The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Kiwon Kim - One of the best experts on this subject based on the ideXlab platform.
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synovial cyst of the Transverse Ligament of the atlas in a patient with os odontoideum and atlantoaxial instability
Spine, 2000Co-Authors: Han Chang, Jongbeom Park, Kiwon KimAbstract:STUDY DESIGN A case report and review of the literature. OBJECTIVE To describe the diagnosis and successful treatment of a synovial cyst arising from the Transverse Ligament in a patient with os odontoideum and atlantoaxial instability. SUMMARY OF BACKGROUND DATA Synovial cysts arising from the Transverse Ligament of the atlas are extremely rare. Development of a synovial cyst is thought to be attributable to degenerative changes of the C1-C2 facet joints or to microtrauma. Direct excision of the cyst is the only treatment cited in previous reports. METHODS A synovial cyst arising from the Transverse Ligament of the atlas in a 45-year-old man with os odontoideum and atlantoaxial instability was treated surgically with posterior atlantoaxial fusion alone. The magnetic resonance images, surgical treatment, and related literature are reviewed. RESULTS Preoperative magnetic resonance images of the cervical spine showed a large cystic mass located ventral to the cord arising at the level of the Transverse Ligament of the atlas: the mass was of low signal intensity on T1-weighted images, was of high signal intensity on T2-weighted images, and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Spontaneous regression of the cyst was identified on the follow-up magnetic resonance images taken 3 months after C1-C2 posterior wiring and fusion. CONCLUSIONS A patient with a synovial cyst arising at the C1-C2 junction ventrally at the level of the Transverse Ligament showed spontaneous regression of the lesion after C1-C2 posterior wiring and fusion.
Christoph Ozdoba - One of the best experts on this subject based on the ideXlab platform.
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surgical approach for synovial cyst of the atlantoaxial joint a case report and review of the literature
Spine, 2009Co-Authors: Serge Marbacher, Anton Lukes, Istvan Vajtai, Christoph OzdobaAbstract:STUDY DESIGN: Case report and review of the literature. OBJECTIVE: We describe the first case of a synovial cyst arising from pseudarthrosis of a previous dens fracture. The literature is reviewed and etiological, diagnostic, and therapeutic options of atlantoaxial cysts are discussed. SUMMARY OF BACKGROUND DATA: Symptomatic synovial cysts of the atlantoaxial joint are rare. To the authors' knowledge only 24 cases have been reported.A 60-year-old patient presented with bilateral hand numbness, quadrihyperreflexia, and gait deterioration. Magnetic resonance imaging of the cervical spine disclosed a cystic mass located at the Transverse Ligament of dens axis causing bulbomedullary compression. METHODS: Surgery was performed via transoral image guided approach. The ventral atlas arch, dens, Transverse Ligament, tectorial membrane, and the compressing cyst were removed, followed by a C0-C3 fusion. RESULTS: Two months postsurgery the patient recovered completely from the cervical myelopathy with transient remnant dysparesthesia of the finger tips. CONCLUSION: Magnetic resonance imaging findings are not specific enough to establish a preoperative diagnosis. Radical resection via image-guided transoral route followed by posterior fusion allows complete resection of the cystic lesion and results in excellent long-term decompression.
G. Maestretti - One of the best experts on this subject based on the ideXlab platform.
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An uncommon C1 fracture with longitudinal split of the Transverse Ligament
European Spine Journal, 2011Co-Authors: D. R. Kaiser, R. Ciarpaglini, G. MaestrettiAbstract:We present a unique variant of C1 fracture, which, at the best of our knowledge, has never been previously reported. This lesion consists in a lateral mass atlas fracture with a longitudinal separation of the Transverse Ligament that remains functionally preserved. We considered this lesion to be stable and treated the patient conservatively with good recovery. Even if many classifications of atlas fractures have been proposed, none of them ever described this uncommon variant. We debate about biomechanical aspects and therapeutic implication of the reported case.
Helton Luiz Aparecido Defino - One of the best experts on this subject based on the ideXlab platform.
