1/260. Transoral fusion with internal fixation in a displaced hangman's fracture. STUDY DESIGN: A case is reported in which late displacement of a "hangman's fracture" was managed by transoral C2-C3 fusion by using bicortical iliac crest graft and a titanium cervical locking plate. OBJECTIVES: To review the management of unstable fractures of the axis and to study other reports of transoral instrumentation of the cervical spine. SUMMARY OF BACKGROUND DATA: Undisplaced fractures of the axis are considered to be stable injuries. Although late displacement is unusual, it can lead to fracture nonunion with persisting instability and spinal cord dysfunction. In this situation, an anterior fusion of the second and third cervical vertebrae is preferred to a posterior fusion from the atlas to the third cervical vertebra, which would abolish lateral rotation between C1 and C2. methods: The literature on hangman's fractures was reviewed. Clinical and radiographic details of a case of C2 instability were recorded, and the particular problems posed by late displacement were considered. RESULTS: There are no other reports of transoral instrumentation of the cervical spine. A sound fusion of C2-C3 was obtained without infection or other complications. Good neck movement returned by 6 months after surgery. CONCLUSION: Undisplaced fractures of the axis are not always stable. The transoral route allows good access for stabilization of displaced hangman's fractures. In special circumstances, a locking plate may prove useful in securing the bone graft. The cervical spine locking plate can be inserted transorally with no complications and by using standard instrumentation. ( info) |
| We report a case of traumatic spondylolisthesis in a 31-year-old man struck by a steel I-beam. Although most reported traumatic spondylolisthesis cases are from low-energy trauma, this was a high-energy trauma case. The initial examination revealed no signs of cauda equina syndrome, and the patient's spinal injury was primarily capsuloligamentous. We present this rare case, with a review of pertinent literature and treatment mechanisms for traumatic spondylolisthesis. ( info) |
3/260. Spondyloptosis of the cervical spine in neurofibromatosis. A case report. STUDY DESIGN: Case report and literature review. OBJECTIVES: To review the English literature pertaining to spondyloptosis of the cervical spine in patients with Von Recklinghausen's disease and to present as an illustrative example the case of a 41-year-old woman with a spondyloptotic kyphotic curve of the spine at C5-C7 of more than 110 degrees. SUMMARY OF BACKGROUND DATA: Involvement of the cervical spine in neurofibromatosis has only rarely been documented, although the spine is the part of the skeleton mostly affected in this hereditary disease. Only a few cases with a cervical kyphotic curve exceeding 90 degrees or with cervical spondyloptosis have been reported until now. methods: A literature and chart review was conducted. The patient was first treated conservatively, but over time, the spontaneous neck pain increased to an intolerable level and progressive neurologic deficits developed in the four limbs. For these reasons, surgical intervention was undertaken, according to suggestions from the literature. RESULTS: Postoperative imaging showed improved realignment of the cervical spine with a residual kyphos of 30 degrees. At later follow-up stable bony fusion was obtained in the lower cervical spine. CONCLUSIONS: A successful one-stage anterior and posterior correction and fusion-stabilization procedure was performed with extension from the occiput to T1. ( info) |
4/260. Spondyloptosis and multiple-level spondylolysis. An unusual case of a combination of multiple bilateral spondylolyses (L2, 3 and 4), spondylolisthesis at L3/4, spondyloptosis at L4/5 and sacralization of L5 in a teenage female is described. The patient had severely increasing lower back pain radiating to the left lower limb. radiography identified the abnormalities and myelography revealed complete obstruction and compression of the thecal sac at the L4/5 level. The case was treated surgically by posterior decompression, corpectomy and fusion in a three-stage operation. The follow-up was extended to 2 years with no complications. No similar case has previously been reported. ( info) |
| spondylolisthesis, the anterior or posterior displacement of one vertebra on another, usually affects the lumbar region. Five percent of the population has one of the five classes of spondylolisthesis, which include dysplastic, isthmic, degenerative, traumatic, and pathologic spondylolisthesis. This article focuses on the dysplastic type, which makes up 14% to 21% of all spondylolisthesis. Dysplastic spondylolisthesis usually causes no symptoms in children; pain usually begins in adolescence. The key to diagnosis is the appropriate use of radiography in the evaluation of low back pain. This report describes a case involving a 21-year-old woman presenting with back pain to the family physician. Also, it details how the diagnosis was achieved and evaluates conservative and aggressive treatment options. ( info) |
