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Liu C, Huang K, Dai L, Huang X, Zhang X. The biomechanical study of different fixation techniques for combination fractures of atlas and axis: a finite element analysis. Eur J Med Res 2025; 30:184. [PMID: 40102998 PMCID: PMC11921601 DOI: 10.1186/s40001-025-02459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 03/12/2025] [Indexed: 03/20/2025] Open
Abstract
Combination atlas-axis fractures are less studied but relatively common with a higher incidence of neurological deficits than isolated C1 or C2 fractures. Several authors focused on the treatment strategies, but there is no study to compare the stability of different fixation methods; neither not yet clear which technique represents the best choice and whether stabilization devices can be efficient and beneficial for complex atlantoaxial fractures. The aim of this study was to compare the biomechanical properties of three fixation techniques: atlantoaxial pedicle screws fixation (PSF), occipital-cervical fusion (OCF) and transarticular screw fixation (TSF) based on combination factures model. Our results showed the range of motion (ROM) of fracture model increased obviously than intact model. The ROM in flexion/extension and rotation of C0-C1 in PSF and TSF models were increased. The ROM of C1-C2 in all conditions in PSF, OCF and TSF models were decreased. The ROM of C2-C3 was decreased in OCF, but remains the same stage in PSF and TSF. These suggested that three surgical methods are effective for the combination fractures of atlas and axis, which can ensure good stability. It can properly increase the ROM of C0-C1 when using PSF. These findings would aid in the treatment of this complex fractures.
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Affiliation(s)
- Chao Liu
- Department of Orthopedics, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People's Republic of China
| | - Kai Huang
- Department of Orthopedics, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People's Republic of China
| | - Lei Dai
- Department of General Surgery, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People's Republic of China
| | - Xiaogang Huang
- Department of Gastroenterology, Shanghai Songjiang Sijing Hospital, 389 Sitong Road, Songjiang District, Shanghai, 201601, People's Republic of China.
| | - Xinjun Zhang
- Department of Orthopedics, Shanghai Songjiang Sijing Hospital, 389 Sitong Road, Songjiang District, Shanghai, 201601, People's Republic of China.
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Cloney MB, Buell TJ, Paul DA, Nail TJ, Polavarapu H, Jawad-Makki MA, Adida S, Okonkwo DO. Simultaneous Traumatic Fractures of the Atlas and Axis: Presentation, Management, and Outcomes from a Series of 103 Consecutive Patients. World Neurosurg 2025; 195:123580. [PMID: 39694137 DOI: 10.1016/j.wneu.2024.123580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 12/08/2024] [Accepted: 12/10/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND Simultaneous C1 and C2 fractures are increasingly common, but contemporary series are limited. METHODS All patients with traumatic fractures of both C1 and C2 admitted to an academic trauma center from 2012 to 2022 were retrospectively analyzed. Multivariable regression was used to identify characteristics relevant to management and outcomes. RESULTS Of 103 patients identified, most were ≥80 years old (52.4%), sustained ground-level falls (80.6%), and had minor associated injuries (median Injury Severity Score 1); a 28.2% had a 1-year mortality rate. Landells type 1 fractures were the most common C1 fracture (50.5%), and dens fractures were the most common C2 fracture (74.8%). Most patients did not undergo magnetic resonance imaging, but ligamentous injury was seen in 54.8% of those who did. Fourteen patients (13.6%) had upfront surgery, and 7 patients (6.8%) had surgery after a trial of nonoperative management. Selection for upfront surgery was associated with neurologic deficits (P = 0.010) and age (P = 0.026). Patients with dens fracture tended to have C2 as their lower instrumented vertebra (P = 0.0902), and patients with hangman's fracture tended to have C3 as their lower instrumented vertebra (P = 0.0714). Upfront surgery decreased the odds of bony nonunion (P = 0.0281). In 91.7% of patients with bony nonunion with flexion-extension x-rays, the x-rays showed fibrous nonunion. CONCLUSIONS Simultaneous atlantoaxial fractures commonly occur in elderly patients after ground-level falls with minor associated injuries. Surgical selection is driven by neurologic deficits and age, and C2 fracture type may influence procedure choice. Surgery decreases the odds of bony nonunion, and fibrous nonunion is common in the absence of surgery.
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Affiliation(s)
| | - Thomas J Buell
- Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David A Paul
- Department of Neurosurgery, University of Rochester Medicine, Rochester, New York, USA
| | - T Jayde Nail
- Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Hanish Polavarapu
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Mohamed-Ali Jawad-Makki
- Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samuel Adida
- Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Department of Neurological Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Li S, Xu X, Chang M, Li H, Xu R, Fu W, Wang L, Li Y, Yuan S, Tian Y, Wang L, Liu X. The establishment of a novel upper cervical complex fracture classification system. Spine J 2025; 25:127-135. [PMID: 39154938 DOI: 10.1016/j.spinee.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/11/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND CONTEXT Upper cervical complex fractures are associated with high rates of neurological damage and mortality. The Dickman's classification is widely used in the diagnosis of upper cervical complex fractures. However, it falls short of covering the full spectrum of complex fractures. This limitation hinders effective diagnosis and treatment of these injuries. PURPOSE To address the diagnostic gap in upper cervical complex fractures, the study introduces a novel classification system for these injuries, assessing its reliability and usability. STUDY DESIGN Proposal of a new classification system for upper cervical complex fractures. PATIENT SAMPLE The study comprised the clinical data of 242 patients with upper cervical complex fractures, including 32 patients treated at our hospital, along with an additional 210 cases from the literature. OUTCOME MEASURES The interobserver and intra-observer reliability (kappa coefficient, κ) of this classification system were investigated by 3 spine surgeons. The 3 researchers independently reevaluated the upper cervical complex fracture classification system 3 months later. METHODS The proposed classification categorizes upper cervical complex fractures into 3 main types: Type I combines odontoid and Hangman's fractures into 2 subtypes; Type II merges C1 with odontoid/Hangman's fractures into 3 subtypes; and Type III encompasses a combination of C1, odontoid, and Hangman's fractures, divided into 2 subtypes. Meanwhile, a questionnaire was administered in 15 assessors to evaluate the system's ease of use and clinical applicability. RESULTS A total of 45 cases (18.6%) unclassifiable by Dickman's classification were successfully categorized using our system. The mean κ value of inter-observer reliability was 0.783, indicating substantial reliability. The mean κ value of intraobserver reliability was 0.862, indicating almost perfect reliability. Meanwhile, thirteen assessors (87.7%) stated that the classification system is easy to remember, easy to apply, and they expressed intentions to apply it in clinical practice in the future. CONCLUSIONS This system not only offers high confidence and reproducibility but also serves as a precise guide for clinicians in formulating treatment plans. Future prospective applications are warranted to further evaluate this classification system.
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Affiliation(s)
- Shangye Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Xiulian Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Mingzheng Chang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Hao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Rongkun Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Wenyang Fu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Lulu Wang
- Department of Orthopedics, Shengli Oilfield Central Hospital, Dongying, Shandong, P.R. China
| | - Yonggang Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China.
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Tao H, Shao S, Yang K, Liu C, Shen C, Zhang Y. Rotation Preserving Fixation for the Treatment of C1 Burst Fracture Combined With Type II Odontoid Fracture: 2 Case Reports and Literature Review. Int J Spine Surg 2024; 18:617-625. [PMID: 39443161 PMCID: PMC11616375 DOI: 10.14444/8646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures. METHODS We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability. RESULTS Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively. CONCLUSIONS A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment. CLINICAL RELEVANCE In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Hui Tao
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shanzhong Shao
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Yang
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chang Liu
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yinshun Zhang
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Chen ZD, Tu CQ, Jiang YJ, Zeng YZ, Huang ZZ, Cai TY, Lin B. Management of non-contiguous upper and lower cervical spine fractures. INTERNATIONAL ORTHOPAEDICS 2024; 48:2941-2952. [PMID: 39242395 DOI: 10.1007/s00264-024-06308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Upper cervical fracture combined with non-contiguous lower cervical fracture are not uncommon but complicated. In order to outline a management principle for the upper cervical fracture combined with non-contiguous lower cervical fracture and assess its clinical characteristics, we retrospectively analyzed 59 cases of patients who underwent surgical treatment for upper cervical fracture combined with non-contiguous lower cervical fracture. METHODS 59 patients of upper cervical fracture combined with non-contiguous lower cervical fracture were treated by surgery in our hospital. According to the AO Spine classification for cervical fractures, there were 21 cases of type B atlas fractures, nine cases of type C atlas fractures; 15 cases of type B axis fractures, 14 cases of type C axis fractures; 19 cases of type B lower cervical fractures, 40 cases of type C lower cervical fractures. The operation time, intraoperative blood loss, complications, VAS scores, JOA scores, ASIA grades, and radiological evaluation of cervical lordosis and stability were collected and recorded. RESULTS Our results showed the segments of upper cervical fracture combined with non-contiguous lower cervical fracture are mainly concentrated in the atlas-axis and C6, C7 levels. There were 43 cases (72.88%) of associated injuries, mainly involving head trauma and thoracic injuries. Four patients underwent anterior approach surgery only, 43 patients underwent posterior approach surgery only, and 12 patients underwent combined anterior and posterior approach surgery in one stage. All patients had regular follow up with an average duration of 67.83 ± 11.25 months (range, 39 to 103 months). The VAS scores and JOA scores at 12 months postoperatively and at final follow-up showed significant improvement compared to preoperative scores (P < 0.05). At the final follow-up, ASIA grades had improved by 0 to 2 levels. The cervical lordosis at the final follow-up (24.71°±7.39°) showed no statistically significant difference compared to preoperative measurements (26.89°±13.32°). Surgical complications occurred in 17 patients. No cases of vertebral artery injury, screw loosening, or other internal fixation failures were found at final follow-up. CONCLUSIONS Upper cervical fracture combined with non-contiguous lower cervical fracture can result in varying extents of cervical spinal cord injury and combined trauma in other parts. Surgical treatment of these injuries can achieve favourable clinical and radiological outcomes in the medium to long term follow-up. More research is still needed to optimize clinical decision-making regarding surgical approach.
