Click on the link below to review Hangman’s fracture or traumatic spondylolisthesis of the axis vertebra using a mind map! Classifications, mechanism of injury, imaging, and treatment options are presented.
This is a talk on vertebral artery injury and how to tackle it if it happens during craniovertebral surgery.
In brief, the vertebral artery can be injured in two locations:
Extraosseous injury (open space injury): The vertebral artery (VA) is vulnerable to injury above the C1 posterior arch and lateral to the atlantoaxial joints. Sometimes, there is an anomalous course of VA than can get injured. The bleeding tends to be torrential. The quickest way to stop bleeding is by using tamponade for about 20-30 minutes. Endovascular intervention may be required if the bleeding cannot be controlled. Ligation or repair of the VA in this region is technically quite challenging.
Intraosseous injury (in the screw hole): The VA is vulnerable to injury in the C2 pars especially if it has an anomalous course (high riding VA). The bleeding can be controlled by using bone wax and by inserting the screw. The opposite side has to be abandoned to prevent bilateral VA injury. Postoperative angiography may be needed to assess the damage or to detect ongoing bleeding.
Dr. Robert Bohinski, a neurosurgeon with Mayfield Chiari Center, explains the causes, symptoms, diagnosis and treatment of Chiari malformation type 1. This patient webinar originally aired January 18, 2014. For further information regarding Chiari I Malformation and for info regarding upcoming webinars, please visit: http://www.MayfieldChiariCenter.com
This is a highly instructive and comprehensive talk, especially for orthopedic spine deformity surgeons, who frequently encounter this pathology in patients with scoliosis.
This is a surgical technique video demonstrating posterior atlantoaxial fusion (C1 lateral mass – C2 pedicle screw fixation) technique as described by Dr. Goel and Dr. Laheri, which was subsequently modified by Dr. Jurgen Harms.
Patient is a 45 year old woman with atlantoaxial instability due to Rheumatoid arthritis. She presented with intractable neck pain without myelopathy. Since the PADI (posterior atlanto-dens interval) was significantly reduced, decision was taken to perform C1-C2 fusion.
Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 1994;129:47–53.
Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 2001;26:2467–2471.