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Atlanto Occipital Dislocation

Atlanto-occipital dislocation: case report and discussion David A. McKenna, MB, MRCOG, MRCPI, FFRRCSI;* Clare J. Roche, MB.BCh, BAO, MRCPI, DMRD, FRCR;* W. Kit Lee, MB.BS, FRANZCR;† William C. Torreggiani, MB.BCh, BAO, LRCP&SI, MRCPI, FRCR, FFRRCSI;† Vinay A. Duddalwar, MB.BS, MD, FRCR, DNB, MRad† *Department of Radiology, University College Hospital Galway, Newcastle, Galway City, County Galway, Ireland†Department of Radiology, Vancouver General Hospital, Vancouver, BC Received: June 7, 2005; final submission: Oct. 20, 2005; accepted: Nov. 9, 2005 This article has been peer reviewed. Can J Emerg Med 2006;8(1):50-3 ABSTRACT Atlanto-occipital dislocation (AOD) is a devastating condition that frequently results in prehospital cardiorespiratory arrest and accounts for 15% of fatal spinal trauma. Atlanto-occipital dislocation occurs 5 times more commonly in children than adults, and is believed to be caused by hyperextension. Because of improvements in prehospital resuscitation, more victims with AOD now survive to reach the emergency department. Neurologic injury is usually severe secondary to ligamentous disruption that allows the cranium to move with respect to the cervical spine, and associated facial and head injuries are common. There are, however, reports of survivors without neurologic deficits. We present the case of a 46-year-old woman who suffered an AOD after a motor vehicle crash and we discuss the diagnosis of this condition. The signs of AOD are often subtle, and the possibility of this diagnosis must be kept in mind in all patients with a neck injury, even in the absence of neurologic signs. A systematic approach to assessing the cranio-cervical relationship on the lateral cervical x-ray and the appropriate use of CT scanning is essential to identifying AOD. Through this case report we hope to familiarize clinicians with mechanisms of injury and appropriate imaging interpretation that will assist in the diagnosis of AOD.

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Blunt trauma to the Carotid

Case Presentation and literature review of the importance of screening for this injury

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Cervical Degeneration in a 34 year old male

In this SpineUniverse patient case presented by Dr. Michael Kaiser, neruosurgeon, Columbia University in New York, NY the patient underwent an anterior cervical discectomy and fusion at C5-C6 and C6-C7 with PEEK/BMP interbody grafting and anterior plate stabilization. Dr. Gerard Girasole, orthopedic surgeon offers a case review.  Each SpineUniverse case features polling of other spine professionals to capture the prevailing treatment recommendations for the spine community at large.

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Congenital Kyphosis Myelomeningocele

GICD-Europe Case III Carlos Villanueva Spain

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Cryptococcal Osteomyelitis Medscape

From Applied Radiology Cryptococcal Osteomyelitis Posted 09/04/2003 Timothy C. Sloan, DVM, MD, Jason Hosey, MD Summary A 51-year-old man presented to the emergency department with chest pain radiating to the right shoulder. The pain had been present for several months but had become refractory to analgesics. Past medical history was remarkable for recently diagnosed diabetes mellitus with negative cardiac and gastrointestinal workups. Physical examination revealed the patient had a low-grade fever and pain localized over the midthoracic spine. A radiograph of the thoracic spine (Figure 1) prompted subsequent computed tomography (CT; Figure 2) and magnetic resonance (MR; Figure 3) examinations.

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fracture of cervical spine in a patient with ankylosing spondylitis

A patient with thirty years history of ankylosing spondylitis sustained a head and neck injury after a fall.He was transmitted to the emergency department .His GCS was 15 with no findings in neurological examination.He had x-rays of the head and neck which considered normal and the patient discharged from the hospital.The patient for the next three months complained for neck pain and numbness of the upper arms
and had new x-rays and MRI which revealed a burst fracture of C7 vertebra.The patient is treated in a cervical collar Philadelphia type and is examined every month.
Fractures of cervical spine are obtained easily in patients with ankylosing spondylitis even after a minor trauma  due to osteoporosis and altered embiomechanics . Most of them have fractures in the C6-C7 vertabra and are three- column fractures.Doctors must have in mind this serious complication of ankylosing spondylitis 