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Affiliation(s)
- Zhi-da Chen
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Cheng-Quan Tu
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Yuan-Jie Jiang
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Yu-Zhe Zeng
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Zhuan-Zhi Huang
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Tao-Yi Cai
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China.
| | - Bin Lin
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China.
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Gomez-Rios JC, Uribe-Alpizar C, Reyes-Sanchez A, García-Ramos CL, Rosales-Olivarez LM, Zárate-Kalfópulos B. Malunion in a Self-stabilized Fracture of the Odontoid Process Type II with a Chronic Anterior Atlantoaxial Subluxation in a Neurologically Intact Patient: A Case Report. Rev Bras Ortop 2024; 59:e133-e137. [PMID: 39735464 PMCID: PMC11679622 DOI: 10.1055/s-0043-1770979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/12/2023] [Indexed: 12/31/2024] Open
Abstract
Atalanto-occipital dislocations with type II fractures of the odontoid process are rare, reporting 7 cases for every 784 upper cervical spine injuries, an incidence of <0.3% and are related to a high rate of morbidity and mortality. Regarding C2 fractures, the most common are in the odontoid process, representing 7%, classified by Anderson and D'Alonso according to their level, with the highest rate of pseudarthrosis in zone II of up to 85% are caused mainly by car accidents. In the acute event, there is no consensus regarding its optimal management. We performed a complete anamnesis and a physical examination in our institution. A systematic review of case reports was carried out with the keywords "mal-union, type II odontoid process fracture, chronic atlantoaxial subluxation" in four different databases, and a comparative analysis of the cases found was performed. There were not found identical cases to the one in our report, 9 similar case reports were published with the general differences of a pseudarthrosis of the odontoid process, as well as neurological alterations in symptomatic patients and the consequent surgical treatment. Observing a patient with a type II odontoid process fracture consolidating viciously and a stable anterior atlantoaxial subluxation without neurological alterations is rare. We determined to maintain expectant management with annual follow-up.
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Affiliation(s)
- Juan Carlos Gomez-Rios
- Serviço de Cirurgia de Coluna, Instituto Nacional de Rehabilitación, Cidade do México, México
| | - Claudio Uribe-Alpizar
- Serviço de Cirurgia de Coluna, Instituto Nacional de Rehabilitación, Cidade do México, México
| | - Alejandro Reyes-Sanchez
- Serviço de Cirurgia de Coluna, Instituto Nacional de Rehabilitación, Cidade do México, México
| | | | | | - Baron Zárate-Kalfópulos
- Serviço de Cirurgia de Coluna, Instituto Nacional de Rehabilitación, Cidade do México, México
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Diaz S, Al Barajraji M, Dembour V, Rothenfluh D, Barges-Coll J. Assessing the Impact of Undiagnosed C1‒C2 Rotatory Subluxation in the Conservative Treatment of Odontoid Fractures. World Neurosurg 2024:S1878-8750(24)01568-7. [PMID: 39270795 DOI: 10.1016/j.wneu.2024.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with second cervical vertebrae (C2) fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent first and second cervical vertebrae (C1‒C2) rotatory subluxation. METHODS A retrospective, cohort (nested case-control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1‒C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio and generate a receiver operating characteristic curve of the association between the degree of subluxation and failure of conservative treatment. RESULTS One hundred fifteen patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 patients, 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation (odds ratio 10), compared with patients without C1‒C2 subluxation. CONCLUSIONS In our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.
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Affiliation(s)
- Simon Diaz
- Department of Spinal Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland; Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mejdeddine Al Barajraji
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Victoria Dembour
- Department of Spinal Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Dominique Rothenfluh
- Department of Spinal Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Juan Barges-Coll
- Department of Spinal Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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8
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Meng Y, Zhang C, Song T, Gao R, Zhou X. Vertebral artery injury following combination Jefferson fracture of C1 and Type II odontoid fracture: A case report. Clin Case Rep 2024; 12:e9173. [PMID: 39035121 PMCID: PMC11258472 DOI: 10.1002/ccr3.9173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 07/23/2024] Open
Abstract
Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74-year-old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito-cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.
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Affiliation(s)
- Yichen Meng
- Department of OrthopedicsShanghai Changzheng HospitalShanghaiPeople's Republic of China
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Shanghai National Clinical Research Center for Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Chenglin Zhang
- Department of OrthopedicsShanghai Changzheng HospitalShanghaiPeople's Republic of China
| | - Tengfei Song
- Department of OrthopedicsShanghai Changzheng HospitalShanghaiPeople's Republic of China
| | - Rui Gao
- Department of OrthopedicsShanghai Changzheng HospitalShanghaiPeople's Republic of China
| | - Xuhui Zhou
- Department of OrthopedicsShanghai Changzheng HospitalShanghaiPeople's Republic of China
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9
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Iyer RD, Mengesha MG, Shetty AP, Rajasekaran S. Odontoid Fracture with Locked Posterolateral Atlantoaxial Dislocation: A Case Report and Review of Literature. JBJS Case Connect 2024; 14:01709767-202409000-00051. [PMID: 39270046 DOI: 10.2106/jbjs.cc.24.00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
CASE Odontoid fractures with atlantoaxial dislocations are rare injuries. We report a case of a 41-year-old man with a Type 2 odontoid fracture with locket facet and posterolateral dislocation. He underwent single-stage C1-C4 posterior fixation and fusion, and at 2-year follow-up, he is symptom-free without any residual pain. Follow-up radiograph and CT scan show healed odontoid fracture with posterior fusion. CONCLUSION This case highlights successful management of a complex odontoid fracture by a single-stage posterior surgery. Closed reduction is usually unsuccessful, and open reduction using posterior approach is preferable.
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Affiliation(s)
- R Dinesh Iyer
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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10
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Mahadewa TGB, Junus ES, Awyono S, Japardi D, Lauren C. Severe traumatic atlantoaxial dislocation and type III odontoid fracture treated with occipitocervical fixation: a case report. J Surg Case Rep 2024; 2024:rjae281. [PMID: 38706486 PMCID: PMC11066803 DOI: 10.1093/jscr/rjae281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
The combination of atlantoaxial joint dislocation accompanied by an odontoid process fracture is exceptionally rare, with only a few cases reported. The estimated frequency of these cases is < 2% of all upper cervical spine injuries. In this report, the authors describe an unusual case of traumatic atlantoaxial dislocation with a type III odontoid fracture in a 44-year-old male patient. Before the diagnosis, the patient had a history of seeking a masseur for a neck massage. Subsequently, the patient underwent occipitocervical stabilization to address the underlying condition. This procedure aims to treat the instability between the skull and cervical spine and should be considered in the treatment planning if the patient's anatomy suits it.
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Affiliation(s)
- Tjokorda Gde Bagus Mahadewa
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Eufrata Silvestris Junus
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Steven Awyono
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Denny Japardi
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World Neurosurg 2024; 184:112-118. [PMID: 38266989 DOI: 10.1016/j.wneu.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. METHODS We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. RESULTS We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. CONCLUSIONS Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
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Affiliation(s)
- Alessandro Frati
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Cimatti
- Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Hernán Ileyassoff
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Capobianco
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
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Lu Q, Tang J, Xie W, Mei X, Kang H, Liu X, Xu F, Cai X. Anterior atlantoaxial motion preservation fixation technique for axis complex fractures (odontoid process with Hangman's fractures) and technique notes. Sci Rep 2024; 14:687. [PMID: 38182723 PMCID: PMC10770067 DOI: 10.1038/s41598-024-51367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
This study aims to investigate the feasibility and efficacy of anterior atlantoaxial motion preservation fixation (AMPF) in treating axis complex fractures involving the odontoid process fracture and Hangman's fractures with C2/3 instability. A retrospective study was conducted on eight patients who underwent AMPF for axis complex fractures at the General Hospital of Central Theater Command from February 2004 to October 2021. The types of axis injuries, reasons for injuries, surgery time, intraoperative blood loss, spinal cord injury classification (American Spinal Injury Association, ASIA), as well as complications and technical notes, were documented. This study included eight cases of type II Hangman's fracture, five cases of type II and three cases of type III odontoid process fracture. Five patients experienced traffic accidents, while three patients experienced falling injuries. All patients underwent AMPF surgery with an average intraoperative blood loss of 288.75 mL and a duration of 174.5 min. Two patients experienced dysphagia 1 month after surgery. The patients were followed up for an average of 15.63 months. One case improved from C to E in terms of neurological condition, three cases improved from D to E, and four cases remained at E. Bony fusion and Atlantoaxial Motion Preservation were successfully achieved for all eight patients. AMPF is a feasible and effective way for simultaneous odontoid process fracture and Hangman's fractures with C2/3 instability, while preserving atlantoaxial movement.
