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How to revise a failed C1–C2 fusion
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Nizar Moayeri, Michael G. Fehlings
There are several biomechanical reasons for C1–C2 nonunions. The C1–C2 segment has the widest range of motion of any spinal motion segment, and this motion is increased significantly when there is pathological instability present. The difficulty of achieving adequate control of C1–C2 motion during bone healing has led to a number of strategies to improve the fusion rate. Adjunctive use of a halo brace or internal fixation with rigid transarticular screws has been promoted to improve the success rate of surgery.
Difficult airway
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Halo brace: This is the most rigid immobilization technique of all spinal orthoses. It is highly effective in limiting upper cervical spine motion, thus limiting both flexion/extension and lateral bending movements of the cervical spine by 96% and axial rotation by 99%. But it makes DL very difficult. FOB intubation is recommended (awake or after induction).
Pediatric Orthopedic Trauma: Spine and pelvis trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Jaclyn F. Hill, Alysia K. Robertson
Atlas (Jefferson) fractures are caused by an axial load injury and result in disruption of the stability of the C1 ring (Figure 20.2.8). Patients often present with history of axial compression or hyperextension injury and neck pain. The fracture can be identified on AP x-ray or axial CT imaging. Stable injuries (<7 mm of lateral mass widening) may be treated in rigid cervical orthosis or halo [1, 12, 13]. Unstable injuries may require halo brace or occiput to C1 or C2 fusion [11, 14].
Swallowing rehabilitation following spinal injury: A case series
Published in The Journal of Spinal Cord Medicine, 2022
Shaolyn Dick, Jess Thomas, Jessica McMillan, Kelly Davis, Anna Miles
All four patients completed the full 6-week program. P3 and P4 both had one session which was truncated due to fatigue. Patients all progressed in total number of repetitions during their therapy sessions (Week 1 range 180–280 repetitions; Week 6 range 450–800 repetitions). Pre- and post-session feeling scores were positive and showed no statistically significant change over the session, with the exception of P1 who felt more positive post-sessions. Post-session fatigue scores were statistically heightened for all patients with the exception of P3 (Table 3). Patients’ spinal metalwork and/or neck flexion restricted exercise choice particularly for P4 who had minimal neck movement with Chin Tuck Against Resistance (CTAR) not manageable.28 No patients were able to complete Shaker Head Lift29 nor able to transfer easily from bed to chair to move between exercise tasks (Fig. 2). Despite clearance from her surgical team, P1 had recently had her HALO brace removed and found CTAR minimally uncomfortable at times. This did not prevent her from completing the task. P1 and P3 had restricted upper limb movements making holding the ball for CTAR difficult but not impossible with support.