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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Klippel-Feil syndrome (KFS) is a congenital cervical vertebral union caused by a failure of segmentation during abnormal development and frequently accompanies conditions such as basicranial malformation, atlas assimilation, or dens malformation. Especially in basilar invagination (BI), which is a dislocation of the dens in an upper direction, compression of the spinomedullary junction from the ventral side results in paralysis, and treatment is required. ⋯ Reduction and internal fixation using instrumentation are effective techniques for KFS with BI; however, caution should be exercised because of the possibility of paralysis caused by intraoperative reduction.
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Dorsal herniation of the spinal cord through the dura is an uncommon phenomenon and this is only the fifth reported case in the thoracolumbar spine, the first following surgery at the thoracolumbar junction. ⋯ The hernia was reduced surgically and the defect closed directly without the need for a dural patch leading to a full recovery. Posterior cord herniation, its possible aetiologies and management strategies are discussed.
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In the realm of spinal surgery, infections have multiple etiologies and sites of origin. In this case series, we describe a juxtafacet cyst spinal infection that can often be missed or attributed to common symptomology of benign processes despite florid infection. ⋯ In our two patient presentations, both were diabetics and had remote histories of cancer that necessitated chemotherapy or radiation therapy. They also seemingly had de novo onset of infected juxtafacet cyst. The variety of causes and presentations of spinal infections should heighten the astute surgeon to be suspicious of these entities and thus intervene early with appropriate management.
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Unilateral hypertrophy of the lateral mass of the atlas is an extremely rare condition. The authors present a rare type of unilateral atlantal mass hypertrophy with atlanto-occipital fusion which is associated with an invaginated lateral mass of the atlas and the odontoid process into the foramen magnum. ⋯ To our knowledge, such a case of unilateral atlantal mass hypertrophy associated with atlanto-occipital fusion has not been described previously. The authors discuss the pathology of this case and review the literature on unilateral atlantal mass hypertrophy and associated anomalies of the upper cervical spine.
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To quantify the dimensions of the atlas pedicles and to analyze the relationship between extra medullary height (EMH) with intra medullary height (IMH) of the atlas pedicle. ⋯ The EMH and the IMH of the atlas pedicles were measured by using CT images of the atlas, providing anatomic parameters for surgery. They showed a certain correlation but with a high variability. C1 pedicle screw fixation was well performed when the medullary canal was ≥1 mm, but the surgical procedure should be careful when it was between 0 and 1 mm, and avoided when there was no medullary canal in the atlas pedicle! So 3D CT reconstruction should be conducted to obtain data and establish individualized fixation strategy preoperatively.