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Volker K. H. Sonntag - One of the best experts on this subject based on the ideXlab platform.

  • Atlantoaxial stabilization with the use of C1-3 lateral mass screw fixation. Technical note.
    Journal of Neurosurgery, 2006
    Co-Authors: Eric M. Horn, Nicholas Theodore, Stephen M. Papadopoulos, Jonathan S. Hott, Randall W. Porter, Volker K. H. Sonntag
    Abstract:

    Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1-3 lateral mass-sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23-84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid Cervical Orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1-3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.

  • Pediatric subaxial Cervical spine injuries: origins, management, and outcome in 51 patients.
    Neurosurgical Focus, 2006
    Co-Authors: Seref Dogan, Harold L. Rekate, Nicholas Theodore, Eric M. Horn, Sam Safavi-abbasi, Volker K. H. Sonntag
    Abstract:

    Object. In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial Cervical spine injuries (C3‐7). Methods. Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months‐16 years) with subaxial Cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture‐dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6‐7 (33%); C3‐4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid Cervical Orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8%) who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgeryrelated deaths or complications. Conclusions. Subaxial Cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial Cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.

  • The effect of wearing a restrictive neck brace on driver performance.
    Neurosurgery, 2003
    Co-Authors: Christopher Barry, Darin Smith, Peter J. Lennarson, Julie Jermeland, Warren G. Darling, Laura Stierman, Matthew Rizzo, Vincent C. Traynelis, Mark N. Hadley, Volker K. H. Sonntag
    Abstract:

    OBJECTIVE Thousands of Americans are prescribed Cervical orthoses each year. These orthoses restrict motion, which may influence the patient's driving performance. No legal restrictions exist that prohibit patients from wearing Cervical orthoses while driving. No study addressing this issue has been published to date. Thus, we sought to assess the effects of wearing a restrictive neck brace on driver performance on the open road. METHODS We conducted a prospective, randomized block design study in 23 volunteers. Twenty-three adult licensed drivers from the state of Iowa were recruited. Evaluation of neck motion was performed with and without the rigid Cervical Orthosis. On-road performance testing was conducted with the use of a state-of-the-art mobile laboratory. Drivers were randomly assigned to one of two testing groups. Each driver was evaluated during two separate drives. Volunteers in Group A (n = 11) wore a neck brace for the first drive but not during the second. Participants in Group B (n = 12) did not wear a neck brace in the first drive but did for the second. The assessment included velocity, acceleration, Cervical axial rotation, and evaluation of the driver's blind spot. RESULTS Driving performance measures were collected and analyzed for both drives. Wearing a Cervical Orthosis resulted in decreased velocity (P < 0.05), decreased lateral acceleration (P < 0.05), decreased axial rotation (P < 0.05), inadequate evaluation of intersection traffic, and an increase in the blind spot. CONCLUSION A rigid Cervical Orthosis alters driver performance.

  • Technique of occipitoCervical fusion with a threaded steinmann pin
    Operative Techniques in Neurosurgery, 1998
    Co-Authors: Paul J. Apostolides, Dean G. Karahalios, Volker K. H. Sonntag
    Abstract:

    The threaded Steinmann pin technique of occipitoCervical fusion represents an excellent method for treating occipitoCervical instability, failed C1–C2 fusion, or atlantoaxial instability in situations in which the posterior arches of C1 or C2 are deficient, fractured, or absent. Immediate rigid internal fixation is achieved by securing a wide diameter, contoured, threaded Steinmann pin or grooved titanium rod to the occipitoCervical region by means of suboccipital and sublaminar wires. Fusion is facilitated with autologous bone graft and a Cervical Orthosis.