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Iatrogenic Spondylodiscitis

From Neurosurgical Focus Iatrogenic Spondylodiscitis: Case Report and Review of the Literature Posted 07/15/2004 Erol Taþdemiroðlu, M.D.; Ahmet Sengöz, M.D.; Erdem Bagatur, M.D. Abstract and Introduction Abstract Iatrogenic intervertebral disc space infection is encountered following microsurgical discectomy, percutaneous laser disc decompression, automated percutaneous lumbar nucleotomy operations, and discography. The purpose of this paper is to present a case report and review the literature on the uncommon origins of pyogenic spondylodiscitis and to emphasize the significance of prophylactic antibiotic therapy following transrectal ultrasonography-guided needle biopsy of the prostate (TUGNBP). According to the authors, this is the first reported case of pyogenic spondylodiscitis as a complication of TUGNBP in the English language literature.

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Kyphoplasty for Vertebral Compression Fractures

Physicians with HealthEast Care System will perform an innovative spine procedure live on the Internet. The procedure at St. Joseph's Hospital in St. Paul, Minnesota will take place on April 19 at 4:00 pm Central Time.

This live webcast will involve physicians from HealthEast Spine Care and HealthEast Osteoporosis Care. Mark Myers, MD, an interventional neuroradiologist, will perform the balloon kyphoplasty. Joining Dr. Myers with commentary will be Michael Madison, MD, an interventional neuroradiologist and medical director of the HealthEast Neurovascular Institute, and international osteoporosis expert, Christine Simonelli, MD, internal medicine physician and medical director of HealthEast Osteoporosis Care.

During balloon kyphoplasty, the doctor makes a small incision in the back and places a narrow tube through it. Using x-ray images, the doctor inserts a special balloon through the tube and into the vertebrae and then the balloon is inflated. As the balloon inflates, it elevates the fracture, achieving a more normal position. The balloon is removed and the doctor uses specially designed instruments under low pressure to fill in the cavity with a cement-like material called polymethylmethacrylate or PMMA. The paste material hardens quickly and stabilizes the bone. Balloon Kyphoplasty can be done as an outpatient procedure.

This cutting-edge treatment is ideal for certain patients with osteoporosis experiencing painful symptoms from recent compression fractures. Balloon Kyphopasty should be done within eight weeks of a fracture for the best results in restoring the patient's height.

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Live Webcast AxiaLIF 360 Percutaneous Stabilization

See the least invasive solution for truly percutaneous 360-degree lumbar fusion at L5-S1. The AxiaLIF®360™ procedure will be presented in a live webcast from Texas Back Institute & Plano Presbyterian Center for Diagnostics and Surgery at 12 Noon CDT (17:00 UTC)

AxiaLIF 360º combines the stability of the TranS1® 3D Axial Rod™ with percutaneous facet screws to provide a percutaneous fusion and stabilization solution at L5-S1. The AxiaLIF 360º system provides posterior stability comparable to pedicle screw fixation. This least invasive system allows atraumatic access to the facet joints, no muscle splitting or stripping, and there is less morbidity and blood loss compared to pedicle screw fixation. The AxiaLIF 360º system preserves native soft tissue, provides robust anterior fixation with a posterior tension band, and can be reproducibly completed in 60-90 minutes.

Texas Back Institute surgeon Dan Bradley, MD will perform the procedure and accept questions from viewers during the live webcast.

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Lumbar Kyphosis And Spondylolisthesis

Orthochina.org Case Presentation March 2006 Lumbar Kyphosis and Spondylolisthesis

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Septic Sacroiliitis

Septic Sacroiliitis: The Overlooked Diagnosis from Journal of the Southern Orthopedic Association David E. Attarian, MD, Durham, NC Abstract Infection of the sacroiliac joint is extraordinarily rare. However, the initial symptoms and signs associated with this condition are mundane, thus leading to delay in diagnosis, or even misdiagnosis. I report an extremely unusual pyogenic sacroiliitis caused by Salmonella and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.

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Treatment Of A Chronic Scedosporium Apiospermum Vertebral Osteomyelitis Medscape

Case Report Neurosurg Focus 17(6), 2004 Posted 01/18/2005 John W. German, M.D.; Susan M. Kellie, M.D.; Manjunath P. Pai, Pharm.Dc.; Paul T. Turner, M.D.
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.

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AONA Case Presentations Spine

AO North America Spine Case Presentations collection

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Clinical Case Presentations from NMIS

Networked Medical Information Services was an early orthopaedic Internet organization which provided a case discussion site. Abandoned 2003

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