• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.89-92
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• 2015

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.884-887
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• 2018

We report a female proband carrying a de novo 5q34-q35.2 deletion breakpoint, and review the unique skeletal phenotype and possible genotype related to this mutation. The patient presented with a persistent head tilt and limited head rotation. Non-contrast-enhanced three-dimensional computed tomography of the cervical spine revealed several malformations including a bone cleft in the right pars interarticularis, a bone defect in both C5 lamina and the transverse foramen at C2-C3, agenesis of the right articular process of C5, bony fusion of C4-C5, and subluxation of the craniocervical joints. Several deformities of the cervical spine seen in this patient have not been associated with the 5q deletion. A review of 5q-related mutations suggests that abnormalities associated with MSX2 gene might cause cervical spine abnormalities.

• Journal of Korean Neurosurgical Society
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• v.45 no.4
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• pp.246-248
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• 2009

Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine' motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone.

• Journal of Veterinary Clinics
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• v.31 no.6
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• pp.519-522
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• 2014

A 2-year-old, 2 kg Maltese dog was evaluated for progressive tetraparesis and neck pain. The dog had been treated with steroids for the preceding 2 weeks after unknown trauma but was deteriorating progressively and had become tetraparetic. The dog was presented with a non-ambulatory tetraparesis. Radiographic and computed tomographic examinations revealed a transverse C2 fracture with subluxation of the atlantoaxial joint and C2-C3. In addition, hydrocephalus was observed on magnetic resonance imaging. Stabilization of C1-C3 using screws, wires, and polymethyl methacrylate (PMMA) was performed. Application of ventral screws, wires, and PMMA resulted in improvement of the clinical signs after 4 weeks, and the dog could walk as before the tetraparesis 6 weeks after the operation. This stabilization method is an effective surgical treatment for management of cervical instability.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.295-300
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• 2007

Objective : Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. Methods : Fourteen patients [10 men and 4 women] with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. Results : Thirteen [93%] patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. Conclusion : In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.348-352
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• 2014

High-flow vertebral arteriovenous fistulas (VAVF) are rare complications of cervical spine surgery and characterized by iatrogenic direct-communication of the extracranial vertebral artery (VA) to the surrounding venous plexuses. The authors describe two patients with VAVF presenting with ischemic presentation after C1 pedicle screw insertion for a treatment of C2 fracture and nontraumatic atlatoaxial subluxation. The first patient presented with drowsy consciousness with blurred vision. The diffusion MRI showed an acute infarction on bilateral cerebellum and occipital lobes. The second patient presented with pulsatile tinnitus, dysarthria and a subjective weakness and numbness of extremities. In both cases, digital subtraction angiography demonstrated high-flow direct VAVFs adjacent to C1 screws. The VAVF of the second case occurred near the left posterior inferior cerebellar artery originated from the persistent first intersegmental artery of the left VA. Both cases were successfully treated by complete occlusion of the fistulous portion and the involved segment of the left VA using endovascular coil embolization. The authors reviewed the VAVFs after the upper-cervical spine surgery including C1 screw insertion and the feasibility with the attention notes of its endovascular treatment.

• Journal of Yeungnam Medical Science
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• v.38 no.2
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• pp.152-156
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• 2021

Diplopia is a rare complication of spine surgery. The abducens nerve is one of the cranial nerves most commonly related to diplopia caused by traction injury. We report a case of a 71-year-old woman who presented with diplopia developing from abducens nerve palsy after C1-C2 fixation and fusion due to atlantoaxial subluxation with cord compression. As soon as we discovered the symptoms, we suspected excessive traction by the instrument and subsequently performed reoperation. Subsequently, the patient's symptoms improved. In other reported cases we reviewed, most were transient. However, we thought that our rapid response also helped the patient's fast recovery in this case. The mechanisms by which postoperative diplopia develops vary and, thus, remain unclear. We should pay attention to the fact that the condition is sometimes an indicator of an underlying, life-threatening condition. Therefore, all patients with postoperative diplopia should undergo thorough ophthalmological and neurological evaluations as well as careful observation by a multidisciplinary team.

• Journal of the Korea Convergence Society
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• v.12 no.10
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• pp.305-310
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• 2021

Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint with an inflammatory condition in the adjacent soft tissues. Due to the instability of the cervical spine, careful airway management is crucial to prevent potential cervical spinal cord injury following airway manipulation. We successfully secured the patient airway using a supraglottic airway device (I-gel) in a patient who had previously diagnosed with Grisel's syndrome. The operation was successfully completed, and the patient recovered without any neurological complications. I-gel can be a good option for airway management during general anesthesia in a patient diagnosed with Grisel's syndrome.

• Journal of Acupuncture Research
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• v.19 no.1
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• pp.76-83
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• 2002

Forteen cases were observed among the Temporomandibular Disorder who were outpatients at the Department of Acupuncture & Moxibustion Oriental Medical Hospital, Dae Jeon University. Objective : To improve the therapeutic rate of Temporomandibular Disorder by treatment of acupuncture, chiropractic therapy and exercise therapy. Methods : Forteen outpatients suffering from Temporomandibular Disorder were treated by acupuncture, chiropractic therapy and exercise therapy. Acupuncture therapy was taken on Waiguan(TE5,外關), Zulingi(G41, 足臨泣), Sidu(TE9, 四瀆), Yanglingquan(G34, 陽陸泉), Qiuxu(G40, 丘墟), Xiaguan(S7, 下關). Chiropractic therapy was taken, when the subluxation of outpatients's Cervical spine was observed. Results : The syndrome of TMD, that is the Pain, the movement disorder and the click sound, was disappeared by 2~3 times acupuncture, chiropractic and exercise therapy.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.164-172
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• 2006

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.