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Zein-Elabedin, Mostafa
- Evaluation of Different Techniques in the Management of Craniocervical Instability
Authors
1 Neurosurgery Department, Cairo University, Cairo, EG
2 Neurosurgery Department, Beni-suef University, EG
Source
Indian Journal of Public Health Research & Development, Vol 10, No 12 (2019), Pagination: 1559-1564Abstract
Objectives: Evaluation of clinical picture and results of occipitocervical and atlanto-axial fusion with craniocervical instabilities
Patients and Method: The investigation included 22 patients, 14 males (63.6%) and 8 females (36.4%). Ages ranged (10 to 70) years. Instability resulted fromfracture of the odontoid process in 8 cases(36.4%), transverse atlantal ligament injury with C1 C2 sub laxation in 6 cases(27.3%), osodontodium in 4 cases(18.2%), Morquio’s syndrome in 2 cases(9%) , C2 Hangman’s fracture type III one case(4.5%), and transverse atlantal ligament injury associated with sub axial sublaxation in one case(4.5%). Trauma was the most common cause of instability (73%).Single hollow titanium anterior odontoid screw was done in 4 cases (18,2%), posterior atlanto-axial fixation in 12 patients(54.5%) three of them (25%) needed trans oral odontoidectomy prior to fixation, fixation was performed from C1to C4 in one patient(4.5%) , and occipitocervical fixation in 5 patients(22.7%). Postoperative Philadelphia neck collar was applied for 8-12 weeks.
Results: Postoperative clinical evaluation revealed good outcome of neurological ASIA grading. 10 patients improved (45.5%), while 11 patients (50%) remained at the same ASIA score as pre-operative, and only one patient (4.5%) deteriorated from ASIA score D to A. Pain and neck disability scores reduced postoperatively compared to preoperative. Fusion was achieved in 18 cases (81.8%) at last follow-up. Instrumentation failure occurred in only 2 cases (9%). Three mortality cases due to respiratory problems (2cases died in the first week after surgery and the third case died one month after the surgery).
Keywords
Craniocervicalinstability, Occipitocervical Fusion, Odontoidscrew, Trauma.
- Anterior Odontoid Screw, Single Institutional Experience in Tertiary Care Center in Developing Country
Authors
1 Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, EG
2 Neurosurgery Department, Faculty of Medicine, Beni-Suef University, EG
Source
Indian Journal of Public Health Research & Development, Vol 10, No 11 (2019), Pagination: 3417-3421Abstract
Objective: This study was done to evaluate clinical picture, radiographic findings and results of anterior odontoid screw fixation in cases of odontoid fracture, using one hollow titanium odontoid screw, according to our limited facilities in absence of intraoperative neuronavigation or O-arm using only one C-arm to ensure ideal trajectory.
Method: The present study included 14 patients, 10 males and 4females. Their ages ranged from 19 to 56 years. Instability resulted from fracture of the odontoid process type II in 12 cases, and type III in 2 cases. Single hollow titanium anterior odontoid screw was used in fixation using only one C-arm intraoperative to ensure ideal trajectory. Postoperative Philadelphia neck collar was applied for 8-12 weeks. Outcome Measures included radiological evaluation of successful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, and neck disability index (NDI). Evaluations were conducted preoperatively and at end of follow-up period which ranged from 6 to 12 months.
Results: Postoperative evaluation revealed that 50% of patients improved, while 50% of patients remained at the same ASIA score as pre-operative. Pain and neck disability scores were reduced postoperatively compared with preoperative. Fusion was achieved in 13 cases (93%) at last follow-up. Instrumentation failure occurred in only one case due to screw break.