  • Threaded Steinmann Pin Fusion of the Craniovertebral Junction
    Spine, 1996
    Co-Authors: Paul J. Apostolides, Curtis A. Dickman, John G. Golfinos, Stephen M. Papadopoulos, Volker K. H. Sonntag
    Abstract:

    Study Design. In a clinical retrospective study, the authors review long-term results of occipitoCervical fusion using a wide diameter, contoured, threaded Stainmann pin. Objectives. To evaluate the clinical and radiographic results of occipitoCervical fusion using this technique in a variety of abnormalities including rheumatoid arthritis. Summary of Background Data. The various surgical techniques and hardware developed for occipitoCervical fusion have been associated with mixed results, particularly in patients with rheumatoid arthritis or basilar invagination. Methods. Thirty-nine patients with occipitoCervical instability were internally fixed with a wide diameter, contoured, threaded Steinmann pin wired to the occiput and Cervical laminae or facets. Fusion was facilitated using autologous iliac crest bone graft and a Cervical Orthosis. Instability resulted from rheumatoid arthritis (n = 12), congenital anomalies (n = 12), trauma (n = 10), tumor (n = 4), or osteogenesis imperfecta (n = 1). Fifteen patients had radiographic evidence of basilar invagination. Long-term outcome (mean follow-up period, 38.9 months, range, 12-78 months) was based on clinical and radiographic review. Results. Thirty-seven patients (97%) had a stable postoperative occipitoCervical construct: there were 35 osseous unions, two fibrous unions, and one nonunion. There wase on postoperative death from pulmonary complications. No patient developed evidence of new, recurrent, or progressive basilar invagination. Conclusion. The authors concluded that rigid segmental fixation of the craniovertebral junction using a wide diameters, contoured, threaded Steinmann pin and supplemental autograft creates excellent fusion with minimal complications. This technique is appropriate for a variety of abnormalities including rheumatoid arthritis.

Yasuo Ito - One of the best experts on this subject based on the ideXlab platform.

  • The Effect of the Cervical Orthosis on Swallowing Physiology and Cervical Spine Motion During Swallowing
    Dysphagia, 2016
    Co-Authors: Kojiro Mekata, Tomoyuki Takigawa, Jun Matsubayashi, Kazukiyo Toda, Yasuhiro Hasegawa, Yasuo Ito
    Abstract:

    Cervical Orthosis is used to immobilize the neck in various disorders such as trauma and post-operation. However, it is still uncertain how Cervical Orthosis restricts the degree of movement of the Cervical spine during swallowing and how they affect swallowing physiology. The purpose of this study was to evaluate these issues using the Philadelphia^® Collar. We conducted videofluorography of swallowing in 39 healthy subjects (23 men, 16 women; mean age of 34.3 years) with and without Cervical Orthosis. To compare the two conditions regarding the Cervical spine motion, we determined the angular and positional changes of the occipital bone (C0) and each Cervical vertebra (C1–C7) from the oral phase to the pharyngeal phase. Similarly, to compare swallowing physiology, we assessed the start and end times and the durations of soft palate elevation, rapid hyoid anterosuperior movement, epiglottis inversion, closure of the laryngeal vestibule, and pharyngoesophageal segment (PES) opening. Finally, we compared the transit times of contrast agent in the two conditions. The respective extensions of C1, C2, and C3 were 0.31°, 0.07°, and 0.05° (mean) with Cervical Orthosis, and the respective flexions of C1, C2, and C3 were 0.98°, 1.42°, and 0.85° (mean) without. These results suggested that Cervical Orthosis restricted the flexion of C1–C3. Analysis of swallowing physiology revealed that the average durations of hyoid anterosuperior elevation, epiglottic inversion, and PES opening were prolonged by 0.09, 0.19, and 0.05 s, respectively. In conclusion, the Cervical Orthosis restricted the movement of the Cervical spine during swallowing and changed swallowing physiology.

Mitchel B Harris - One of the best experts on this subject based on the ideXlab platform.

