Background: Acute myocardial infarction (MI) frequently leads to consciousness disturbance following hemodynamic collapse. Therefore, MI can occur together with upper cervical spine trauma. Herein, we report the successful treatment of complex C1/C2 fractures in a patient with concomitant three-vessel coronary artery disease (CAD).
Case Presentation: A 70-year-old patient presented in our emergency outpatient clinic after a hemodynamic collapse without neurological deficits or heart-related complaints. Computed tomography (CT) scan of the cervical spine revealed a dislocated odontoid fracture Anderson and D'Alonzo type II and an unstable Gehweiler type III injury (Jefferson's fracture). An intradiploic arachnoid cyst in the posterior wall of the posterior fossa was a coincident radiological finding. Furthermore, coronary angiography confirmed three-vessel CAD with high-grade coronary artery stenosis. Indication for upper cervical spine surgery and bypass surgery was given. An interdisciplinary team of neurosurgeons, cardiothoracic surgeons and anesthesiologists evaluated the patient's case to develop the most suitable therapy concept and alternative strategies. Finally, in first step, C1-C2 fusion was performed by Harms technique under general anesthesia with x-ray guidance, spinal neuronavigation, Doppler ultrasound and cardiopulmonary monitoring. Cardiothoracic surgeons were on standby. One month later bypass surgery was performed uneventfully. Follow-up CT scan of cervical spine revealed intraosseous screw positioning and beginning fusion of the fractures. The patient did not develop neurological deficits and recovered completely from both surgeries.
Conclusions: Treating complex C1/C2 fractures with concomitant severe CAD requiring treatment is challenging and carries a high risk of complications. To our knowledge, the literature does not provide any guidelines regarding therapy of this constellation. To receive upper cervical spine stability and to prevent both, spinal cord injury and cardiovascular complications, an individual approach is required. Interdisciplinary cooperation to determine optimal therapeutic algorithms is needed.
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http://dx.doi.org/10.3389/fsurg.2023.1123947 | DOI Listing |
BMC Surg
December 2024
Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
Background: The best open side for unilateral open-door laminoplasty (UODL) to treat inconsistent cervical ossification of the posterior longitudinal ligament (OPLL) needs to be identified.
Methods: Thirty-one individuals with inconsistent OPLL who underwent UODL between January 2016 and December 2018 were retrospectively divided into two groups: when the side of the open door was consistent with the side of the larger ossification occupancy area, patients were placed in the Consistent group; when the side of the open door was contralateral to the side of the larger ossification occupancy area, patients were placed in the Contralateral group. The following parameters were evaluated: neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, postoperative laminoplasty opening width and angle, and spinal cord diameter ratio.
Clin Neurol Neurosurg
December 2024
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States. Electronic address:
Background: Degenerative cervical myelopathy is one of the most common causes of spinal cord dysfunction. Cervical laminoplasty is an excellent surgical procedure that address the underlying pathology along with motion preservation with various advantages over other surgical options. While the advantages are intuitive and are being proven in multiple recent studies, concerns regarding failure still remains precluding wider utilization despite evidence to the contrary.
View Article and Find Full Text PDFEur J Neurol
January 2025
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Background: Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.
Methods: Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing.
Lancet Neurol
January 2025
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Background: Spinal cord injury results in permanent neurological impairment and disability due to the absence of spontaneous regeneration. NG101, a recombinant human antibody, neutralises the neurite growth-inhibiting protein Nogo-A, promoting neural repair and motor recovery in animal models of spinal cord injury. We aimed to evaluate the efficacy of intrathecal NG101 on recovery in patients with acute cervical traumatic spinal cord injury.
View Article and Find Full Text PDFSpine J
December 2024
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University.. Electronic address:
Background Context: Hybrid surgery (HS), which involves both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (ACDR), is increasingly used to treat multilevel cervical disc degenerative disease, yielding satisfactory clinical outcomes. Early fusion is critical after anterior cervical fusion surgeries, but there are no studies comparing the rate of early fusion of HS with that of ACDF.
Purpose: The purpose of this study was to compare the rate of early fusion (3-6 months postoperatively) of two-level HS with that of two-level ACDF surgery.
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