Objective: The recently described C1-C2 fixation without foramen magnum decompression (FMD) for the management of Chiari malformations (CMs) has sparked a controversy. C1-C2 fixation has been reported to be more effective than traditional FMD. However, the results after such a procedure have not been as well validated. We assessed the efficacy of C1-C2 distraction and fusion without FMD in patients with CM and without demonstrable atlantoaxial instability.
Methods: A total of 40 patients with CM had undergone C1-C2 distraction and fusion without FMD. The preoperative and follow-up clinicoradiological data were prospectively compared using the Klekamp neurologic score, visual analog scale, pBC2 index (ventral brainstem compression), and Vaquero index (syringomyelia).
Results: Of the 40 patients, 28 (70%) showed improvement in their neurological score and visual analog scale, 8 remained in same status, 3 showed deterioration, and 1 died during the follow-up period. The clinical improvement did not correlate with the severity of ventral cervicomedullary compression or the presence of osseous deformities (assimilated C1 arch, platybasia and basilar invagination) despite the reduction in the mean pBC2 index (7.9 vs. 5.9). The syringomyelia had decreased in 51.7%, with a reduction in the Vaquero index at follow-up (0.48 vs. 0.38).
Conclusions: The overall results after C1-C2 distraction and fusion for CM without instability were not exceptionally better and appeared to be similar to the outcomes reported with FMD. The neurological improvement seen in some patients had possibly resulted from indirect ventral decompression (due to distraction of C1-C2) rather than the stabilization itself. The presence of bony anomalies such as an assimilated C1 arch, platybasia, basilar invagination, and ventral brainstem compression did not significantly influence the outcomes.
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http://dx.doi.org/10.1016/j.wneu.2019.12.122 | DOI Listing |
Asian Spine J
December 2024
Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt.
Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions.
View Article and Find Full Text PDFAnn Med Surg (Lond)
December 2024
Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
Introduction And Importance: Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1-C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries.
View Article and Find Full Text PDFAnnu Rev Food Sci Technol
December 2024
1Sustainable Food Systems Engineering Group, Department of Food Science and Technology, University of Georgia, Athens, Georgia, USA; email:
Harnessing CO and CO-derived C1-C2 compounds for microbial food production can mitigate greenhouse gas emissions and boost sustainability within the food sector. These innovative technologies support carbon neutrality by generating nutrient-rich edible microbial biomass and biocompounds using autotrophic and heterotrophic microbes. However, qualifying microbial food viability and future impacts in the food sector remains challenging due to their diversity, technical complexity, socioeconomic forces, and incipient markets.
View Article and Find Full Text PDFActa Orthop Traumatol Turc
November 2024
Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
World Neurosurg
November 2024
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. Electronic address:
Objective: To analyse patients with recurrent atlanto-axial dislocation and give a criterion of an ideal patient who can benefit from redo surgery.
Methods: This retrospective study was conducted in a tertiary care center, which included 20 patients who failed atlanto-axial surgery from January 2013 to June December 2021. They were evaluated using X-ray, computed tomography, and magnetic resonance imaging examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system.
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