6/260. Contact of hydroxyapatite spacers with split spinous processes in double-door laminoplasty for cervical myelopathy. We developed a new type of spacer made of hydroxyapatite (the STSS spacer) for double-door laminoplasty, and evaluated the contact of 93 STSS spacers with the split spinous processes in 20 patients with double-door laminoplasty. Contact was assessed by measuring the extent of touch of the spacer to the spinous processes, classified into four categories based on computed tomography (CT) images: excellent, complete touch on both sides of the spacer to the spinous process; good, complete touch on one side and more than half touch on the other side; fair, more than half touch on both sides; poor, half or less touch on at least one side. Excellent contact was achieved in 65 spacers (69.9%); good, in 13 (14.0%); fair, in 11 (11. 8%); and poor, in 4 (4.3%). The percentages of excellent or good categories were 75.0% at the C3 level, 73.7% at the C4 level, 78.9% at the C5 level, 90.0% at the C6 level, and 100% at the C7 level. The contact rate of the STSS spacer with the spinous process was better than that achieved with other spacers, probably because the characteristic shape of the STSS spacer was compatible with the widened space between the bilateral spinous processes; i.e., it is trapezoidal on both the axial and the frontal sections. However, the appropriate size of the spacer must be selected in accordance with the size of the spinous process to obtain higher percentages of excellent or good contact. ( info) |
7/260. ehlers-danlos syndrome associated with multiple spinal meningeal cysts--case report. A 40-year-old female with ehlers-danlos syndrome was admitted because of a large pelvic mass. Radiological examination revealed multiple spinal meningeal cysts. The first operation through a laminectomy revealed that the cysts originated from dilated dural sleeves containing nerve roots. Packing of dilated sleeves was inadequate. Finally the cysts were oversewed through a laparotomy. The cysts were reduced, but the postoperative course was complicated by poor wound healing and diffuse muscle atrophy. ehlers-danlos syndrome associated with spinal cysts may be best treated by endoscopic surgery. ( info) |
| The literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages. ( info) |
9/260. Mechanical instability as a cause of gait disturbance in high-grade spondylolisthesis: a pre- and postoperative three-dimensional gait analysis. Mechanical instability of the spinopelvic junction is a suspected cause of abnormal gait in high-grade spondylolisthesis. Computerized three-dimensional gait analysis was performed on a 10-year-old with grade III spondylolisthesis at L-5. Preoperatively, the gait pattern was characterized by posterior pelvic tilt, decreased hip flexion, increased knee flexion, and decreased stride length and walking speed. All temporal and kinematic parameters of gait normalized after laminectomy and instrumented, in situ arthrodesis (L-4-S-1). The absence of any neurologic abnormalities on preoperative imaging, intraoperative somatosensory-evoked potentials (SSEP) monitoring, and nerve-root exploration, together with the observed improvement after stabilization of the spinopelvic junction, suggests a mechanical basis for the gait changes in high-grade spondylolisthesis. ( info) |
10/260. Spinal markers: A new method for increasing accuracy in spinal navigation. Spinal navigation opens up a completely new dimension in the planning and realization of neurosurgical and orthopedic procedures, and offers the possibility of simulating the operation preoperatively. There is currently only limited experience with spinal navigation, and despite the development of advanced software, intraoperative difficulties include identification of characteristic and reproducible anatomical landmarks, localization of these points in the surgical field, referencing, and intraoperative control. We report the use of a new kind of implantable fiducial marker in a case of a 58-year-old female patient with spondylolisthesis. Percutaneously applied spinal markers were used as prominent anatomical landmarks and permitted much easier intraoperative handling. In our opinion, in the hands of an experienced neurosurgeon or orthopedist, the additional preoperative time required for placement of such spinal markers is negligible. ( info) |