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Affiliation(s)
- Qilin Lu
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Jin Tang
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Wei Xie
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Xianzhong Mei
- Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Hui Kang
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Ximing Liu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, South China Hospital of Shenzhen University, No. 1 Fuxin Road, Longgang District, Shenzhen, 518111, Guangdong, People's Republic of China.
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13
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Cloney MB, Texakalidis P, Roumeliotis AG, Thirunavu V, Shlobin NA, Swong K, El Tecle N, Dahdaleh NS. The demographic, clinical, and management differences between traumatic dens fracture patients with and without simultaneous atlas fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:21-29. [PMID: 38644924 PMCID: PMC11029115 DOI: 10.4103/jcvjs.jcvjs_147_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/25/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction Atlas fractures often accompany traumatic dens fractures, but existing literature on the management of simultaneous atlantoaxial fractures is limited. Methods We examined all patients with traumatic dens fractures at our institution between 2008 and 2018. We used multivariable logistic regression and ordinal logistic regression to identify factors independently associated with presentation with a simultaneous atlas fracture, as well myelopathy severity, fracture nonunion, and selection for surgery. Results Two hundred and eighty-two patients with traumatic dens fractures without subaxial fractures were identified, including 65 (22.8%) with simultaneous atlas fractures. The distribution of injury mechanisms differed between groups (χ2 P = 0.0360). On multivariable logistic regression, dens nonunion was positively associated with type II fractures (odds ratio [OR] = 2.00, P = 0.038) and negatively associated with having surgery (OR = 0.52, P = 0.049), but not with having a C1 fracture (P = 0.3673). Worse myelopathy severity on presentation was associated with having a severe injury severity score (OR = 102.3, P < 0.001) and older age (OR = 1.28, P = 0.002), but not with having an atlas fracture (P = 0.2446). Having a simultaneous atlas fracture was associated with older age (OR = 1.29, P = 0.024) and dens fracture angulation (OR = 2.62, P = 0.004). Among patients who underwent surgery, C1/C2 posterior fusion was the most common procedure, and having a simultaneous atlas fracture was associated with selection for occipitocervical fusion (OCF) (OR = 14.35, P = 0.010). Conclusions Among patients with traumatic dens, patients who have simultaneous atlas fractures are a distinct subpopulation with respect to age, mechanism of injury, fracture morphology, and management. Traumatic dens fractures with simultaneous atlas fractures are independently associated with selection for OCF rather than posterior cervical fusion alone.
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Affiliation(s)
- Michael Brendan Cloney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pavlos Texakalidis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anastasios G. Roumeliotis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin Swong
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Diaz S, Zenkhri S, Omoumi P, Maeder B, Penet N, Rothenfluh D, Barges-Coll J. C2 Odontoid Fracture Associated with C1-C2 Rotatory Dislocation: A Retrospective Analysis of 2 Surgical Techniques. World Neurosurg 2023; 180:e460-e467. [PMID: 37777174 DOI: 10.1016/j.wneu.2023.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Odontoid fractures in association with a C1-C2 rotatory luxation reports are seldom found in the literature. The fusion between the lateral mass of C1 and C2 could be of interest to ensure adequate treatment in these particular cases. We report 23 cases where there was coexistence of an odontoid fracture and rotatory subluxation, which were treated surgically using cages between C1 and C2 or just traditional Goel-Harms technique. We evaluated the radiologic fusion rate, reoperation rate, and complications. METHODS This was a single-center, retrospective, cohort study of patients with C2 fractures (mixed type and C1-C2 rotatory luxation according to the Fielding classification) who were treated surgically. Radiologic computed tomography scans were used to assess fusion (presence of bridging trabecular bone end plate or pseudoarthrosis) between 6 months and 1.5 years after the surgery. RESULTS Twenty-three patients were diagnosed with C2 fractures and C1-C2 rotatory luxation that were treated surgically and were suitable for the analysis; 11 patients underwent C1-C2 fusion with intra-articular cages, and 12 underwent a classical Goel-Harms technique. The fusion rate at the C1-C2 joint was higher in the cages group. Only 12 patients exhibited fusion at the level of the odontoid fracture. CONCLUSIONS C2 fractures associated with C1-C2 rotatory dislocation are rare. The fusion rate at the level of the odontoid in these patients appears to be lower than that reported in patients without rotatory dislocation. It may be of special interest to obtain a clear fusion at the C1-C2 joint, where this type of implant seems to offer an advantage.
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Affiliation(s)
- Simon Diaz
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland; Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Salim Zenkhri
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Benoit Maeder
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Penet
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Dominique Rothenfluh
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Juan Barges-Coll
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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15
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Pirillo V, Berti PP, Prontera A, Rizzo P, Broger M. Biomechanics considerations in the treatment of double traumatic non-contiguous subaxial cervical lesions. Br J Neurosurg 2023; 37:1781-1785. [PMID: 33792457 DOI: 10.1080/02688697.2021.1907309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Double traumatic non-contiguous lesions of the subaxial cervical region are a rare event mostly caused by multiple, simultaneous or rapidly consecutive high-energy-impact traumas. The modality of treatment chosen for these lesions must be related to local lower cervical spine biomechanics. We present the case of a 59 year-old patient who suffered a subaxial cervical spine double fracture-dislocation following a complex-dynamic trauma. Radiological imaging displayed a C4-C5 and C7-T1 fracture-dislocation with cord signal intensity abnormalities. This patient showed a complete neurological deficit (ASIA A; mJOA 0) with a C4 sensory-motor level. He was urgently operated upon through an anterior approach, reduction of both dislocations and positioning of intervertebral cages and anterior plates at C4-C5 and C7-T1. At a 16-month follow-up he displays neurological improvement, moving his upper extremities at the C7-C8 motor level and a T5 sensory level (mJOA 3; Odom's Criteria 3). The check-CT scan at 24-month shows the correct positioning of the stabilization system and a complete bone fusion.Double traumatic lesions of the subaxial cervical spine, when interposed by healthy functional segments can be treated as two single independent lesions in order to allow a better outcome.
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Affiliation(s)
- Vania Pirillo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Pier Paolo Berti
- Department of Neurosurgery, Civile Maggiore Hospital, University of Verona, Verona, Italy
| | - Andrea Prontera
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Paolo Rizzo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
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Cloney MB, Texakalidis P, Roumeliotis AG, Tecle NE, Dahdaleh NS. Atlas fractures with and without simultaneous dens fractures differ with respect to clinical, demographic, and management characteristics. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:418-425. [PMID: 38268695 PMCID: PMC10805171 DOI: 10.4103/jcvjs.jcvjs_126_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
Background Patients with simultaneous fractures of the atlas and dens have traditionally been managed according to the dens fracture's morphology, but data supporting this practice are limited. Methods We retrospectively examined all patients with traumatic atlas fractures at our institution between 2008 and 2016. We used multivariable regression and propensity score matching to compare the presentation, management, and outcomes of patients with isolated atlas fractures to patients with simultaneous atlas-dens fractures. Results Ninety-nine patients were identified. Patients with isolated atlas fractures were younger (61 ± 22 vs. 77 ± 14, P = 0.0003), had lower median Charlson Comorbidity Index (3 vs. 5, P = 0.0005), had better presenting Nurick myelopathy scores (0 vs. 3, P < 0.0001), and had different mechanisms of injury (P = 0.0011). Multivariable regression showed that having a simultaneous atlas-dens fracture was independently associated with older age (odds ratio [OR] =1.59 [1.22, 2.07], P = 0.001), worse presenting myelopathy (OR = 3.10 [2.04, 4.16], P < 0.001), and selection for surgery (OR = 4.91 [1.10, 21.97], P = 0.037). Propensity score matching yielded balanced populations (Rubin's B = 23.3, Rubin's R = 1.96) and showed that the risk of atlas fracture nonunion was no different among isolated atlas fractures compared to simultaneous atlas-dens fractures (P = 0.304). Age was the only variable independently associated with atlas fracture nonunion (OR = 2.39 [1.15, 5.00], P = 0.020), having a simultaneous atlas-dens fracture was not significant (P = 0.2829). Conclusions Among patients with atlas fractures, simultaneous fractures of the dens occur in older patients and confer an increased risk of myelopathy and requiring surgical stabilization. Controlling for confounders, the risk of atlas fracture nonunion is equivalent for isolated atlas fractures versus simultaneous atlas-dens fractures.
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Affiliation(s)
- Michael Brendan Cloney
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Pavlos Texakalidis
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Anastasios G Roumeliotis
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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Ibrahim Y, Li H, Zhao G, Yuan S, Zhao Y, Liu W, Tian Y, Wang L, Liu X. Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up. Global Spine J 2023; 13:1522-1532. [PMID: 34409875 PMCID: PMC10448083 DOI: 10.1177/21925682211039186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective. OBJECTIVES To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. METHODS A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. RESULTS The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° (P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 (P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation (P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out (P < 0.001). CONCLUSIONS Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.
