Neuro-Orthopedic Criteria of Dorsopathy in Pregnant Women

Study Objective: To improve the diagnostic and therapeutic efficiency of dorsopathy in pregnant women by introducing a neuro-orthopedic examination algorithm. Study Design: prospective cohort study. Materials and Methods. The study enrolled 171 pregnant women: 87 dorsopathy patients (study group) and 84 healty women (controls). Inclusion criteria in both groups were progressive single uterine pregnancy, while the inclusion criterion for the study group was lower back pain (LBP) or pelvic ring pain (PRP). Neuro-orthopedic examination complied with the Russian clinical recommendations. Study Results. Neuro-orthopedic criteria to differentiate between pregnant women with or without dorsopathy were lower craniosacral rhythm (7.37 ± 1.53 vs. 8.14 ± 1.46 cycle/min, р = 0.002); sacral counternutation (odds ratio (OR) = 2.66); somatic dysfunctions (SD) in the lower and/or middle third of the right shank, right knee, Th11 NSRL, right clavicle, atlantooccipital joint, cuniform bone (left torsion), dura mater. SD in the right hip and pubic symphysis was included into gestation-associated changes which were unrelated to dorsopathy (LBP and PRP). A probability of LBP and PRP during pregnancy is higher in right sacroiliac joint SD (OR = 13.28; 95% CI: 1.69-104.59). Conclusion. It is reasonable to use osteopathic methods in dorsopathy (LBP and PRP) during pregnancy. Neuro-orthopedic differential diagnosis of lower back and pelvic ring pain reduces the risk of unjustified therapy to prolong pregnancy. Keywords: dorsalgia, somatic dysfunction, pregnancy, neuro-orthopedic examination.

Modern approaches to the diagnosis and treatment of meningiomas of the craniocervical junction region

34 cases of craniocervical junction region meningiomas are analyzed. It was about 1.6% of the general number of patients with primary symptomatic intracranial meningiomas. Lateral or anterolateral meningiomas were in 31 cases (91.2%), posterior – in 2 cases (5.9%), anterior without lateralization – in 1 case (2.9%). 27 patients (79.4%) are operated on through the suboccipital approach, 7 patients (20.6%) – through the far-lateral suboccipital (transcondyllar) approach. Total removal of tumors was made in 24 cases (70.6%), subtotal removal – in 6 cases (17.6%), partial removal – in 4 cases (11.8%). Mortality was not observed. Intraoperative monitoring significantly improved the preservation of neurological functions. There were no cases of tumors recidivating during a long-term observation.The suboccipital lateralized approach with laminectomy till the level of the lower pole of the tumor was sufficient to provide an adequate microsurgical removal of meningiomas of the craniocervical junction without resection of an atlantooccipital joint. The approach to the neoplasm matrix should be carried out after partial tumor resection without traction of brain stem parts. The use of intraoperative neuromonitoring supervised the stem functions at all stages of tumor removal and during the vertebral artery allocation.

Unilateral hypoglossal nerve palsy caused by an intraneural ganglion cyst

The authors describe a rare case of unilateral hypoglossal nerve palsy caused by an intraneural ganglion cyst. Three similar cases have been reported with pathological classification still under consideration. One case was classified as an intraneural ganglion cyst and 2 cases were classified as atlantooccipital joint synovial cysts.

Ligament of Barkow of the craniocervical junction: its anatomy and potential clinical and functional significance

Object Knowledge of the anatomy of the ligaments that unite the head with the neck is important to the clinician who treats patients with lesions in this region. Although the anatomy and function of these ligaments have been well described, those of the Barkow ligament (BL) have yet to be studied. Methods Via an anterior approach, 13 unembalmed adult cadavers underwent dissection of the craniocervical junction with special attention to the presence, anatomy, and function of the BL. Results The BL was found in 92.3% of specimens. The attachment of each ligament onto the medial aspect of the occipital condyle was consistent and just anterior to the attachment of the alar ligaments. In 75% of specimens, there was some connection between the BL and the anterior atlantooccipital membrane. Connections between other adjacent ligamentous structures were not identified. The average width, length, and thickness of the BL were 4, 2.5, and 3.5 mm, respectively. With ranges of motion of the craniocervical junction, only extension of the atlantooccipital joint produced tension in the BL. The mean tension to failure of the ligament was 28 N. Statistical analysis revealed no significant difference in width, length, and thickness of the ligaments based on sex. Conclusions The BL was found in all but 1 of our specimens. This ligament appears to resist extension of the atlantooccipital joint and may be synergistic with the anterior atlantooccipital membrane. Interestingly, the function of this ligament as found in this study relies on the integrity of the transverse ligament. Knowledge of this ligament may aid in further understanding craniocervical stability and help in differentiating normal from pathological tissue using imaging modalities.