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Martin H Pham - One of the best experts on this subject based on the ideXlab platform.
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bilateral vertebral artery occlusion after Cervical Spine Fracture dislocation
World Neurosurgery, 2019Co-Authors: Ben A Strickland, Courtney S Lewis, Martin H PhamAbstract:Background Vertebral artery injury is known to potentially occur in conjunction with blunt Cervical Spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed Cervical Spine trauma have been described in the reported data, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. Case Description Our patient presented after a traumatic C5-C6 flexion–distraction injury that had resulted in bilateral locked facets and spinal cord injury and bilateral vertebral artery occlusions at the V1 segment. However, our patient did not show any cranial symptoms despite his neurovascular injury. Conclusions We present our patient's case as a rare illustration of a bilateral vertebral artery occlusion after blunt Cervical Spine trauma without clinical vertebrobasilar ischemic sequelae.
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bilateral vertebral artery occlusion after Cervical Spine Fracture dislocation
World Neurosurgery, 2019Co-Authors: Ben A Strickland, Courtney S Lewis, Martin H PhamAbstract:Vertebral artery injury is known to potentially occur in conjunction with blunt Cervical Spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed Cervical Spine trauma have been reported in the literature, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. Our patient presented after a trauatic C5-6 flexion-distraction injury resulting in bilateral locked facets and spinal cord injury as well as bilateral vertebral artery occlusions at the V1 segment, but did not show any cranial symptomatology despite his neurovascular injury. We present this as a rare illustration of a bilateral vertebral artery occlusion after blunt Cervical Spine trauma without clinical vertebrobasilar ischemic sequelae.
Francis H Shen - One of the best experts on this subject based on the ideXlab platform.
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traumatic Fracture dislocation of c5 on c6 through a previously solid multilevel anterior Cervical discectomy and fusion a case report and review of the literature
The Spine Journal, 2006Co-Authors: Dg Orndorff, Dino Samartzis, Richard Whitehill, Francis H ShenAbstract:Abstract Background context Due to the underlying pathology and altered biomechanics, traumatic Cervical Fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a Fracture-dislocation through a solid multilevel anterior Cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. Purpose To report the development of an unstable Cervical Spine Fracture that occurred through a previous multilevel anterior Cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. Study design/setting A case report and review of the literature. Methods A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a Cervical Spine Fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. Results The patient underwent emergent reduction and realignment of the Cervical Fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. Conclusions Multilevel Cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a Fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving Fracture reduction, decompression, and proper stabilization.
Jean Wong - One of the best experts on this subject based on the ideXlab platform.
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Cervical Spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation a case report
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2015Co-Authors: Alexander N J White, David T Wong, Christina L Goldstein, Jean WongAbstract:Purpose We present a case of upper airway obstruction in a patient with an unstable Cervical Spine Fracture in a halo orthosis. We also describe the mechanism by which the obstruction occurred and identify features that predispose patients in a halo orthosis to upper airway obstruction.
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Cervical Spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation a case report
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2015Co-Authors: Alexander N J White, David T Wong, Christina L Goldstein, Jean WongAbstract:We present a case of upper airway obstruction in a patient with an unstable Cervical Spine Fracture in a halo orthosis. We also describe the mechanism by which the obstruction occurred and identify features that predispose patients in a halo orthosis to upper airway obstruction. An 81-yr-old female presenting to hospital with an unstable Cervical Spine Fracture was scheduled for spinal fusion. She was fitted with a halo traction device in a flexed position, and an awake tracheal intubation was planned. The patient’s airway was topicalized and 1 mg of midazolam was administered. Her oxygen saturation dropped, and mask ventilation was difficult and insufficient. She then became unresponsive and pulseless. Emergency release of the halo orthosis device was carried out and her neck was held in a neutral position. Mask ventilation was successfully performed and oxygenation improved. The patient’s trachea was intubated via video laryngoscopy, and she was resuscitated and taken to the intensive care unit. The degree of Cervical Spine flexion resulting from the halo fixation was examined in subsequent radiographs, as defined by the occiput to C2 (O-C2) angle, and the oropharyngeal cross-sectional area was measured. Spine flexion from halo fixation in concert with the topical treatment and sedation predisposed the patient to acute airway obstruction. In this case, external Cervical Spine fixation in flexion resulted in a change to the O-C2 angle, which reduced the oropharyngeal area and predisposed to upper airway obstruction. This highlights the need for anesthesiologists to evaluate the degree of Cervical Spine flexion in patients with halo devices and to have the surgical team present during airway management in the event of acute airway obstruction.
Sharon E. Mace - One of the best experts on this subject based on the ideXlab platform.
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The unstable occult Cervical Spine Fracture: a review.
American Journal of Emergency Medicine, 1992Co-Authors: Sharon E. MaceAbstract:Abstract The initial evaluation and management of Cervical Spine injuries is of critical importance because of the impact of early treatment and management on the patient's eventual outcome. The devastation and cost of missing even one unstable Cervical Spine Fracture is tremendous. The existence of patients with an unsuspected Cervical Spine Fracture who have few, if any, symptoms and/or signs of an injury to the Cervical Spine is a valid concern and a dilemma for the practicing physician. Thus the principle of the occult unstable Cervical Spine Fracture, which has been established as the standard of care, has major significance and implications. Recently, however, the concept of the occult Cervical Spine Fracture has been challenged. Does the entity of an occult Cervical Spine Fracture exist? If so, how should this affect our indications for obtaining Cervical Spine radiographs? The author presents the case of an unstable occult Cervical Spine Fracture and a review of the literature.
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unstable occult Cervical Spine Fracture
Annals of Emergency Medicine, 1991Co-Authors: Sharon E. MaceAbstract:Recognition of injuries to the Cervical Spine is of critical importance. Such injuries may be difficult to recognize in patients who have an altered level of consciousness or other significant injuries. We present the case of an alert ambulatory patient with no complaint of neck pain, no tenderness of the neck on physical examination, and no history of trauma who, while being evaluated for fever, was found to have an unstable Cervical-Spine Fracture that was not present on radiographs done one year earlier.
Ben A Strickland - One of the best experts on this subject based on the ideXlab platform.
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bilateral vertebral artery occlusion after Cervical Spine Fracture dislocation
World Neurosurgery, 2019Co-Authors: Ben A Strickland, Courtney S Lewis, Martin H PhamAbstract:Background Vertebral artery injury is known to potentially occur in conjunction with blunt Cervical Spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed Cervical Spine trauma have been described in the reported data, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. Case Description Our patient presented after a traumatic C5-C6 flexion–distraction injury that had resulted in bilateral locked facets and spinal cord injury and bilateral vertebral artery occlusions at the V1 segment. However, our patient did not show any cranial symptoms despite his neurovascular injury. Conclusions We present our patient's case as a rare illustration of a bilateral vertebral artery occlusion after blunt Cervical Spine trauma without clinical vertebrobasilar ischemic sequelae.
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bilateral vertebral artery occlusion after Cervical Spine Fracture dislocation
World Neurosurgery, 2019Co-Authors: Ben A Strickland, Courtney S Lewis, Martin H PhamAbstract:Vertebral artery injury is known to potentially occur in conjunction with blunt Cervical Spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed Cervical Spine trauma have been reported in the literature, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. Our patient presented after a trauatic C5-6 flexion-distraction injury resulting in bilateral locked facets and spinal cord injury as well as bilateral vertebral artery occlusions at the V1 segment, but did not show any cranial symptomatology despite his neurovascular injury. We present this as a rare illustration of a bilateral vertebral artery occlusion after blunt Cervical Spine trauma without clinical vertebrobasilar ischemic sequelae.