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Affiliation(s)
- Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Hao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Geng Zhao
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Yiwei Zhao
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Wubo Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
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Mohile NV, Kuczmarski AS, Minaie A, Syros A, Geller JS, Maaieh MA. Management of combined atlas and axis fractures: a systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100224. [PMID: 37440984 PMCID: PMC10333716 DOI: 10.1016/j.xnsj.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 07/15/2023]
Abstract
Background Combined atlas-axis fractures are rare occurrences with substantially higher rates of neurologic deficits compared with isolated injuries. Given the intricate anatomic relationship between the atlas and axis vertebra, variable fracture patterns may occur, warranting special considerations from surgeons. Methods A systematic search of PubMed and EMBASE was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies on acute combined atlas-axis fractures that provided data on patient demographics, presentation (injury mechanism, neurologic deficits, fracture type), management, complications, and study conclusions were reviewed. Results A total of 22 articles published from 1977 to 2022, comprising 230 patients, were included in the final analysis. Thirty-seven of the 213 patients (17%) presented with neurologic deficits. The most common atlas injuries were posterior arch fractures (54/169 patients; 32%), combined posterior arch/anterior arch fractures (44/169 patients; 26%), and anterior arch fractures (43/169 patients; 25%). The most common axis injuries were type II odontoid fractures (115/175 patients; 66%). Of the 127 patients managed operatively (127/230 patients; 55%), 45 patients (35%) were treated with C1-C2 posterior spinal fusion, 33 patients (26%) were treated with odontoid screw fixation and anterior/posterior C1-C2 trans-articular screws, 16 patients (13%) were treated with occiputocervical fusion and 12 patients (9%) were treated with odontoid screw fixation alone. Conclusions Management strategies are generally based on the type of axis fracture as well as the condition of the transverse ligament. Patients with stable fractures can be successfully managed nonoperatively with a cervical collar or halo immobilization. Combined atlas-axis fractures with an atlantodental interval >5 mm, C1 lateral mass displacement >7 mm, C2-C3 angulation >11° or an MRI demonstrating a disrupted transverse ligament are suggestive of instability and are often successfully managed with surgical intervention. There is no consensus regarding surgical technique.
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Affiliation(s)
- Neil V. Mohile
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States
| | - Alexander S. Kuczmarski
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States
| | - Arya Minaie
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States
| | - Alina Syros
- Department of Medical Education, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States
| | - Joseph S. Geller
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States
| | - Motasem Al Maaieh
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States
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Spiegl UJA, Keil H, Krause J, Osterhoff G, Scheyerer MJ, Schnake KJ, Perl M. Combined Odontoid (C2) and Atlas (C1) Fractures in Geriatric Patients: A Systematic Review and Treatment Recommendation. Global Spine J 2023; 13:22S-28S. [PMID: 37084349 PMCID: PMC10177310 DOI: 10.1177/21925682221127951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to conduct a systematic overview of the pathogenesis and the treatment options of combined odontoid and atlas fractures in geriatric patients. METHODS This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for articles published until February 2021 dealing with combination fractures of C1 and C2 in geriatric patients. RESULTS Altogether, 438 articles were retrieved from the literature search. A total of 430 articles were excluded. The remaining eight original articles were included in this systematic review depicting the topics pathogenesis, non-operative treatment, posterior approach, and anterior approach. The overall level of evidence of the studies is low. CONCLUSION Combined odontoid and atlas fractures in the geriatric population are commonly caused by simple falls and seem to be associated with atlanto-odontoid osteoarthritis. Non-operative treatment with a cervical orthosis is a feasible treatment option in the majority of patients with stable C2 fractures. In case of surgery posterior C1 and C 2 stabilization and anterior triple or quadruple screw fixation are possible techniques. Some patients may also deserve an occipito-cervical fusion. A possible treatment algorithm is proposed.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Holger Keil
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Krause
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Max J Scheyerer
- Department of Orthopedics and Trauma Surgery, University hospital, Duesseldorf, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mario Perl
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Riddoch FI, Leerssen A, Abu-Rajab R, Leung A. Mortality From Combined Fractures of the Atlas (C1) and Axis (C2) in Adults. Cureus 2022; 14:e27554. [PMID: 36059318 PMCID: PMC9428941 DOI: 10.7759/cureus.27554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Study design A retrospective case report of all upper cervical spine fractures diagnosed by CT imaging between 01/01/2013 and 31/12/2015 in NHS Greater Glasgow and Clyde, Scotland. Objective To compare the mortality following combined fractures of the atlas and axis to that of isolated fractures of either vertebra. Background The mortality from axis fractures is well documented in the literature. However, a combined fracture of the atlas and axis is seldom reported, leading to relatively unknown outcomes and mortality. Methods A total of 171 patients with atlas and/or axis fractures. Thirty-three presented with concurrent lower cervical spine fractures and were excluded from further analysis. Kaplan-Meier curves were used to compare survivorship between 108 patients with isolated and 30 with combined fractures. Similar analysis adjusted for comorbidities, including dementia and previous fragility fractures. Results Patients were followed up for 47.3±10.3 months (SD). Patients with isolated atlas fractures were significantly younger than those with an axis or combined fracture. Nearly half (8/17) of combined fracture mortalities occurred within the first 120 days. The mortality at 120 days was 26.7% in the combined fractures group and 18.5% in the isolated fracture group. There was no significant difference in the 120-day and overall mortality between these injury patterns. Furthermore, cognitive impairment and previous fragility fractures bore no significant impact on mortality. Nevertheless, mortality in the combined fracture group with previous fragility fractures did trend to shorter survivorship. Conclusions Patients with combined fractures are older and with the ever-increasing elderly population, the incidence of these injuries is expected to rise. While our data show that the 120-day mortality is proportionally higher in the combined fractures group, no long-term statistically significant difference is demonstrated. This evidence contests the notion that combined fractures of the atlas and axis have higher mortality than isolated injuries of either cervical vertebra.
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Carneiro-Filho GDS, de Macêdo LP, Andrade LI, Alves-Sá BF, Sousa LAM, de Medeiros Quirino SC, Chaves JR, Bezerra-Júnior DL, Almeida NS, Azevedo-Filho HRC. Upper Cervical Spine Injuries: Profile and Management of 120 Cases. Int J Spine Surg 2022; 16:1001-1008. [PMID: 35831063 PMCID: PMC9807045 DOI: 10.14444/8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To identify the profile and management of patients with upper cervical spine injury. METHODS Retrospective cohort study of patients with upper cervical spine injuries managed at Hospital da Restauração between 2014 and 2020. RESULTS It presents the profile of 145 injuries recorded by location and classification among the 120 patients, and the management performed. Men are more affected than women, almost half of the patients (42.5%) were aged 16 to 29 years. Neurological deficit was present in 18 cases (15%). Twenty cases presented injury involving the level C1. Most injuries (109 [90.8%]) occurred at the C2 level, the most frequent of which were as follows: isolated type II odontoid fracture (29.2%), miscellaneous fracture of C2 (20%), and isolated hangman's fracture (13.3%). The most used management in type II odontoid fracture was C1-C2 posterior arthrodesis (17/42) followed by odontoid osteosynthesis (12/42). Regarding isolated hangman's fracture, conservative management was performed in 37.5% (6/16), and the technical approach most performed was anterior C2-C3 discectomy and interbody fusion (5/16). CONCLUSIONS Upper cervical spine injury has a higher prevalence in young men and is most often caused by traffic accidents. The main level affected is C2, and type II odontoid fracture is the most frequent subtype. C1 injury is related to conservative treatment, while C2 or combined C1-C2 injury is related to surgical approach. The management of these injuries is mainly performed with surgical treatment, with C1-C2 posterior arthrodesis and anterior odontoid osteosynthesis representing most of the approaches.
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Affiliation(s)
| | - Lívio Pereira de Macêdo
- Hospital da Restauração, Recife, Pernambuco, Brazil, Lívio Pereira de Macêdo, Hospital da Restauração Recife, Rua João Fernandes Vieira, 544, Boa Vista, Recife, PE, Brazil;
| | | | | | | | | | | | | | - Nivaldo S. Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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22
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Dibble CF, Javeed S, Zhang JK, Pennicooke B, Ray WZ, Molina C. Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21414. [PMID: 35855058 PMCID: PMC9265201 DOI: 10.3171/case21414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact. Serial cervical traction was placed with minimal radiographic reduction. Ultimately, she underwent intraoperative reduction, instrumentation, and fusion. Freehand C1 lateral mass reduction screws were placed, then C2 translaminar screws, and finally lateral mass screws at C3 and C4. The C2–4 instrumentation was used as bilateral rod anchors to reduce the C1 lateral mass reduction screws engaged onto the subluxated atlantodental complex. As a final step, cortical allograft spacers were inserted at C1–2 under compression to facilitate long-term stability and fusion. LESSONS This is the first description of a technique using extended tulip cervical reduction screws to correct traction-irreducible atlantoaxial subluxation. This case is a demonstration of using intraoperative tools available for the spine surgeon managing complex cervical injuries requiring intraoperative reduction that is resistant to traction reduction.
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Affiliation(s)
| | - Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Camilo Molina
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
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23
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Lasswell TL, Medley JB, Callaghan JP, Cronin DS, McKinnon CD, Singh S, Rasoulinejad P. Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion. Proc Inst Mech Eng H 2021; 235:1463-1470. [PMID: 34278841 PMCID: PMC8573685 DOI: 10.1177/09544119211032479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL). Each specimen was tested in a spinal loading simulator that separately applied axial rotation, flexion-extension and lateral bending. In each test condition, displacement controlled angular motion was applied in both directions at a speed of 2 deg/s until a resulting moment of 1.5 Nm was achieved. The measured ranges of motion (ROM) of the C1-C2 segments were compared for each test condition using nonparametric Friedman tests. The destabilized state had significantly more C1-C2 motion (p < 0.05) than the intact state in all cases, and all constructs greatly reduced this motion. C2 pedicle screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension as well as axial rotation and no statistically significant difference was detected in lateral bending. C2 translaminar screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension and no statistically significant difference was detected in axial rotation or in lateral bending. Data from the current study suggested that constructs using the novel C1PA clamp would provide as good, or improved, biomechanical stability to the C1-C2 segment compared with constructs using C1LM screws.
