scholarly journals A Case of Cardiac Arrest during C1 Laminectomy for Irreducible Atlantoaxial Subluxation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Yosuke Shibao ◽  
Masao Koda ◽  
Keita Nakayama ◽  
Tomoyuki Asada ◽  
Kosuke Sato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Resonance Imaging ◽  
Intraoperative Complication ◽  
Cervical Spine Surgery ◽  
Trigeminocardiac Reflex ◽  
Upper Cervical ◽  
Atlantodental Interval

We report a case of cardiac arrest, which occurred during C1 laminectomy for irreducible atlantoaxial subluxation, with return of spontaneous circulation (ROSC) upon interruption of the laminectomy. A 60-year-old woman with rheumatoid arthritis presented with neck pain, bilateral finger numbness, and bladder-rectal disturbance. Simple radiograph images showed that the atlantodental interval (ADI) was enlarged to 8 mm, and magnetic resonance imaging revealed severe spinal stenosis at C1. She was diagnosed with cervical spondylotic myelopathy due to atlantoaxial subluxation. Cardiac arrest occurred twice during the C1 laminectomy and occipito-cervical fusion (Occ-C3), and ROSC occurred without any treatment. There was no postoperative worsening of neurological symptoms, and the improvement of sensory and motor palsy was favorable. The pathogenic mechanism was presumed to be trigeminocardiac reflex. Cardiac arrest during upper cervical spine surgery is an important intraoperative complication of which operators should be made aware.

Atlantoaxial Subluxation in Different Intraoperative Head Positions in Patients with Rheumatoid Arthritis

2006 ◽  
Vol 104 (4) ◽  
pp. 675-679 ◽  
Author(s):  
Daisaku Tokunaga ◽  
Hitoshi Hase ◽  
Yasuo Mikami ◽  
Tatsuya Hojo ◽  
Kazuya Ikoma ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
General Anesthesia ◽  
Perioperative Period ◽  
Head Position ◽  
Lateral View ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Upper Cervical ◽  
Atlantodental Interval

Background Disorders of the cervical spine are often observed in patients with rheumatoid arthritis (RA). However, the best head position for RA patients with atlantoaxial subluxation in the perioperative period is unknown. This study investigated head position during general anesthesia for the patients with RA and proven atlantoaxial subluxation. Methods During anesthesia of patients with RA and proven atlantoaxial subluxation, the authors used fluoroscopy to obtain a lateral view of the upper cervical spine in four different positions: the mask position, the intubation position, the flat pillow position, and the protrusion position. Copies of the still fluoroscopic images were used to determine the anterior atlantodental interval, the posterior atlantodental interval, and the angle of atlas and axis (C1-C2 angle). Results The anterior atlantodental interval was significantly smaller in the protrusion position (2.3 mm) than in the flat pillow position (5.1 mm) (P < 0.05). The posterior atlantodental interval was significantly greater in the protrusion position (18.9 mm) than in the flat pillow position (16.2 mm) (P < 0.05). The C1-C2 angle was, on average, 9.3 degrees greater in the protrusion position than in the flat pillow position (P < 0.05). Conclusion This study showed that the protrusion position using a flat pillow and a donut-shaped pillow during general anesthesia reduced the anterior atlantodental interval and increased the posterior atlantodental interval in RA patients with atlantoaxial subluxation. This suggests that the protrusion position, which involves support of the upper cervical spine and extension at the craniocervical junction, might be advantageous for these patients.

scholarly journals Normal kinematics of the upper cervical spine during the Flexion–Rotation Test – In vivo measurements using magnetic resonance imaging

2011 ◽  
Vol 16 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Hiroshi Takasaki ◽  
Toby Hall ◽  
Sadanori Oshiro ◽  
Shouta Kaneko ◽  
Yoshikazu Ikemoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Upper Cervical Spine ◽  
Resonance Imaging ◽  
Rotation Test ◽  
In Vivo Measurements ◽  
Upper Cervical

Abstract 280: Evaluation of Cerebral Blood Oxygenation by NIRS During Asphyxia Cardiac Arrest and Resuscitation in Rats

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Koichiro Shinozaki ◽  
Yu Okuma ◽  
Tai Yin ◽  
Mitsuaki Nishikimi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Near Infrared ◽  
Oxygenation Index ◽  
Spontaneous Circulation ◽  
Blood Oxygenation ◽  
Upper Cervical Spine ◽  
Sprague Dawley ◽  
Abrupt Increase ◽  
Cerebral Blood Oxygenation ◽  
End Tidal

Background: Clinical investigators have focused on the real-time evaluation of cerebral blood oxygenation (CBO) by near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR). A previous study showed that an abrupt increase of Oxy-hemoglobin (Hb) concentration and tissue oxygenation index (TOI) was associated with the timing of return of spontaneous circulation (ROSC). However, it is not clear how TOI decreases in cardiac arrest (CA) and increases by resuscitation. Therefore, this study aimed to assess CBO with asphyxia CA and its association with CPR to ROSC in rats Method: Male Sprague-Dawley rats were used. We attached NIRS (NIRO-200NX, Hamamatsu Photonics, Japan) from nasion to upper cervical spine in rats. 10-minute asphyxia was given to induce CA. After CA, mechanical ventilation was restarted, and manual CPR was performed. We examined the mean arterial pressure (MAP), end-tidal carbon dioxide (ETCO2), and Oxy/Deoxy-Hb and TOI. Results: Out of 12 rats, 9 obtained sustained ROSC. After the induction of asphyxia, TOI rapidly dropped, and as subsequent CPR was undergoing, Oxy-Hb, Deoxy-Hb, and TOI increased in synchrony with chest compressions. And then, an abrupt increase in MAP, ETCO2, and TOI observed at the time of ROSC. Conclusion: Recent CPR guidelines suggest a use of ETCO2 during CPR since its abrupt increase is a reasonable indicator of ROSC. TOI can be an alternative of ETCO2, and in addition, it has the potential to serve as monitoring CBO during CPR and subsequently in post-ROSC care.

