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Pediatric spinal trauma

Review of 122 cases of spinal cord and vertebral column injuries

Mark N. Hadley, Joseph M. Zabramski, Carol M. Browner, Harold Rekate and Volker K. H. Sonntag

have a higher incidence of neurological injury, but this difference is not significant (p = 0.34). Four patterns of injury were recognized on the radiographic studies: 1) fracture of the vertebral body or posterior elements without subluxation (41% of patients); 2) fracture with subluxation (33%); 3) subluxation without fracture (10%); and 4) spinal cord injury without radiographic evidence of fracture or subluxation (16%). Cross-comparisons of the pattern of injury with patients' age and with the neurological examination on admission are depicted in

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Curtis A. Dickman, Mark N. Hadley, Carol Browner and Volker K. H. Sonntag

open reduction and internal fixation (four early, one delayed) had good bone fusion without evidence of subluxation on follow-up radiographic studies. At last follow-up examination, no patient had developed new neurological symptoms. The two patients with neurological compromise demonstrated incomplete recovery. Six patients (including three of five treated surgically) complained of persistent neck pain and/or a decreased range of head and neck motion. Discussion Sir Geoffrey Jefferson is credited for describing the bursting atlas fracture. 6 In fact, he

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The transoral approach to the superior cervical spine

A review of 53 cases of extradural cervicomedullary compression

Mark N. Hadley, Robert F. Spetzler and Volker K. H. Sonntag

rheumatoid arthritis, had two unrelated complications. The superior aspect of his pharyngeal incision dehisced, requiring reexploration and closure. No infection was noted. Two weeks after the second procedure, he returned to the hospital with signs of acute neurological deterioration. Radiographic studies revealed what appeared to be vertical occipitoatlantal subluxation, with vertebral artery occlusion and a brain-stem stroke. The patient was improving neurologically on the rehabilitation ward in a halo vest when he died from severe pneumonitis and respiratory compromise

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Mark N. Hadley, Curtis A. Dickman, Carol M. Browner and Volker K. H. Sonntag

/surgical Morbidity 0% 0% 0% 0% * Follow-up data available for 92% of patients; median duration 4 years 9 months. SOMI = sterno-occipitomandibular immobilizer. † Each of these patients had a C-2 fracture with marked C2–3 subluxation. Two patients did not achieve bone union with halo vest immobilization and required surgical stabilization. The first was a 64-year-old woman with marked C2–3 subluxation and distraction. She could not be held in adequate alignment with the halo device and underwent posterior wiring and fusion of C1–3 with

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Curtis A. Dickman, Mark N. Hadley, Conrad T. E. Pappas, Volker K. H. Sonntag and Fred H. Geisler

injury, the patient had a mild spastic weakness (4/5) of the left arm, with hyperreflexia, and a positive Hoffmann's sign in this limb. Follow-up flexion and extension roentgenograms of the cervical spine were without evidence of subluxation. Case 12 This 62-year-old man lost control of his all-terrain vehicle in the desert. He fell from the vehicle, striking his cranial vertex, but did not lose consciousness. He experienced the sudden onset of quadriplegia and respiratory arrest. He reported remaining fully alert but “trapped inside [his] body, unable to

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Stephen M. Papadopoulos, Curtis A. Dickman and Volker K. H. Sonntag

arthritis are atlantoaxial subluxation, subaxial subluxation, and superior migration of the odontoid. 3, 13, 30, 31 The incidence of atlantoaxial subluxation alone or in combination with other lesions of the cervical spine is reported to occur in 19% to 71% of patients with rheumatoid arthritis. 1, 13, 19, 20, 23, 25, 26 Suboccipital pain secondary to compression of the C-2 root is the most common symptom associated with atlantoaxial subluxation. 3, 4, 13, 23, 31 The presence and severity of an associated myelopathy correlate with the degree of subluxation, the extent

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Curtis A. Dickman, Volker K. H. Sonntag, Stephen M. Papadopoulos and Mark N. Hadley

,  delayed osseous  union * Traumatic = ligamentous atlantoaxial instability without fracture. † Atlantoaxial subluxation in Cases 1 to 7, 16, 18, 20, 21, and 23; dens dislocation in the rest. ‡ s = single-stranded wire; d = double-stranded wire, twisted. TABLE 2 Clinical summary in 13 patients treated with bicortical iliac bone grafts Case No. Age (yrs), Sex Diagnosis Presenting Symptoms Dislocation (mm) * Wire (gauge) † Follow-Up Period (mos) Outcome 24 76

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Curtis A. Dickman, Alexander Mamourian, Volker K. H. Sonntag and Burton P. Drayer

-echo scan. Postmortem Examination of the Transverse Ligament The MR imaging appearance of the in vitro cadaveric transverse ligaments was identical to the in vivo imaging characteristics of the ligament ( Fig. 2 ). The postmortem studies confirmed that the imaged ligamentous structure was indeed the transverse ligament. Transverse ligament disruption was verified by the postmortem examination in a 59-year-old woman who sustained an atlantoaxial subluxation in a high-speed automobile accident. Plain lateral cervical radiographs revealed a 2-cm anterior

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Paul Marcotte, Curtis A. Dickman, Volker K. H. Sonntag, Dean G. Karahalios and Janine Drabier

patients chose screw fixation. Full preoperative imaging was performed in all cases to delineate the pathological process causing the C1–2 instability. Plain radiographs were used to assess the C1–2 alignment and determine if subluxations could be reduced. Computerized tomography (CT) scans (axial, sagittal, and coronal reconstructions) were used to delineate fractures and assess whether the bone architecture and course of the vertebral artery would permit screw placement. Patient Population During a 12-month period at our facility, 18 patients were treated

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dislocations. Surg Neurol 40 : 395 – 399 , 1993 Berrington NR, van Staden JF, Willers JG, et al: Cervical intervertebral disc prolapse associated with traumatic facet dislocations. Surg Neurol 40: 395–399, 1993 2. Eismont FJ , Arena MJ , Green BA : Extrusion of an intervertebral disc associated with traumatic subluxation or dislocation of cervical facets. Case report. J Bone Joint Surg (Am) 73 : 1555 – 1560 , 1991 Eismont FJ, Arena MJ, Green BA: Extrusion of an intervertebral disc associated with traumatic