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Affiliation(s)
- Timothy L Lasswell
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John B Medley
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Duane S Cronin
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Colin D McKinnon
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Supriya Singh
- Division of Orthpaedic Surgery, Department of Surgery, Western University and Victoria Hospital, London Health Sciences Centre, London, ON, Canada
| | - Parham Rasoulinejad
- Division of Orthpaedic Surgery, Department of Surgery, Western University and Victoria Hospital, London Health Sciences Centre, London, ON, Canada
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24
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Zhu Y, Wu XX, Jiang AQ, Li XF, Yang HL, Jiang WM. Single door laminoplasty plus posterior fusion for posterior atlantoaxial dislocation with congenital malformation: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zhu Y, Wu XX, Jiang AQ, Li XF, Yang HL, Jiang WM. Single door laminoplasty plus posterior fusion for posterior atlantoaxial dislocation with congenital malformation: A case report and review of literature. World J Clin Cases 2020; 8:6136-6143. [PMID: 33344615 PMCID: PMC7723728 DOI: 10.12998/wjcc.v8.i23.6136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Posterior atlantoaxial dislocation (PAD) is a rare type of upper cervical spine disease. We sought to describe a unreported case of old PAD with os odontoideum (OO) and atlas hypoplasia (AH) and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.
CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma, was diagnosed with old PAD with OO and AH. The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion. During the 3-year follow-up, he was able to walk by himself instead of using a wheelchair and with a ± 25° range of head rotation as well as a ± 10° range of flexion-extension. Three-year follow-up images showed satisfactory reduction and fusion.
CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option. Compared with laminectomy and occipitocervical fusion, it retains more cervical range of motion, has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.
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Affiliation(s)
- Yi Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xie-Xing Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - An-Qing Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xue-Feng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Wei-Min Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Zhao W, Sun Y, Xu G, Yan J. Combined Procedure Allowing Atlantoaxial and Atlanto-Occipital Joint Motion for Complex Injuries in the Upper Cervical Spine. Orthopedics 2020; 43:e329-e333. [PMID: 32379337 DOI: 10.3928/01477447-20200428-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 09/23/2019] [Indexed: 02/03/2023]
Abstract
This study was performed to explore an ideal limited fixation method for the treatment of unstable atlantoaxial fractures that can preserve the range of motion of the occipital and atlantoaxial joints and restore the stability of the upper cervical spine. A 64-year-old man was diagnosed with a complicated injury of the upper cervical spine. The anterior and posterior approach was used to reconstruct the stability of the upper cervical spine while preserving the range of motion of the occipital and atlantoaxial joints. Preoperative imaging and neurologic examinations were performed. Follow-up lasted 24 months. The patient clinically improved after undergoing this novel procedure. Seven days postoperatively, the patient's visual analog scale score was 3. Follow-up contrast computed tomography showed good reduction and fixation in the upper cervical spine. Two weeks postoperatively, the patient displayed good cervical vertebral activity, with no restriction during flexion, extension, rotation, or other movements. No intraoperative or postoperative complications occurred. This modified procedure for restoration of cervical stability may be an improvement over traditional posterior fusion because atlantoaxial motion is preserved. [Orthopedics. 2020;43(4):e329-e333.].
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27
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Ghailane S, Alsofyani MA, Pointillart V, Bouloussa H, Gille O. Traumatic posterior Atlanto-axial dislocation: case report of an atypical C1-C2 dislocation with an anterior arch fracture of C1. BMC Musculoskelet Disord 2019; 20:612. [PMID: 31861991 PMCID: PMC6925510 DOI: 10.1186/s12891-019-3005-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background An atypical case of a traumatic posterior C1-C2 dislocation with an anterior arch fracture of C1 is reported. A novel conservative treatment for this rare lesion is described. Case presentation An eighty-nine-year-old male fell off a ladder at home and presented with an acute traumatic cervical spine trauma, which we believe involved a distraction mechanism. The patient was neurologically intact; he denied any weakness, numbness or paresthesia. A preoperative CT-scan demonstrated a posterior dislocation with an anterior arch of C1 fracture. Conservative management was elected. Reduction was achieved by closed manual reduction under general anesthesia. A postoperative CT demonstrated a complete reduction of the atlanto-axial dislocation. Conclusion Based on this case report and relevant literature, we present an unusual lesion of the upper cervical spine treated nonoperatively with closed manual reduction under general anesthesia. To date, there is no available consensus for the management of these lesions.
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Affiliation(s)
- Soufiane Ghailane
- Spine Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
| | - Mohammad A Alsofyani
- Spine Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.,Department of Orthopedic Surgery, College of Medicine, University of Hail, P O Box, 2440, Hail, Kingdom of Saudi Arabia
| | - Vincent Pointillart
- Spine Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Houssam Bouloussa
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - Olivier Gille
- Spine Surgery Unit 1, C.H.U Tripode Pellegrin, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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28
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Zitouna K, Riahi H, Lassoued NB, Selmene MA, Barsaoui M, Drissi G. Traumatic Atlantoaxial Dislocation with an Odontoid Fracture: A Rare and Potentially Fatal Injury. Asian J Neurosurg 2019; 14:1249-1252. [PMID: 31903373 PMCID: PMC6896646 DOI: 10.4103/ajns.ajns_214_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Traumatic dislocation of the atlanto-axial joint in combination with an odontoid fracture remains a rare entity. Beaucause of its instability, it's alsoo a seriuous injury. A fatal outcome is feared especially in elderly. We report a case of 74-year-old man who presented with neck pain Confusion and spastic tetraparesia after a low energy trauma. Radiographs and computed tomography demonstrated a C1C2 dislocation with odontoid fracture. After an unsuccessful attempt at closed reduction with halo traction, a surgical stabilisation was performed using a posterior approach. Death was occured in early postoperative due to respiratory distress.
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Affiliation(s)
- Khaled Zitouna
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Hend Riahi
- Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia.,Department of Radiology, Kassab Institute, Tunis, Tunisia
| | - Nabil Ben Lassoued
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Mohamed Amine Selmene
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Maher Barsaoui
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Ghassen Drissi
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
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Prost S, Barrey C, Blondel B, Fuentes S, Barresi L, Nicot B, Challier V, Lleu M, Godard J, Kouyoumdjian P, Lonjon N, Marinho P, Freitas E, Schuller S, Allia J, Berthiller J, Charles YP. Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients. Orthop Traumatol Surg Res 2019; 105:703-707. [PMID: 31005699 DOI: 10.1016/j.otsr.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used. HYPOTHESIS Among patients with hangman's fracture, those with disc damage must be treated surgically. MATERIAL AND METHODS A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely. RESULTS We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up. CONCLUSION Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Solène Prost
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Cédric Barrey
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Benjamin Blondel
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Stéphane Fuentes
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Laurent Barresi
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Benjamin Nicot
- Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Vincent Challier
- Unité d'orthopédie-traumatologie rachis I, CHU de Bordeaux, hôpital Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Maxime Lleu
- Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France
| | - Joël Godard
- Service de neurochirurgie, hôpital Jean-Minjoz, 3, boulevard A. Fleming, 25030 Besançon cedex, France
| | - Pascal Kouyoumdjian
- Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr. Debré, 30000 Nîmes, France
| | - Nicolas Lonjon
- Service de neurochirurgie, hôpital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Paulo Marinho
- Service de neurochirurgie, CHRU de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Eurico Freitas
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Sébastien Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Jérémy Allia
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Julien Berthiller
- Pôle IMER, hospices civils de Lyon, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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- Société Française de Chirurgie Rachidienne, 56, rue Boisonnade, 75014 Paris, France
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Biakto KT, Arifin J, Lee J, Benjamin M. Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report. Int J Spine Surg 2019; 13:11-16. [PMID: 30805280 DOI: 10.14444/6001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Only a few cases of traumatic atlantoaxial fracture-dislocation have been reported, and neglected cases are seldom found because of the fatal nature of this condition. Methods We reported a neglected case of Jefferson fracture-dislocation associated with type II displaced odontoid peg fracture which was nonambulatory and myelopathic. A surgical plan involving posterior fossa decompression and laminectomy of the posterior arch of atlas following posterior spinal instrumentation was then conducted. Results Patient experienced marked neurologic recovery and was able to stand and walk with assistance during the early postoperative period. Conclusions This procedure may be an effective alternative treatment in neglected cases.