scholarly journals Dynamic Kine Magnetic Resonance Imaging in Whiplash Patients and in Age- and Sex-Matched Controls

2009 ◽  
Vol 14 (6) ◽  
pp. 427-432 ◽  
Author(s):  
Karl-August Lindgren ◽  
Jyrki A Kettunen ◽  
Markku Paatelma ◽  
Raija HM Mikkonen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Proton Density ◽  
Upper Cervical Spine ◽  
Resonance Imaging ◽  
Motion Patterns ◽  
Alar Ligaments ◽  
Abnormal Movements ◽  
Upper Cervical

The multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings. The ligaments that stabilize the upper cervical spine can be injured. Dynamic kine magnetic resonance imaging (dMRI) may reveal the pathological motion patterns caused by injury to these ligaments. To compare the findings and motion patterns in the upper cervical spine, 25 whiplash trauma patients with longstanding pain, limb symptoms and loss of balance indicating a problem at the level of C0–C2, as well as matched healthy controls were imaged using dMRI. Imaging was performed with an Intera 1.5 T (Philips Healthcare, USA) magnet. A physiotherapist performed the bending and rotation of the upper cervical spine for the subjects to ensure that the movements were limited to the C0–C2 level. An oblique coronal T2- and proton density-weighted sequence and a balanced fast field echo axial sequence were used. The movements between C0–C2 and the signal from the alar ligaments were analyzed. Contact of the transverse ligament and the medulla in rotation was seen in two patients. The signal from the alar ligaments was abnormal in 92% of the patients and in 24% of the control subjects (P<0.0001). Abnormal movements at the level of C1–C2 were more common in patients than in controls (56% versus 20%, P=0.028). Whiplash patients with longstanding symptoms had both more abnormal signals from the alar ligaments and more abnormal movements on dMRI at the C0–C2 level than controls.

Kinematic Magnetic Resonance Imaging of the Upper Cervical Spine Using a Novel Positioning Device

Spine ◽  
1999 ◽  
Vol 24 (19) ◽  
pp. 2046 ◽  
Author(s):  
Jari O. Karhu ◽  
Riitta K. Parkkola ◽  
Markku E. S. Komu ◽  
Martti J. Kormano ◽  
Seppo K. Koskinen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Upper Cervical Spine ◽  
Resonance Imaging ◽  
Upper Cervical ◽  
Positioning Device ◽  
Kinematic Magnetic Resonance Imaging

scholarly journals Robot-assisted screw fixation in upper cervical spine using TiRobot system: an accurate and reliable procedure

10.29007/7j81 ◽  
2018 ◽  
Author(s):  
Qiang Yuan ◽  
Jingye Wu ◽  
Yajun Liu ◽  
Yonggang Xing ◽  
Yong Zhang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Screw Fixation ◽  
Three Dimensional ◽  
Upper Cervical Spine ◽  
Robot Arm ◽  
Average Deviation ◽  
Cervical Spine Surgery ◽  
Upper Cervical ◽  
Reliable Procedure ◽  
Underlying Diseases

Screw fixation in upper cervical spine surgery is one of the most challenging spinal procedures. For that reason, the free-hand techniques are not a reliable procedure in upper cervical spine. Wei Tian reported the first posterior C1-2 transarticular screw fixation which was assisted by robotic systems using TiRobot system in 2016. Our study was aimed to assess the accuracy and reliability of screw fixation in upper cervical spine prospectively.All the patients undergoing screw fixation assisted by robotic system (TiRobot) in upper cervical spine were prospectively studied from August 2015 to January 2018 in Beijing Jishuitan hospital. During surgeries, intraoperatively obtained images by C-arm were transferred into the TiRobot system and three-dimensional images were created. Surgeons' plannings of the screw trajectories were performed in TiRobot system. Afterwards, the robot arm with a guidance tube on its end was automatically moved to the entry point of each trajectory and held still. Guiding pins were inserted and followed by cannulated or conventional screws placements. A fluoroscopic re-scan by C-arm was performed, and the merging of two sets of images demonstrated the deviations between the planned and real trajectories. The deviations were analyzed and any intraoperative difficulties or errors were recorded. Postoperatively, any screw perforations were reviewed and recorded on CT scan images.Twenty-six patients (13 males/13 females) were included in this study. The average age was forty-nine. The underlying diseases of these patients covered dens fractures, Hangman's fractures, congenial and acquired deformities. 64 screws were placed assisted by TiRobot system. The average deviation between the planned and real trajectories was 0.9 mm. No screw perforations were detected on postoperative CT scans.Cervical spine, particularly the upper cervical spine has small size bony structures, higher accuracy requirements are significantly important. The results of our study showed only 0.9 mm deviations between planned and real trajectories occurred. This level of accuracy allowed safe and accurate placement of screws in upper cervical spine and no screw perforations were observed. For that reasons, screw fixation in upper cervical spine is an accurate and reliable procedure using TiRobot system.

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