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Henry T. Wycis

odontoid process on the medulla oblongata. It was not until 1911 that the condition was recognized as a clinical entity. At this time Schlüller 12 made the first premortem diagnosis, describing the effects of the bony deformity on the central nervous system. Since that time, clinico-pathologic reports have appeared by Sinz, 13 Kecht, 7 Krause, 8 Juhlin-Dannfelt, 6 Merio and Risak, 10 and Ebenius. 3 In 1939, Chamberlain 2 described four cases of basilar impression with bizarre neurological abnormalities. In two cases, suboccipital decompression, carried out by

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Jerzy Chorobski and Lucjan Stȩpien

the skull, consists of the dorsal arching of the basiocciput and basisphenoid with flattening of the sphenoid angle. The result of this is a projection of the atlas and of the odontoid process above a line drawn from the posterior edge of the hard palate to the posterior border of the foramen magnum (Schüller 16 ). This malformation is sometimes associated with such anomalies of the spinal column as Klippel-Feil's syndrome (Merio and Risak 12 ), cervical spina bifida (Gustafson and Oldberg; 8 List; 11 Naffziger and Boldrey 13 ), et cetera, all of which are the

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Non-Traumatic Atlanto-Axial Dislocation

Report of Case with Recovery after Quadriplegia

Leonard A. Titrud, C. A. McKinlay, Walter E. Camp and Hewitt B. Hannah

In 1830, Bell 1 described the occurrence of dislocation of the atlas because of destruction of the transverse ligament that holds the odontoid process of the axis in its normal anterior position. This particular instance was associated with a neck infection in the patient. Greig 8 demonstrated that during a cervical infection, a diffuse tissue hyperemia occurs which results in adjacent bone decalcification with loosening of the intervertebral ligaments, especially between the atlas and axis, so that the skull and 1st cervical vertebra dislocate anteriorly. In

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The Syndrome of Acute Central Cervical Spinal Cord Injury

With Special Reference to the Mechanisms Involved in Hyperextension Injuries of Cervical Spine

Richard C. Schneider, Glenn Cherry and Henry Pantek

. On the anteroposterior roentgenogram, the pedicles of C4, C5 and C6 seemed to be comminuted on the right side and dislocated, but their counterparts on the left side appeared intact ( Fig. 15 ). Open-mouth roentgenograms of the cervical spine showed a greenstick fracture of the base of the odontoid process, so that a major portion of it was avulsed on the left side, but on the right the process was intact ( Fig. 16 ). On the lateral view this structure seemed to be displaced about 8 mm. posteriorly. There was no significant displacement of C1 on C2. The C4

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Joseph Stratford

Injury to the upper cervical spine resulting in a separate odontoid process and atlanto-axial dislocation presents a serious problem. The patient may survive the initial episode and the injury may remain undetected and untreated. A sudden recurrence of the deformity may produce signs of damage to the spinal cord, or, over a period of many months or years, evidence of cord damage may slowly develop as the result of recurrent gliding of the atlas on the axis, with consequent narrowing of the vertebral canal. Corner, 6 in 1907, describing a series of patients

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B. Ramamurthi and G. S. Visvanathan

interference with the blood supply of the cord in diseases of the vertebrae is being studied separately in relation to fluorosis and spondylitis. Collapse of the vertebra from softening, with resultant kyphosis and cord compression, is another cause of paraplegia. Dislocation may occur leading to vertebral displacement. In the case reported by Whalley 7 in 1946 the spinal canal was narrowed because of the enlargement of the axis. Platybasia or basilar impression is associated with Paget's disease of the atlas and axis. In these cases, the odontoid process, being at a

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Dislocation of the Atlas on the Axis

The Value of Early Fusion of C1, C2, and C3

Eben Alexander Jr., H. F. Forsyth, C. H. Davis Jr. and Blaine S. Nashold Jr.

T he odontoid process of the axis owes its importance to its anatomical location high in the cervical spine. Since fractures of this small process are associated with dislocations of the atlas on the axis, which in turn compress the upper cervical spinal cord, it is not surprising that both morbidity and mortality are high with these injuries. Geoffrey Jefferson 21 in 1920 and Osgood and Lund 28 in 1928 surveyed 55 of the fractures of the odontoid process reported to that time, the mortality being about 50 per cent. In at least 10 of the fatal cases reviewed

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Embryonal Atresia of the Fourth Ventricle

The Cause of “Arachnoid Cyst” of the Cerebellopontine Angle

W. James Gardner, Lawrence J. McCormack and Donald F. Dohn

to compression of the medulla by the odontoid process which was rendered abnormally mobile because of assimilation of the atlas. Case 4. Cyst of the foramen of Luschka . A 16-year-old boy was examined on Oct. 12, 1935, because of somnolence and headache. Four months before he had headache, nausea, and vomiting, followed by jaundice and enlargement of the liver. The jaundice cleared within 2 months, but the headache and vomiting continued at intervals. Deafness of the right ear began 3 months prior to entry. He had been noted to stagger on occasions and a weakness

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H. M. Askenasy, J. Braham and I. Z. Kosary

Traumatic atlanto-axial fracture with dislocation of the odontoid process results in most cases in immediate quadriplegia and has a high mortality. In a few instances, however, neurological complications are slight or not apparent and the fracture dislocation is not suspected at the time. The late onset of a syndrome compatible with spinal myelopathy could then present diagnostic problems in which an underlying lesion of this nature might not be suspected; this would of course be particularly likely if a period of years separated the trauma and the emergence of

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Vertebral Artery Insufficiency in Acute and Chronic Spinal Trauma

With Special Reference to the Syndrome of Acute Central Cervical Spinal Cord Injury

Richard C. Schneider and George W. Schemm

. Brain. 1952 , 75 : 187 – 225 . Brain , W. R., Northfield , D., and Wilkinson , M. The neurological manifestations of cervical spondylosis. Brain . 1952, 75: 187–225. 6. Ford , F. R. vertigo and disturbances of vision resulting from intermittent obstruction of the vertebral arteries due to defect in the odontoid process and excessive mobility of the second cervical vertebra. Bull. Johns Hopk. Hosp. , 1952 , 91 : 168 – 173 . Ford , F. R. Syncope, vertigo and disturbances of vision resulting from intermittent