European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The purpose of the study was to: (1) introduce a new CT-based parameter: free facet area and provide its normative data; (2) standardize the method of measuring isthmus width and height of the axis vertebra; (3) propose a new grading system to predict the difficulty in inserting transarticular and C2 pedicle screws. ⋯ Inserting a transarticular screw was more frequently difficult as compared to pedicle screw. A new CT-based parameter (free facet area) and an efficient grading have been proposed to help surgeons choose the appropriate screw options, appreciate the complex anatomy of this region and compare data across various studies.
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Regardless of the etiology, severe cervical deformities can be extremely debilitating and are a challenge to correct. Often a multi-modality team approach is required to safely and effectively reduce the deformity, provide adequate decompression, and ensure solid fixation and fusion. In cases of iatrogenic cervical deformity necessitating five-level corpectomy and fixation, the feasibility, safety, and durability of this procedure remains unknown. ⋯ The feasibility and safety of five-level vertebrectomy and reconstruction for chin-on-chest deformity remains poorly described. The current case suggests that thoughtful planning that involves maximizing the patient's health status, judicious use of traction under direct neurological examination, staged circumferential release, and design of a construct that provides anterior and posterior column support with several points of fixation beyond the axis of rotation will attenuate the risk of peri-operative morbidity and potentiate the durability of deformity correction.
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The surgical removal of lateral mass lesions is demanding due to their close anatomical relationship with the vertebral artery, upper spinal cord as well as overlying muscular structures. Usually a dorsal approach will be performed to reach the lateral mass. The disadvantage of this approach is the extensive mobilization of the neck muscles required to allow exposure of the lateral mass, which can be accompanied by severe muscular atrophy due to the damage of the local innervation. Additionally, management of the exposure of the vertebral artery is hindered by the dorsal approach. ⋯ This far lateral approach offers the advantage of direct visualization of the lateral aspect of the upper cervical spine with the opportunity for local stabilization at the center of rotation.
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Several developmental anomalies have been described with respect to the odontoid process. The purpose of the study was to describe the MR appearance of the odontoid process and to calculate the prevalence of its morphological variants. ⋯ The configuration types of odontoid process are reported herein. The clinical relevance of this morphological variation needs to be elucidated with further studies.
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To present case of vertebral artery duplication surrounding the posterior arch of atlas. ⋯ Precise diagnostic imaging is necessary before surgical interventions at the level of cranio-spinal junction in order to avoid conflict with rare vascular variations.