World Neurosurg
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Comparative Study
Measurement of cervical sagittal alignment parameters on X-ray films of adults without severe spinal deformity whose shoulder hides the lower cervical column.
The Cobb angle between the lower endplate of C2 and C7 (C2L-C7L angle) is a traditional parameter used for the assessment of the cervical alignment. However, when the lower cervical column is masked by the shoulder, measurements are difficult. In the present study, we inspected 191 X-ray films, measured the Cobb angle between C2L and the endplates at the several levels of the lower cervical column, and assessed their usefulness of such measurements for the determination of cervical sagittal alignment. ⋯ To measure the C2L-C7L angle on unclear X-ray films, C7U can be substituted for C7L. Our measurement data for the C6 and C5 endplates were statistically different; however, the correlation between the C2L-C7L angle and C2L-C6U angle, C2L-C6L angle or C2L-C5L angle was very strong. In patients with unclear lower vertebral bodies, cervical sagittal alignment can be predicted by using adjacent endplates.
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Upper cervical fixation with C2 pedicle screw insertion may predispose patients to vertebral artery injury, in particular, patients with craniovertebral junction anomalies. The aim of this study was to describe an alternative technique with trans-C2 inferior articular process screw (C2IAPS) insertion for rigid C2 fixation, which can be used to anchor the C2 vertebra for upper cervical fixation. ⋯ For patients who are not eligible for C2 pedicle screw fixation, C2IAPS fixation can be considered as an alternative technique for upper cervical fixation of C2.
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Isolated abducens nerve palsy can be the presenting sign of a ruptured PICA aneurysm. Few cases have been reported in the literature. In the majority of cases, cranial nerve VI resolved following microsurgical clipping. ⋯ Here, we present the first case of an abducens nerve palsy associated with a ruptured PICA aneurysm to completely resolve following endovascular coil embolization. The direction and amount of subarachnoid hemorrhage extravasation from the ruptured aneurysm are most likely responsible for cranial nerve palsy.
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Cervical spondylotic amyotrophy (CSA) is not common. The clinical features and long-term surgical outcomes of patients with CSA are also unclear. We sought to summarize clinical features, assess long-term surgical outcomes, and determine the prognostic factors relevant for patients with CSA. ⋯ Besides significant muscular atrophy in one upper extremity, CSA also occasionally presents with mild atrophy in the other upper extremity, sensory disturbance in the upper extremities, or hyperflexia in the lower extremities. Anterior decompression is generally effective in the treatment of patients with CSA. Preoperative duration of symptoms, type of CSA, and ossification of the posterior longitudinal ligament are important predictors for the surgical outcome.
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"Swirl sign" is a relatively uncommon sign, seen on noncontrast CT scan in patients of head trauma who develop extradural hematoma. It has 2 components: hyperacute, which represents ongoing active intracranial bleed, and acute, which comprises surrounding hyperattenuated clotted blood. The importance of early identification of this sign by surgeons and aggressive surgical management might have a bearing on the prognosis and survival of the patients, as emphasized here by 2 clinical scenarios. The clinical implication is that identification of the swirl sign suggests expanding extradural hematoma with ongoing active bleed, warranting aggressive surgical management.