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Affiliation(s)
- Karya T Biakto
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Jainal Arifin
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Jansen Lee
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Michael Benjamin
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
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31
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Musa A, Farhan SA, Lee YP, Uribe B, Kiester PD. Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report. Int J Spine Surg 2019; 13:79-83. [PMID: 30805289 DOI: 10.14444/6010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background We report a case of an elderly patient who was diagnosed with lateral atlantoaxial subluxation with type II odontoid fracture, an extremely uncommon upper cervical spine injury that has not been previously reported in the literature to the knowledge of the authors. Methods An 87-year-old male reported to the emergency room following a syncopal episode after sustaining a fall. He complained of dizziness, fatigue, disruption of vision and audition, and worsening neck pain. Computed tomographic scans were positive of partial dislocation of the C1 relative to C2 and chronic fracture of dens classified as type II according to the Anderson and D'Alonzo classification system. Magnetic resonance imaging further revealed large fracture pannus tissue at the level of the dens, reducing the space in the spinal cord. There was no evidence of spinal cord injury. Atlas-axis fusion with instrumentation was performed to manage the injury. A review of the classification, occurrence, and management of upper cervical spine surgeries was performed. Results An acute injury to a previously unrecognized type II odontoid fracture with partial C1-C2 dislocation was identified as a rare upper cervical spine injury and classified based on the Anderson and D'Alonzo and Fielding and Hawkins classification systems. The decision was made to perform instrumented spinal fusion by inserting mass screws into C1, pars screws into C2, and locking rods to realign the vertebral bodies and address the atlantoaxial instability. Follow-up scans indicated good postsurgical reduction and fixation, including resolution of the pannus overgrowth without direct intervention. Conclusions Lateral atlantoaxial subluxation with chronic type II fracture of the dens constitutes a rare injury of the upper cervical vertebrae. Posterior instrumented spinal fusion was used to effectively manage the injury, leading to reabsorption of retro-odontoid pannus tissue.
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Affiliation(s)
- Arif Musa
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Saif Aldeen Farhan
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Brittany Uribe
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey
| | - P Douglas Kiester
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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The Decision-Making Process in Traumatic Lesions of the Craniovertebral Junction: An Evidence-Based Approach? Part II. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019. [PMID: 30610339 DOI: 10.1007/978-3-319-62515-7_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
This paper is Part II of a two-part report. Part I of the report covered atlanto-occipital dislocation or dissociation, and isolated condylar fractures. This part of the report covers isolated and combination fractures of the atlas and axis.
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Type II Odontoid Fracture: a case series highlighting the treatment strategies. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:317-324. [PMID: 30610340 DOI: 10.1007/978-3-319-62515-7_46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A type II odontoid fracture, if unstable, can cause spinal cord damage. In this case, it is essential to choose the correct treatment-but the issues of what the correct treatment is and which of the different surgical options is best are quite controversial. In this paper we present strategies for treatment of type II odontoid fracture. MATERIALS AND METHODS Thirty consecutive cases of type II odontoid fracture were treated at the Division of Neurosurgery at Villa Sofia Hospital in Palermo (23 cases) and at the Neurosurgical Clinic, University Hospital of Palermo (seven cases), from January 2011 to August 2016. Four patients were treated with external immobilization. Twenty-six patients underwent a surgical procedure. RESULTS There was no mortality related to the surgical procedure. One patient had a pre- and postoperative neurological deficit, and remained tetraparetic. Follow-up radiological studies in the surgically treated group showed bone union in 21 patients and stable fibrous union in one. CONCLUSION In our and other authors' experience, when the direction of the fracture line is down and forward, external immobilization can be sufficient for healing. Anterior odontoid screw fixation can be considered the treatment of choice for unstable odontoid fractures (with a horizontal, down and back, or comminuted fracture line) without dislocation or with dislocation less than 7 mm.When the odontoid fracture is associated with a Jefferson fracture or dislocation greater than 7 mm, stabilization of C1-C2 may be necessary. In this case, placement of screws in the dens and in the joints through a single approach represents the most valid technique.In the case of an inveterate fracture of the dens with severe C1-C2 dislocation, the surgical operation that offers the best prospects is posterior stabilization, utilizing the Guo technique.
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Zhao ZS, Wu GW, Lin J, Zhang YS, Huang YF, Chen ZD, Lin B, Zheng CS. Management of Combined Atlas Fracture with Type II Odontoid Fracture: A Review of 21 Cases. Indian J Orthop 2019; 53:518-524. [PMID: 31303667 PMCID: PMC6590023 DOI: 10.4103/ortho.ijortho_249_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the therapeutic effects of combined atlas fracture with type II (C1-type II) odontoid fractures and to outline a management strategy for it. PATIENTS AND METHODS Twenty three patients with C1-type II odontoid fractures were treated according to our management strategy. Nonoperative external immobilization in the form of cervical collar and halo vest was used in 13 patients with stable atlantoaxial joint. Surgical treatment was early performed in 10 patients whose fractures with traumatic transverse atlantal ligament disruption or atlantoaxial instability. The visual analog scale (VAS), neck disability index (NDI) scale, and American Spinal Injury Association (ASIA) scale at each stage of followup were then collected and compared. RESULTS Compared to pretreatment, the VAS score, NDI score, and ASIA scale were improved among both groups at followup evaluation after treatment. However, in the nonsurgical group, one patient (1/11) developed nonunion which required surgical treatment in later stage and one patient (1/13) with halo vest immobilization had happened pin site infection. Two patients of the surgical group (2/11) had appeared minor complications: occipital cervical pain in one case and cerebrospinal fluid leakage in one case. Two patients (2/23) were excluded from nonsurgical treatment group because their followup period was less than 12 months. Twenty one patients were followed up regularly with an average of 23.9 months (range 15-45 months). CONCLUSIONS We outlined our concluding management principle for the treatment of C1-type II odontoid fractures based on the nature of C1 fracture and atlantoaxial stability. The treatment principle can obtain satisfactory results for the management of C1-type II odontoid fractures.
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Affiliation(s)
- Zhong-Sheng Zhao
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Guang-Wen Wu
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jie Lin
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying-Sheng Zhang
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yan-Feng Huang
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhi-Da Chen
- Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China
| | - Bin Lin
- Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China,Address for correspondence: Dr. Chun-Song Zheng, Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian, China. E-mail:
Prof. Bin Lin, Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian, China. E-mail:
| | - Chun-Song Zheng
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Address for correspondence: Dr. Chun-Song Zheng, Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian, China. E-mail:
Prof. Bin Lin, Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian, China. E-mail:
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Josten C, Jarvers JS, Glasmacher S, Spiegl UJ. Odontoid fractures in combination with C1 fractures in the elderly treated by combined anterior odontoid and transarticular C1/2 screw fixation. Arch Orthop Trauma Surg 2018; 138:1525-1531. [PMID: 30056532 DOI: 10.1007/s00402-018-3013-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate risk factors of accompanied C1 fractures in elderly patients with type II odontoid fractures (OF) and to analyze the complication rate and the outcomes of patients after combined anterior odontoid and transarticular C1/2 screw fixation (AOTAF). MATERIALS AND METHODS The study represents a retrospective case series at a single level-1 trauma center. All elderly patients (≥ 70 years) with acute combination injuries (CI) including type II OF with an accompanied C1 fracture, who were treated by an anterior approach, were included. All postoperative complications were analyzed based on the patient notes. Clinical and radiological controls were performed after 1 year. Main parameters of interest were 1-year mortality rate, pain level, and satisfaction rate after 1 year. RESULTS A total of 23 patients were included. The average age was 84.6 years (range 73-94 years). All patients had atlanto-odontoid osteoarthritis (AOO) and all but two patients were injured by low-energy falls. Dysphagia was the most common postoperative complication (26.1%). Surgical revision was necessary in one of these patients due to hematoma. Dysphagia improved in all patients considerably. Loss of follow-up was 21.7%. The 1-year mortality was 21.7% (n = 5). The mean pain level and satisfaction rate was 2.5 (± 0.9) and 7.3 (± 0.7), respectively. After 1 year, no signs of non-union were visible. CONCLUSIONS AOO was observed in all patients with CI. The main cause of trauma was a low-energy fall. The pain levels were low to moderate and satisfaction levels were promising 1 year after surgery. Nonetheless, AOTAF is associated with a high rate of postoperative dysphagia, which resolves in the majority of patients due to conservative management.
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Affiliation(s)
- Christoph Josten
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Stefan Glasmacher
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Abstract
Fractures of the C1 vertebrae (atlas) are commonly the result of falls and other trauma, which cause hyperextension, or axial compression of the cervical spine. Although historically thought as a benign injury with lower neurological risks, current data suggests that this may not hold true for geriatric patients (aged 65 y and older) who may be predisposed to these fractures even after lower-energy trauma such as ground-level falls. Advancements in orthopedic trauma care has increased our diagnostic abilities to identify and manage patients with C1 fractures and other upper cervical spine trauma. However, there are no universal treatment guidelines based on level I trials. Current treatment ranges from nonoperative to operative management depending on fracture-pattern and integrity of the surrounding ligaments. Furthermore, in the elderly patients these fractures present a unique dilemma due to preexisting comorbidities and contraindications to various treatment modalities. C1 fractures warrant greater recognition to provide optimal treatment to patients and minimize the risk for developing complications. The goal of this review is to highlight the most updated treatment guidelines and to discuss the complications of both operative and nonoperative management of C1 fractures especially among the elderly patient population.
