Anomalies At The Craniocervical Junction

Congenital or acquired abnormalities on Craniocervical transition include disorders in the area of ??the occiput, the foramen magnum or the two upper cervical vertebrae, which restrict the space for the brain stem and the spinal cord. These abnormalities can lead to neck pain, syringomyelia, cerebellar failures, malfunctions of the caudal cranial nerves and the spinal cord and to vertebrobasilar ischemia. The diagnosis is made by using MRI or CT. The treatment often involves a reduction of the concentration, followed by stabilization with surgical procedures or external aids.

Neuronal tissue is flexible and sensitive to compression. Anomalies Craniocervical transition can cause a compression of the cervical spinal cord or brain stem or contribute to this; some anomalies and their clinical implications are the following:

Congenital or acquired abnormalities on Craniocervical transition include disorders in the area of ??the occiput, the foramen magnum or the two upper cervical vertebrae, which restrict the space for the brain stem and the spinal cord. These abnormalities can lead to neck pain, syringomyelia, cerebellar failures, malfunctions of the caudal cranial nerves and the spinal cord and to vertebrobasilar ischemia. The diagnosis is made by using MRI or CT. The treatment often involves a reduction of the concentration, followed by stabilization with surgical procedures or external aids. Neuronal tissue is flexible and sensitive to compression. Anomalies Craniocervical transition can cause a compression of the cervical spinal cord or brain stem or contribute to this; some anomalies and their clinical implications are the following: the merger of Atlas (HWK1) and occiput: spinal cord compression in a narrowing of the anteroposterior diameter of the foramen magnum behind the Proc. odontoid the second cervical vertebra to <19 mm basilar impression or invagination (protrusion of the dens into the foramen magnum): (Condensed neck and compression, which can affect the cerebellum, the brainstem, the caudal cranial nerves and the spinal cord Atlantoaxial subluxation or dislocation of displacement of the Atlas anteriorly in relation to the axis): Acute or chronic spinal cord compression Klippel-Feil malformation (fusion of the cervical vertebrae): deformation and limited mobility of the neck, but usually no neurological symptoms Platybasie (flattening of the base of the skull, so that the base angle at the intersection of the plane of clivus and anterior cranial fossa> 135 ° is) to present on a lateral imaging of the skull: usually no symptoms or cerebellar or spinal cord failures. Etiology abnormalities of the craniocervical junction can be congenital or acquired. Congenital anomalies Congenital anomalies may be specific structural abnormalities or general or systemic diseases that affect the growth and development of the skeleton. Many patients have multiple abnormalities. The structural changes include the following: Os odontoideum (abnormal bone that replaces all or part of the Proc odontoid of the second cervical vertebra.) Atlas assimilation (congenital fusion of the atlas and occiput) Congenital Klippel-Feil malformation (eg. at Turner or Noonan syndrome), often (with atlanto-occipital anomalies Atllashypoplasie Chiari malformations downward displacement of the cerebellar tonsils or vermis in the cervical spinal canal, sometimes associated with Platybasie) General or systemic diseases that affect the growth and development of the skeleton and the craniocervical include transition, are the following: achondroplasia (epiphysealer impaired bone growth, the condensed, malformed bones related) sometimes results in that the foramen magnum narrows or fused to the Atlas and thus return Enmark or brain stem is compressed. Down syndrome, Morquio’s syndrome (mucopolysaccharidosis IV) or osteogenesis imperfecta can cause atlantoaxial subluxation or dislocation. Acquired abnormalities Acquired causes include injuries and illnesses. Injuries can affect bones, ligaments, or both, and are usually by car or bicycle accidents, falls, and especially caused when diving; Some injuries are immediately fatal. Rheumatoid arthritis (the most common cause of disease-related), and Paget’s disease of the cervical spine can cause atlantoaxial dislocation or subluxation, basilar invagination or Platybasie. Bone metastases can cause atlantoaxial dislocation or subluxation. Slow-growing craniocervical transition tumors (z. B. meningioma, chordoma) can press on the brain stem or spinal cord. Symptoms and signs Symptoms can for a smaller neck trauma or occur spontaneously and vary in their progression. The occurrence varies depending on the degree of compression and the affected structures. The most common manifestations are neck pain, often with headache symptoms and signs of spinal cord compression neck pain often spread to the arms and may be accompanied by headache (often occipital headache radiating to the skull center); it is ascribed to the compression of the C2-root and