  • type ii odontoid fractures of the Cervical spine do treatment type and medical comorbidities affect mortality in elderly patients
    Spine, 2011
    Co-Authors: Andrew J Schoenfeld, Christopher M Bono, William M Reichmann, Natalie Warholic, Kirkham B Wood, Elena Losina, Jeffrey N Katz, Mitchel B Harris
    Abstract:

    Management of odontoid fractures has been recognized as a challenge, since these injuries were first described in the early 20th century.1 Despite significant advances in diagnostic and treatment methods, such fractures remain problematic, particularly in the geriatric population.1–8 Odontoid fractures are the most common Cervical spine fracture in the elderly.1,8 Because of their age associated comorbidities and the ubiquitous presence of degenerative changes in the aging Cervical spine,6 such individuals are at a higher risk for complications and poorer outcomes than younger patients sustaining similar injuries.1–4,6,7,9–11 Furthermore, as the number of elderly patients continues to rise in the United States, the prevalence of such fractures can be expected to increase in the future. Several prior studies have documented increased morbidity and mortality among geriatric patients sustaining odontoid fractures.1–7,9,10,12,13 The nonunion rate in this population has been reported to be as high as 85% (range, 20%–85%),3–7,9,10,12–14 whereas the mortality rate has approached 60% (range, 10%–57.1%).2–7,9,10,12,13 Moreover, the choice of management (operative vs. nonoperative, halo-vest immobilization vs. Cervical Orthosis) has been postulated to influence mortality. The halo vest, in particular, has been associated with an increased risk of complications and death in elderly patients.1,3,4,7,9,12,15 One study reported high complication rates of pneumonia (34%), cardiac arrest (26%), and mortality (42%) in elderly patients treated with a halo vest.7 Most information on mortality in patients with odontoid fracture is derived from reviews of small cohorts comprising less than 50 patients.3,4,5,7,9,11,13 Furthermore, only one study specifically examined treatment-based outcomes,7 while none have analyzed mortality in relation to age, or medical comorbidities. Given the paucity of data, this investigation sought to define the influence of age, treatment, and comorbidities on mortality in a cohort (n = 156) of elderly patients sustaining Anderson and D’Alonzo16 Type II fractures of the odontoid in the Cervical spine. The hypothesis was that patients treated surgically would have lower mortality than those treated nonoperatively with either a halo vest or Cervical Orthosis. It was also anticipated that patients with fewer medical comorbidities would have lower mortality regardless of treatment method.

  • Subchondral cysts of the atlantoaxial joint: a risk factor for odontoid fractures in the elderly
    The Spine Journal, 2009
    Co-Authors: Terrill P. Julien, Andrew J Schoenfeld, Brian Barlow, Mitchel B Harris
    Abstract:

    Abstract Background context Scholars have postulated that Cervical degeneration can predispose the upper Cervical spine to injury after minor trauma. Subchondral cysts have previously been recognized as potentiators of fracture in the hip and knee but no cases of Cervical degenerative cysts contributing to fracture have been reported. Purpose This report documents a case series in which patients sustained significant injury to the upper Cervical spine in the setting of subchondral Cervical cysts. Study design/setting Case series/academic level I trauma center. Methods Between 2004 and 2008, six patients (ages 73–91 years) with Cervical pathology were admitted to the trauma service at our Level I trauma center. The most common mechanism of injury was a low velocity fall, which occurred in 5 out of 6 patients. All patients suffered an odontoid fracture. In all cases, there was radiographic evidence of cyst formation, and computed tomographic imaging demonstrated fracture communication with the subchondral cyst. Results Of the six cases, four were treated definitively with immobilization in a Cervical Orthosis and two required surgery. One patient was treated with an occipital-Cervical fusion, whereas the other underwent Brooks wiring. All patients ultimately went on to heal their fractures. Conclusions Degenerative changes in the Cervical spine have previously been recognized to potentiate injury. This report raises the question of whether degenerative processes at the C1–C2 articulation predispose elderly patients to injury at this level. The presence of cystic degeneration at the atlantoaxial joint should be recognized as a potential risk factor for Cervical injury after relatively minor trauma.

Alan H Daniels - One of the best experts on this subject based on the ideXlab platform.

