Haku Iizuka, Yoichi Iizuka, Tokue Mieda, Ryoichi Kobayashi, Masahiro Nishinome, Tsuyoshi Ara, Yasunori Sorimachi, Takashi Nakajima, Kenji Takagishi


November 2015, Volume 24, Issue 12, pp 2961 - 2966 Original Article Read Full Article 10.1007/s00586-015-4207-4

First Online: 02 September 2015

Purpose

The purpose of this study was to clarify the characteristics of adult cases with instability due to upper cervical spine anomalies who needed fusion surgery regarding the clinical and radiological findings.

Methods

Twenty-two consecutive patients with instability due to upper cervical spine anomaly in adult cases were reviewed. The congenital anomalies included idiopathic atlanto-axial subluxation in nine cases, os odontoideum in seven cases, occipitalization of the atlas in four cases, atlanto-occipital subluxation in one case and AAS with another anomaly in one case. We evaluated the severity of neurological symptoms before surgery and at the last follow-up. We also observed MR images before and 1 year after surgery.

Results

Before surgery, the 22 patients included seven Ranawat Grade I cases, ten Ranawat Grade II cases, and five Ranawat Grade IIIa cases. Regarding the neurological status after surgery, those included eighteen Ranawat Grade I cases, three Ranawat Grade II cases, and one Ranawat Grade IIIa case. Preoperative T2-weighted MR images demonstrated intramedullary high signal intensity (IHSI) in 12 cases. IHSI group did not include significantly more Ranawat Grade IIIa cases compared to the remaining 10 cases. In postoperative MR images (nine cases), the regression or disappearance of IHSI was demonstrated in only three cases.

Conclusions

In adult cases with instability due to upper cervical spine anomalies, we acquired favorable clinical outcomes after surgery. Regarding the neurological severity before surgery, there was no relationship with the IHSI on T2-weighted MR image. Moreover, the regression or disappearance of IHSI after surgery was not frequently demonstrated.


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