44 : 1005 – 1017 , 1999 26 Mummaneni PV , Haid RW : Transoral odontoidectomy . Neurosurgery 56 : 1045 – 1050 , 2005 27 Munshi I , Frim D , Stine-Reyes R , Weir BKA

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John G. Piper and Arnold H. Menezes

tumor embolization was performed in Case 5. Further medical workup was individualized. Patients suspected of harboring metastatic disease underwent extensive evaluation to select those with either solitary metastatic disease or anticipated survival of greater than 6 months. Surgical Decompression Four surgical approaches were used for decompression and diagnosis, including the transoral—transpalatal, 15, 22, 23, 25, 28 lateral extrapharyngeal, 22, 23, 33, 36 posterolateral—transcondylar, 22, 23, 32, 35 and dorsal approaches. 3, 32, 35 The selection of

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Arnold H. Menezes and John C. VanGilder

neurosurgical armamentarium. The reasons for this can be attributed to initial reports of infection, limited exposure, CSF leakage, and unacceptable patient morbidity and mortality rates. Scoville and Sherman 32 stated in 1951 that “the angulation of the medulla over the abnormally high odontoid process is the chief offender and causation of neurologic signs and disability in platybasia. Future surgical advance lies in the development of a successful removal of the odontoid, possibly through the mouth.” Over the past three decades, the value of the anterior surgical approach

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Arnold H. Menezes and Raheel Ahmed

for each patient to identify the course of the vertebral artery in relation to the tumor for the planned surgical approach or to determine tumor involvement. Preoperative tumor embolization was performed for a patient with a large vascular osteoblastoma, a 16-year-old patient with an aneurysmal bone cyst, as a definitive procedure for a patient with radiation-induced aneurysmal bone cyst, and before staged excision for a patient with a C-2 chordoma. One patient underwent embolization for a vascular lesion identified on MR images that was later determined to be

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Douglas L. Brockmeyer, Andrew Jea, Alan R. Cohen and Arnold H. Menezes

surgical concepts and approaches to the CCJ by Dlouhy et al., Mazur et al., Eicker et al., Joaquim and Patel, Klekamp, Huang et al., and Moscovici et al. To give insight into endoscopic approaches and techniques for the CCJ are articles by Morales-Valero et al., La Corte et al., and Liu et al. Last are two articles using national and pooled data to look at surgical approaches to the CCJ and medico-economic trends concerning hospital usage, the first by Chieng et al. and the second by Kukreja et al. We, the editors, hope that you, the reader, find this issue of

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Brian J. Dlouhy, Nader S. Dahdaleh, Arnold H. Menezes and MD

over the last 100 years. Depending on the location of pathology, surgical approaches to the CVJ are divided into those that use the ventral, lateral, and dorsal approaches ( Table 1 ). 74 The transoral approaches for decompression of irreducible ventral pathology at the CVJ have become a mainstay of treatment. In the last 10 years, the emergence of endoscopic endonasal approaches (EEAs) 47 has provided more options for decompression of irreducible ventral CVJ pathology. Additionally, various reduction strategies have evolved. The ability to properly reduce ventral

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Nader S. Dahdaleh, Brian J. Dlouhy and Arnold H. Menezes

process is the determination of the reducibility of the lesion. This dictates the surgical approach: a dorsal-only decompression and fixation, or a more extensive combined ventral decompression and dorsal fixation. 4 , 5 The treatment strategy is evolving due to the availability of better imaging techniques. One milestone was the ability to assess the dynamic anatomical relationship between osseous, ligamentous, and neural structures by using dynamic MR imaging and CT scanning in the presence of distraction forces applied using crown halo traction. Lesions that

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Odontoid upward migration in rheumatoid arthritis

An analysis of 45 patients with “cranial settling”

Arnold H. Menezes, John C. VanGilder, Charles R. Clark and George El-Khoury

rheumatoid arthritis. JAMA 236: 2094–2095, 1976 37. Menezes AH , VanGilder JC , Graf CJ , et al : Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53 : 444 – 455 , 1980 Menezes AH, VanGilder JC, Graf CJ, et al: Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53: 444–455, 1980 38. Michie I , Clark M : Neurological syndromes associated with cervical and craniocervical anomalies. Arch Neurol 18 : 241 – 247 , 1968 Michie I

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Michael G. Muhonen, Arnold H. Menezes, Paul D. Sawin and Stuart L. Weinstein

. Menezes AH , VanGilder JC , Graf CJ , et al : Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53 : 444 – 455 , 1980 Menezes AH, VanGilder JC, Graf CJ, et al: Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53: 444–455, 1980 27. Nordwall A , Wikkelsø C : A late neurologic complication of scoliosis surgery in connection with syringomyelia. Acta Orthop Scand 50 : 407 – 410 , 1979 Nordwall A, Wikkelsø C: A late neurologic complication of