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Minyu Z, Shiyang W, Suraj C, Kelun H, Chaowei L, Honglin T. Traumatic Posterolateral C1-C2 Dislocation Complicated with Locked Lateral Mass and Type II Odontoid Fracture-5-Year Follow-up. World Neurosurg 2018; 114:330-334. [PMID: 29626690 DOI: 10.1016/j.wneu.2018.03.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We sought to document our experience in managing a rare complex of traumatic posterolateral atlantoaxial dislocation combined with locked lateral mass and type II odontoid fracture. METHOD A 30-year-old male patient was referred to the author's department. He complained of a decrease in neck range of motion following a traffic accident. Neurologic examination was normal. Computed tomography and open-mouth radiographs showed a type II odontoid fracture and a posterolateral dislocation with a laterally locked left lateral mass at the C1-C2 level. Considering the difficulty and risk in reduction, due to this rare instability and dislocation, a 2-staged treatment was performed. With up to 11 kg skull traction for 7 days before surgery, the locked lateral mass and the lateral dislocation was finally reduced without any neurologic deficit. And once closed reduction was confirmed by open-mouth and lateral X-ray views in the cervical spine, a second staged C1-C2 surgical fixation and fusion with iliac bone graft was performed to achieve a normal anatomic alignment with a better stability. RESULT The patient showed significant amelioration of neck symptoms postoperatively, and a successful reduction and fixation of the C1-C2 articulation was achieved. At the 5-year follow-up, solid bone fusion was evident on the computed tomography scan. CONCLUSION For traumatic posterolateral atlantoaxial dislocation complicated with type II odontoid fracture, a closed reduction of the lateral dislocation before operation is both useful and safe because surgeons do not need to reduce the extremely rare lateral dislocation during the operation. Posterior atlantoaxial stabilization and fusion, rather than the occipitocervical fusion as reported previously, is biomechanically stable enough to achieve solid fusion in this rare trauma while not sacrificing the occipitoatlantal joint.
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Affiliation(s)
- Zhu Minyu
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wu Shiyang
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chandoo Suraj
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huang Kelun
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lin Chaowei
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Teng Honglin
- Department of Spine Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Chang DG, Park JB, Jang HJ. Traumatic C1-2 rotatory subluxation with dens and bilateral articular facet fractures of C2: A case report. Medicine (Baltimore) 2018; 97:e0189. [PMID: 29595654 PMCID: PMC5895414 DOI: 10.1097/md.0000000000010189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE To the best of our knowledge, this is an extremely rare case of traumatic C1-2 rotatory subluxation associated with multiple C2 fractures. PATIENT CONCERNS We report the case of a 63-year-old man with type 2 traumatic C1-2 rotatory subluxation (Fielding and Hawkins classification) associated with type III dens (Anderson and D'Alonzo classification) and bilateral articular facet fractures of C2. This injury occurred as a result of falling down in a drunken state. The patient complained of neck pain and mild degree of torticollis but did not show any neurologic abnormalities. DIAGNOSES Plain radiographs of cervical spine showed extensive soft tissue swelling, a fracture fragment, disruption of spinolaminar line at C1-2 level, and bony overlapping of right side lateral joint of C1-2. Two- and three-dimensional reconstructed computed tomography scans clearly demonstrated complicated C1-2 combined injury. The atlantodental interval was normal. INTERVENTION By skull traction and derotation, closed reduction of C1-2 rotatory subluxation with a type III dens and bilateral articular facet fractures of C2 was successfully achieved. He was managed with halovest fixation for 3 months. OUTCOMES At the 1-year follow-up visit solid fusion and improvement of clinical symptoms were achieved without C1-2 instability. LESSONS Despite traumatic C1-2 rotatory subluxation associated with multiple C2 fractures, trial of closed reduction should be considered as the first choice of treatment so as to preserve C1-2 motion.
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Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk-Jin Jang
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Opoku-Darko M, Isaacs A, du Plessis S. Closed reduction of traumatic atlantoaxial rotatory subluxation with type II odontoid fracture. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Wang H, Ou L, Zhou Y, Li C, Liu J, Chen Y, Yu H, Wang Q, Zhao Y, Han J, Xiang L. Traumatic upper cervical spinal fractures in teaching hospitals of China over 13 years: A retrospective observational study. Medicine (Baltimore) 2016; 95:e5205. [PMID: 27787377 PMCID: PMC5089106 DOI: 10.1097/md.0000000000005205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 01/19/2023] Open
Abstract
To investigate the incidence and pattern of patients managed for traumatic upper cervical spinal fractures (TUCSFs) in teaching hospitals in China over 13 years.We retrospectively reviewed 351 patients with TUCSF admitted to our teaching hospitals. Incidence rates were calculated with respect to age, gender, etiologies of trauma, anatomical distribution, anatomical classification, American spinal injury association impairment scale (ASIA) classification of neurological deficit and associated injuries.There were 260 male and 91 female patients, with a mean age of 44.2 ± 16.3 years. The mean age of the patients significantly increased by year of admission, from 35.2 ± 14.5 years to 47.5 ± 17.2 years (P = 0.005). Motor vehicle accidents (MVAs) (n = 132, 37.6%) and high falls (n = 104, 29.6%) were the 2 most common mechanisms. The number of C2 fractures (n = 300, 85.5%) was significantly higher than that of C1 (n = 99, 28.2%) (P < 0.001). High falls resulted in significantly more Type I C1 fractures than other etiologies (all P < 0.001). MVAs resulted in many more Type II and Type III C1 fractures and Type II and Type III C2 fractures than other etiologies. High falls were the most common injury type (n = 44, 36.4%) resulting in neurological deficits. Patients who presented with Landell classification Type I single C1 fracture (n = 6, 42.9%) had the highest rate of neurological deficits. Eighty-two patients had combined injuries; the most common pattern was cervical + cervical spine (n = 44, 12.5%), followed by cervical + thoracic spine (n = 27, 7.7%). A total of 121 patients (34.5%) suffered neurological deficits. Of all patients with TUCSF without combined injuries, single C2 fractures accounted for the highest rate of neurological deficits (n = 62, 32.0%). Multivariate logistic regression analysis indicated that sex (OR = 1.876, 95% CI: 1.022-3.443, P = 0.042), etiology (MVA pedestrians vs high fall: OR = 0.187, 95% CI: 0.056-0.629, P = 0.007), level (C1 + OFs vs C1: OR = 6.264, 95% CI: 1.152-34.045, P = 0.034), and injury severity scoring (ISS) (OR = 1.186, 95% CI: 1.133-1.242, P < 0.001) were independent risk factors of neurological deficit.The most common causes of TUCSF were MVAs and high falls; single C2 fractures without combined injuries accounted for the most common neurological deficits. Different etiologies resulted in different specific anatomical injuries and neurological deficits. We should make early diagnoses and initiate timely treatment according to different TUCSF patterns.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
- Correspondence: Hongwei Wang, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning 110016, China (e-mail: ); Jun Liu, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning 110016, China (e-mail: )
| | - Lan Ou
- Department of Radiology, Southwest Hospital
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
- Correspondence: Hongwei Wang, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning 110016, China (e-mail: ); Jun Liu, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning 110016, China (e-mail: )
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
| | - Qi Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning
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Assaghir Y. Burst C2 Fractures Combined with Traumatic Spondylolisthesis: Can Atlantoaxial Motion Be Preserved? Including Some Technical Tips for Reduction and Fixation. Global Spine J 2016; 6:555-62. [PMID: 27555997 PMCID: PMC4993615 DOI: 10.1055/s-0035-1569461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/01/2015] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective comparative clinical case series. OBJECTIVE Burst C2 fractures are very rare. Treatment options include conservative treatment or fusion (anterior, posterior, or anterior and posterior). Anterior fusion addresses mainly hangman component. The bursting body usually needs posterior or combined anterior-posterior fusion, but both permanently sacrifice atlantoaxial motion. Can anterior-"first" approach preserve C1-C2 motion and restore function? METHODS We report nine cases of burst C2 combined with C2-C3 spondylolisthesis and an odontoid fracture. The surgical group included six patients treated initially with an anterior approach, moving to a posterior one when necessary. All were treated with anterior diskectomy fusion using one session and one incision. The halo group included three patients treated conservatively using halo traction followed by rigid collar. Assessments included self-reported, physiologic, and functional measures. Reduction was assessed using Roy-Camille's criteria and improvement of canal compression ratio. Clinical outcome was graded excellent, very good, good, or poor according to pain, range of motion, and work status. RESULTS Mean follow-up was 44.5 ± 8.3 (range 36.0 to 62.0) weeks. Results in the surgical group were judged to be excellent in four and good in two. One patient developed atlantoaxial osteoarthritis. Results were good in one patient and poor in two patients in the halo group. Two patients developed atlantoaxial osteoarthritis. All three cases had work limitations. CONCLUSION A single anterior approach achieved union and preserved C1-C2 motion and function in some cases. Conservative treatment achieved union but failed to achieve good reduction or good clinical outcome in grossly instable fractures. However, we believe that the ideal management is yet to evolve.