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Reviewer’s comment concerning “An uncommon C1 fracture with longitudinal split of the Transverse Ligament” (doi:10.1007/00586-011-2102-1 by D. R. Kaiser, R. Ciarpaglini, G. Maestretti)
European Spine Journal, 2012Co-Authors: Helton Luiz Aparecido DefinoAbstract:Traumatic injuries of the cervical spine depend on several variables such as impact magnitude, impact direction, bone quality, position of the head, neck and thorax, morphology of the vertebrae, final vector and rate of application. Isolated force vectors can produce specific injuries in controlled laboratory experiments. However, in clinical situation the final predominant vector force is the result of multiple simultaneous forces rather than a single isolated force. Atlas fractures, not considering the avulsion fractures, are produced by the force application on the head and the force transmitted to atlas that is compressed between the occiput and C2. According to the final force resultant, different types of atlas fractures can result: hyperextension results in fractures of the posterior arch of C1; lateral bending and axial rotation results in asymmetrical injuries of the atlas and vertical compression produces a burst fracture. The atlas fracture described by the authors is the result of indirect force application on the atlas, which resulted in an atypical fracture that cannot be classified according to the current system, because it is a lengthwise Transverse Ligament split. However, the fracture mechanism can be understood and explained by the current biomechanical principle of cervical spine injuries.
Volker K. H. Sonntag - One of the best experts on this subject based on the ideXlab platform.
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Injuries involving the Transverse atlantal Ligament: classification and treatment guidelines based upon experience with 39 injuries.
Neurosurgery, 1996Co-Authors: Curtis A. Dickman, Karl A. Greene, Volker K. H. SonntagAbstract:Comprehensive anatomic and clinical analyses of 39 patients with injuries involving the Transverse atlantal Ligament or its osseous insertions were performed to assess the morphology of the injured Ligaments and the patients' capacity to heal. Injuries of the upper cervical spine were screened with plain radiographs, thin-section computed tomography, and magnetic resonance imaging studies. The injuries were classified as disruptions of the substance of the Ligament (Type I injuries, n = 16) or as fractures and avulsions involving the tubercle for insertion of the Transverse Ligament on the C1 lateral mass (Type II injuries, n = 23). These two types of injuries had distinctly different clinical characteristics that were useful for determining treatment. Type I injuries were incapable of healing satisfactorily without internal fixation; they should be treated with early surgery. Type II injuries, which rendered the Transverse Ligament physiologically incompetent even though the Ligament substance was not torn, should be treated initially with a rigid cervical orthosis, because they had a 74% success rate nonoperatively. Surgery should be reserved for patients with Type II injuries that have nonunion with persistent instability after 3 to 4 months of immobilization. Type II injuries had a 26% rate of failure of immobilization; therefore, close monitoring is needed to detect patients who will require delayed operative intervention.
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Magnetic resonance imaging of the Transverse atlantal Ligament for the evaluation of atlantoaxial instability.
Journal of neurosurgery, 1991Co-Authors: Curtis A. Dickman, Volker K. H. Sonntag, Alexander C. Mamourian, Burton P. DrayerAbstract:Twenty normal human subjects and 14 patients with upper cervical spine pathology were studied with axial high-field magnetic resonance (MR) imaging to examine the Transverse atlantal Ligament. Gradient-echo MR imaging pulse sequences provided reliable visualization of the Transverse Ligament, which exhibited low signal intensity and extended behind the dens between the medial portions of the lateral masses of C-1. The MR imaging characteristics of the Transverse Ligament were verified in clinical studies and in postmortem specimens. The clinical MR examinations defined 27 normal Ligaments, three Ligament disruptions, and four stretched rheumatoid Ligaments. Atlantoaxial instability associated with Transverse Ligament rupture or Ligamentous laxity required internal fixation. In contrast, fractures of C-1 or C-2 or atlantoaxial rotatory dislocations associated with an intact Transverse Ligament healed without instability or nonunion. The Transverse Ligament is the primary stabilizing component of C-1. The treatment of atlantoaxial instability has previously been based on criteria drawn from computerized tomography or plain radiographic studies, which only indirectly assess the probability of rupture of the Transverse Ligament. It is concluded that MR imaging accurately depicts the anatomical integrity of the Transverse Ligament. After Transverse Ligament failure, the remaining Ligaments of the craniovertebral junction are inadequate to maintain stability. The presence of Ligament disruption should be considered as a criterion for early fusion.