greater occipital nerve and a local musculoskeletal dysfunction. Neck pain and headache reinforce mostly through head movements and can be triggered by coughing or bending forward. In patients with Chiari malformation and hydrocephalus an upright posture can increase the hydrocephalus and lead to headache. The spinal cord compression affects the upper cervical spinal cord area. Among the deficiencies include spastic paralysis in the area of ??the arms and / or legs, caused by the compression motor webs. The position sense and vibration sense (posterior column function) are often disrupted. An electrical “tingling” along its back, often up in the legs can during flexion of the neck (Lhermitte’s sign) occur. Rarely are pain – and temperature sensation (spinothalamic paths) according to one or stocking-glove-shaped distribution pattern disturbed. The appearance and / or the mobility of the neck can be influenced by some anomalies (z. B. Platybasie, basilar invagination, Klippel-Feil malformation). The neck is short, wide (with a fold of skin between approximately sternocleidomastoid and shoulder) or in an abnormal position (e. B. torticollis with Klippel-Feil malformation). Range of motion may be limited. A compression of the brain (eg. As a result of Platybasie, basilar invagination or craniocervical tumors) can lead to deficits of brain stem, cranial nerves and cerebellum. Brainstem, and cranial nerve deficits include sleep apnea, internuclear ophthalmoplegia (ipsilateral weakness of Augenadduktion with contralateral horizontal nystagmus in abduzierenden eye in side view), downbeat nystagmus (fast component down), hoarseness, dysarthria and dysphagia. Cerebellar deficits often interfere with coordination. Vertebrobasilar ischemia can trigger the head position by the change. Symptoms may include intermittent syncope, drop attacks (drop attacks), his dizziness, confusion or altered consciousness, weakness and blurred vision. Syringomyelia (formation of a cavity in the central part of the spinal cord) is common in patients with Chiari malformation. It can cause a segmental flaccid paralysis and atrophy that occurs first in the distal upper extremities and is most severe; Pain and temperature sense may be missing in a hood-like distribution over the neck and upper proximal extremities touch sensitivity, however, is preserved. Diagnosis MRI or CT of the brain and upper spinal cord A craniocervical abnormality is suspected when patients plus have pain in the neck or in the occipital neurological deficits that can be related to the lower brain stem, the upper cervical spinal cord or cerebellum. Disorders of the lower cervical cord can usually be distinguished (based on the level of the spinal cord disorder) and neuroradiological imaging clinically. Neuroimaging In V. a. craniocervical abnormality is made, an MRI or CT of the upper spinal cord and brain, with special consideration of the posterior fossa and the craniocervical junction. Acute or suddenly progressive deficits represent an emergency and require immediate imaging. A sagittal MRI identified lesions associated neural and soft tissue lesions best (z. B. lesions in hindbrain, cerebellum and spinal cord and vascular abnormalities, syringomyelia). The CT shows bony structures more accurate than MRI and can often be carried out more easily in an emergency. Are MRI and CT are not available, are normal radiographs Side, anteriorposteriore and oblique views cervical-made of. If an MRI is not possible or when MRI and CT do not permit reliable diagnosis, a CT myelography is performed (CT after intrathecal injection of a contrast agent). Let MRI or CT suggests a vascular abnormality, MRI angiography or Vertebralisangiographie is performed. Reduction treatment of the constriction and immobilization Sometimes surgical decompression, fixing, or both compressed neural structures, the treatment in the decompression (or traction changes in head position for re-orientation of the craniocervical junction and thereby discharge the compressed neural structures). After decompression head and neck are immobilized. Acute or sudden progressive spinal cord compression requires emergency relief moderate. In most patients, this decompression is at a traction treatment of the axial skeleton with an external Halo ring and a draw weight up to 4 kg. The decompression traction therapy may take 5-6 days. If decompression is achieved, the neck is immobilized in a fixed halo vest for 8-12 weeks. Then X-ray control images must be performed to confirm stabilization. Halo Ring Image courtesy of Depuy / Synthes. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/halo_ring_front_rear_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/halo_ring_front_rear_high_de.jpg?la = en & thn = 0 ‘, title:’ halo ring ‘, description:’ u003Ca id = “v37896424 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eEin halo ring is an efficient way to apply cervical traction. Since the ring is fixed to the skull with a plurality of pins

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