  • halo vest immobilization in elderly odontoid fracture patients evolution in treatment modality and in hospital outcomes
    Journal of Spinal Disorders & Techniques, 2017
    Co-Authors: Mason J Depasse, Mark A. Palumbo, Abdulkareem Ahmed, Charles A Adams, Alan H Daniels
    Abstract:

    STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the utilization and effectiveness of halo-vest (HV) immobilization for type II odontoid fractures from 2004 to 2014. SUMMARY OF BACKGROUND DATA: Controversy persists regarding the optimal treatment method for odontoid fractures in the elderly. Management options include immobilization in a Cervical Orthosis, HV immobilization, and operative intervention. Over the past decade, high mortality and morbidity rates have been reported following HV immobilization in this patient population. MATERIALS AND METHODS: In a retrospective study, patient demographics, presentation, Charlson comorbidity index, treatment method, and outcome data for patients over 65 who had suffered type II odontoid fractures from 2004 to 2014 were compared with a historical cohort from 1997 to 2004. RESULTS: One hundred twenty-six patients met inclusion criteria. The mean age was 82.7±8.8 compared with 80.7±0.9 in the 1997-2004 cohort. The in-hospital mortality rate from 2004 to 2014 was 11.1% (14/126) compared with 31% in the historical cohort, and 10 (7.9%) patients were treated with HV compared with 49%. Mortality in the HV group was higher than the surgical group (P=0.01) but no different from the Orthosis group (P=0.63).There were no differences in injury severity score, Charlson comorbidity index, or complications between treatment groups. CONCLUSIONS: Over the past decade, HV use for elderly odontoid fractures has decreased at our institution. Mortality and morbidity of elderly patients treated with HV has also decreased. These findings are likely the result of improved patient selection and greater attention to respiratory care. This study demonstrates that HV immobilization of odontoid fractures in elderly patients can be as safe as Cervical Orthosis treatment in select patients.

  • Cervical Fracture and Dislocation
    Orthopedic Surgery Clerkship, 2017
    Co-Authors: J. Mason Depasse, Alan H Daniels
    Abstract:

    Cervical spine fractures and dislocations can cause severe permanent disability or death, and trauma patients are routinely screened for Cervical spine injuries in order to ensure that they do not get missed. Cervical spine trauma can be divided into two categories: injuries to the occiput, atlas, and axis and injuries to the subaxial Cervical spine (C3–C7). In general, hyperflexion will result in anterior displacement of the dens or fractures through the vertebral body (flexion teardrops), while hyperextension results in posteriorly displaced dens fractures or posterior displacement pars fracture (traumatic spondylolisthesis). Treatment includes stabilization with a Cervical Orthosis, halo vest, or operative fixation, which may include decompression and fusion.

Namju Lee - One of the best experts on this subject based on the ideXlab platform.

  • effect of Cervical Orthosis upon swallowing
    Annals of Rehabilitation Medicine, 2005
    Co-Authors: Nami Han, Donggun Kim, Hyundong Kim, Namju Lee
    Abstract:

    Objective: To investigate the effect of Cervical Orthosis upon swallowing and the differences of bracing effect between normal people and spinal cord injured patients. Method: 12 normal adults and 32 Cervical cord injured patients who were wearing one of the three common Cervical orthoses (soft neck collar, Philadelphia brace, and Minerva brace) were recruited. Swallowhg function was evaluated by videofluoroscopic swallowing study (VFSS) without Cervical bracing for the baseline dati and with Cervical bracing to compare with baseline data. The parameters observed were oropharyngeal diameter, initiation point of swallowing, hyoid bone movement, laryngeal penetration, aspiration, and residual volume after swallowing. Results: Cervical orthoses decreased oropharyngel diameter, reduced hyoid bone moiement, increased residual volume, and changed initiation point of swallowing. Minerva brace revealed to give more irfluence than other braces. Normal adult group and patient group showed no difference in Cervical bracing effect. Conclusion: Attention should be paid to swallowing function when Cervical bracing is needed because Cervical bracing itself can increase the risk of aspiration.