• 척추신경추나의학회지
• /
• 제3권1호
• /
• pp.1-7
• /
• 2008

Objectives : The os odontoideum is an uncommon abnormality which is due to non fusion of axis and odontoid process that exists as a separate ossicle apart from a hypoplastic dens. Its clinical significance lies in its potential to produce serious neurologic symptoms after cervical Chuna Manipulation Treatment. We experienced a patient diagnosed as os odontoideum which corresponds to absolute contra-indications of chuna manipulation treatment and report it. Methods : The patient was diagnosed as os odontoideum through cervical spine CT and MRI. Results and Conclusion : During cervical physical examination, we encountered L'hermitte's phenomenon from the patient and suspected one of contra-indications of chuna manipulation treatment. We could diagnose the patient as os odontoideum through cervical spine CT, MRI and prevent him from severe sequelae caused by chuna manipulation treatment.

• Journal of Korean Neurosurgical Society
• /
• 제39권3호
• /
• pp.221-223
• /
• 2006

We report the case of a patient with a retro-odontoid synovial cyst, coupled with os odontoideum and atlantoaxial instability. We observed the regression of the cyst after C1-2 transarticular screw fixation and posterior wiring without direct surgical excision of the cyst on the follow-up MR images, which were obtained two and three months postoperatively. The myelopathic symptoms and signs of this patient were resolved by degrees.

• Journal of Korean Neurosurgical Society
• /
• 제64권5호
• /
• pp.837-842
• /
• 2021

An atlantoaxial subluxation from the unstable Os odontoideum by the failure of proper integrations between the embryological somites might be a commonly reported pathology. However, its suspicious origin or paralleled occurrence with other congenital anomalies of vertebral body might be a relatively rare phenomenon. The authors present two cases, who simply presented with clinical signs of prolonged, intractable cervicalgia without any neurological deficits, revealed this rare feature of C1-2 subluxation from the unstable, orthotropic type of Os odontoideum that coincide with congenitally fused cervical vertebral bodies between C2-3. Surprisingly, in one case, when traced from the lower cervical down to the thoracic-lumbar levels during the preoperative work-up process, was also compromised with multi-level butterfly vertebrae formations. Presented cases highlight the association of various congenital vertebrae anomalies and the rationale to fuse only affected joints.

• Journal of Korean Neurosurgical Society
• /
• 제37권3호
• /
• pp.201-206
• /
• 2005

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

• Journal of Korean Neurosurgical Society
• /
• 제29권1호
• /
• pp.95-100
• /
• 2000

Objective : Posterior transarticular screw fixation is known to be one of the best surgical method for the atlantoaxial instability. We assessed the complication and operative risk in 15 patients. Patients and Methods : Between January 1997 and April 1998, 15 patients suffering from this condition were admitted to our institution. Atlantoaxial instability was caused by C1 or C2 fractures in 11, rheumatoid arthritis in 2, and os odontoideum in 2. This technique was used in the treatment of 13 patients and 2 patients was used in sublaminar wire fixation only. Bilateral C1-C2 screws were placed in 11 patients ; 2 patients had only one screw placed becauce of an anomalous vertebral artery and axial destruction. Follow-up period ranged from 5 to 20 months. Results : Most screws were positioned satisfactorily. One screw was malpositioned. No patients had neurological complications. Conclusion : Rigidly fixating C1-C2 instability with transarticular screws showed a significantly higher fusion rate than that achieved using wired grafts alone. The risk of screw malpositioning and catastrophic vascular or neural injury is small and can be minimized by assessing the position of the transverse foramen on preoperative computed tomographic scans and by correctly using intraoperative fluoroscopy and surgeon's precaution.

• Journal of Yeungnam Medical Science
• /
• 제40권1호
• /
• pp.96-101
• /
• 2023

The endoscopic endonasal approach (EEA) to the craniovertebral junction (CVJ) has recently been considered a safer alternative and less invasive approach than the traditional transoral approach because the complications associated with the latter are avoided or minimized. Here, we present two challenging cases of CVJ pathologies. The first case involved os odontoideum associated with anterior displacement of the occipitocervical junction where the EEA was used, followed by C0-C1-C2 fusion using a posterior approach to decompress the CVJ, and was complicated by rhinorrhea and Candida albicans meningitis. The second case involved basilar invagination with syringomyelia previously treated using a posterior approach, where aggravation of neuropathic symptoms required combined treatment with EEA and occipitocervical fusion of C0-C2-C3-C4, with the postoperative course challenged by operative site infection requiring drainage with debridement and antibiotic therapy. The EEA is an alternative approach for accessing the CVJ in well-selected patients. Knowledge of EEA complications is crucial for the optimal care of patients.

• Journal of Korean Neurosurgical Society
• /
• 제29권11호
• /
• pp.1469-1475
• /
• 2000

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.

• 대한영상의학회지
• /
• 제85권4호
• /
• pp.754-768
• /
• 2024

목적 치상돌기 후방부 가성 종양(retro-odontoid pseudotumor; 이하 ROP)이 있는 환자 중, 경추 후방 유합술 후 가성 종양의 퇴행에 대한 임상 및 MR 예측 인자를 조사한다. 대상과 방법 2016년 3월부터 2021년 12월까지 경추 후방 유합술을 받은 만성 환축추 불안정성 환자 중, 수술 전후의 MRI가 모두 있는 환자를 대상으로 하였다. 수술 후 ROP 두께가 감소한 정도에 따라, 10% 이상 감소한 그룹과, 10% 미만으로 감소한 그룹으로 분류한 후 ROP의 퇴행과 관련된 임상 특성(나이 및 성별) 및 MR 영상 소견을 분석하여 통계 분석하였다. 결과 조건을 만족하는 11명의 환자 중 수술 후 8명의 환자에서 ROP 두께가 감소하였으며 (72.7%), 가성 종양의 퇴행에 환자의 나이(p = 0.024)와 수술 전 ROP의 두께(p = 0.012)가 유의하게 연관되었다. 성별, ROP의 유형, ROP의 MR signal 균일성, 척수 신호 변화, 척수 위축, 후종인대골화증, 치상돌기골, 그리고 환추상돌기간격은 ROP의 퇴행과 유의한 연관이 없었다. 결론 만성 환축추 불안정성 환자 중, 연령이 높고, 수술 전 ROP의 두께가 더 두꺼울수록 경추 후방 유합술 후 ROP 퇴행이 더 많이 진행되었다.