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Affiliation(s)
- Yasser Assaghir
- Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt,Address for correspondence Yasser Assaghir, MD Orthopaedic Department, Sohag Faculty of MedicineSohag University, 82425 SohagEgypt
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A Novel Anterior Odontoid Screw Plate for C1-C3 Internal Fixation: An In Vitro Biomechanical Study. Spine (Phila Pa 1976) 2016; 41:E64-72. [PMID: 26555834 DOI: 10.1097/brs.0000000000001165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro study was performed using a standardized experimental protocol in a biomechanical spine testing apparatus. OBJECTIVE The aims of this study were to evaluate the biomechanical stability afforded by 4 cervical fixation techniques: anterior cervical plate+odontoid screw+cage (ACP+OS+cage), anterior odontoid screw plate+bone graft (AOSP+bone graft), posterior C2-3 fixation+odontoid screw (C2PS+C3LMS+OS), and posterior C1-3 fixation (C1PS+C2PS+C3LMS). SUMMARY OF BACKGROUND DATA Unstable axis injuries with multiple fracture lines are uncommon injuries, and their management is still challenging for surgeons who aim to achieve primary stability, early mobilization, preserved cervical range of motion (ROM), and favorable outcome. We designed a novel AOSP to assist in this challenging clinical scenario. METHODS Eight fresh-frozen cadaveric spine specimens (C1-C3) were subjected to stepwise destabilization of the C1-3 complex, with serial replication of a type II Hangman fracture, a type II odontoid fracture, and a C2 to C3 disc injury. Intact specimens, destabilized specimens, and destabilized specimens with various stabilization techniques including anterior and posterior techniques, some using our AOSP, were each tested for stability. Each spine was subjected to flexion, and extension testing, left and right lateral bending, and left and right rotation. RESULTS After AOSP+bone graft fixation, the ROMC2-C3 during all loading modes were reduced to values that were significantly less than normal. During all loading modes, AOSP+bone graft fixation significantly outperformed the ACP+OS+cage fixation in limiting ROMC2-C3. During flexion and extension, AOSP+bone graft fixation significantly outperformed the C1PS+C2PS+C3LMS fixation and C2PS+C3LMS+OS fixation in limiting ROMC2-C3. CONCLUSION The AOSP has excellent biomechanical performance when dealing with type I Hangman fractures, type II odontoid fractures, and C2-3 disc injuries. The AOSP+one graft fixation can preserve the function of atlanto-axial joint, which may be a valuable stabilization strategy for these unique injuries.
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Lin B, Wu J, Chen ZD, Zeng W, Liu Q, Dai L. Management of combined atlas-axis fractures: a review of forty one cases. INTERNATIONAL ORTHOPAEDICS 2015; 40:1179-86. [PMID: 26686497 DOI: 10.1007/s00264-015-3076-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To outline a management principle for the combined atlas (C1)-axis (C2) fractures and assess its therapeutic effects. METHODS Forty-one patients with combined C1-C2 fractures were treated according to their C2 fracture types. Non-operative external immobilization in the form of a cervical collar or halo vest was used in 22 patients. Early posterior pedicle screw fixations were performed in 19 patients whose fractures had a combination of any of the three conditions: an atlantodens interval (ADI) ≥ 5 mm, lateral mass displacement (LMD) > 7 mm, and/or C2-C3 angulation > 11°. Thirty-nine patients were followed up regularly with an average of 19.3 months (range, 12 to 45 months). Clinical and radiographic data were then collected and compared. RESULTS At three months following treatment, patients' visual analog scale (VAS), Neck Disability Index (NDI), American Spinal Injury Association (ASIA) scale, and Frankel grades were all significantly improved when compared to pretreatment. These results indicated that the cervical collar, halo vest, and posterior pedicle screw fixation approaches were all able to effectively treat cases of combined C1-C2 fractures. One patient in the non-surgical group developed nonunion which required late surgical treatment and one patient had pin site infection in the non-surgical group (2/22), while there were three minor complications in the surgical group. CONCLUSION We propose a management principle that bases the treatment of a combined C1-C2 fracture on the nature of the C2 fracture. This treatment strategy has yielded promising results as a satisfactory means for the management of combined C1-C2 fractures.
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Affiliation(s)
- Bin Lin
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
| | - Jin Wu
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China
| | - Zhi-da Chen
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China
| | - Wenrong Zeng
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China
| | - Qingjun Liu
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China
| | - LiLin Dai
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China
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Satyarthee GD, Vaghani G, Mahapatra A. Surgical management of combined fracture of atlas associated with fracture of axis vertebrae (CAAF): Case Series. ROMANIAN NEUROSURGERY 2015. [DOI: 10.1515/romneu-2015-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Combined fracture involving atlas together associated with axis (CAAF) accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5), commonest mode of injury was fall (n=3), time interval since injury was within 24 hours in (n=4), however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3), neurological deficit (n=2), neck tenderness and swelling tenderness (n=3) Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5), one case had multiple site fracture of both arches, odontoid fracture (n=2), lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3), transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study.
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Chaudhary SB, Martinez M, Shah NP, Vives MJ. Traumatic atlantoaxial dislocation with Hangman fracture. Spine J 2015; 15:e15-8. [PMID: 25576900 DOI: 10.1016/j.spinee.2014.12.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/08/2014] [Accepted: 12/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic bilateral-atlantoaxial dislocations are rare injuries. Hangman fractures, conversely, represent 4% to 7% of all cervical fractures and frequently involve a combination C1-C2 fracture pattern. Presently, there is no report in the English literature of a traumatic C2-spondylolisthesis associated with a C1-C2 rotatory dislocation. This injury complex cannot be cataloged using current classification schemes and no established treatment recommendations exist. PURPOSE To report a unique case of a Hangman fracture associated with bilateral C1-C2 rotatory-dislocation, which does not fit into existing classification systems, and discuss our treatment approach. STUDY DESIGN A clinical case report and review of the literature. METHODS Chart review and analysis of relevant literature. There were no study-specific conflicts of interest. RESULTS A 26-year-old man sustained a traumatic C2-spondylolisthesis along with C1-C2 rotatory subluxation in an automobile collision. The patient was originally placed in a halo crown and vest and then taken for an open reduction and stabilization through a posterior approach for persistent C1-C2 subluxation. The patient is currently 16 months postoperative and back to work as a plumber. CONCLUSIONS The injury complex encountered cannot be described using the available classification systems. Our treatment included initial stabilization with halo placement, followed by a posterior C1, C2, and C3 segmental reduction and fixation resulting in radiographic fusion and a good clinical outcome.
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Affiliation(s)
- Saad B Chaudhary
- Department of Orthopaedics, Rutgers, The State University of New Jersey-New Jersey Medical School, 140 Bergen St, ACC-D1610, Newark, NJ 07103, USA.
| | - Maximilian Martinez
- Department of Orthopaedics, Rutgers, The State University of New Jersey-New Jersey Medical School, 140 Bergen St, ACC-D1610, Newark, NJ 07103, USA
| | - Neel P Shah
- Department of Orthopaedics, Rutgers, The State University of New Jersey-New Jersey Medical School, 140 Bergen St, ACC-D1610, Newark, NJ 07103, USA
| | - Michael J Vives
- Department of Orthopaedics, Rutgers, The State University of New Jersey-New Jersey Medical School, 140 Bergen St, ACC-D1610, Newark, NJ 07103, USA
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Malagelada F, Tibrewal S, Lucar GA, Jeyaseelan L, Fahmy A, Gonzalez JS. Combined Type II Odontoid Fracture With Axis Anterior Arch Fracture: A Case Report in an Elderly Patient. Geriatr Orthop Surg Rehabil 2015; 6:37-41. [PMID: 26246952 PMCID: PMC4318804 DOI: 10.1177/2151458514554083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Associated fractures of the atlas and axis are frequent, particularly in the elderly patients following a simple low-energy fall. This injury can be easily misdiagnosed on initial plain radiographs, and therefore computed tomography scan is a useful adjunct in patients with a degenerative spine. There is still no consensus as to the optimal treatment of combined axis-atlas fractures, and the majority of authors propose a therapeutic strategy dependent on the odontoid fracture pattern. We describe a combined atlas and axis fracture in a 92-year-old patient who was managed with nonoperative treatment in a rigid collar. The association of C1 anterior arch with a C2 type II odontoid fracture is a rare combination, which to our knowledge has never been reported following nonoperative treatment. There was a good functional outcome at 1-year follow-up with the fracture progressing to a fibrous nonunion of the odontoid process.
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Affiliation(s)
- Francesc Malagelada
- Department of Orhtopaedic and Trauma Surgery, Hospital de Mataró, Mataró, Barcelona, Spain
| | - Saket Tibrewal
- Department of Orthopaedics, The Royal London Hospital, London, United Kingdom
| | - Gustavo A. Lucar
- Department of Orhtopaedic and Trauma Surgery, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - Amr Fahmy
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Jose Sanchez Gonzalez
- Department of Orhtopaedic and Trauma Surgery, Hospital de Mataró, Mataró, Barcelona, Spain
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Liu C, Kuang L, Wang L, Tian J. Management of combination fractures of the atlas and axis: a report of four cases and literature review. Int J Clin Exp Med 2014; 7:2074-2080. [PMID: 25232389 PMCID: PMC4161549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/27/2014] [Indexed: 06/03/2023]
Abstract
Four cases of combination fractures of the atlas and axis are presented. Three types of management were performed: plaster immobilization, odontoid screw fixation combined with atlantoaxial pedicle screw fixation, occipito-cervical fusion with anterior operation by staged. Based on a literature review and our experience, treatment strategies is discussed according to the stability of the upper cervical spine and neurological involvement, with a reminder that combined injuries in the upper cervical spine should be sought in any patient with a cervical injury and early surgical solution may bring benefits once injury attack.
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Affiliation(s)
- Chao Liu
- Shanghai Jiaotong University Affiliated First People’s Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Linghao Kuang
- Department of Orthopedic Surgery, Zaozhuang Hosptial of Zaozhuang Mining CorporationZaozhuang, China
| | - Lei Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated First People’s HospitalShanghai, China
| | - Jiwei Tian
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated First People’s HospitalShanghai, China
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Meng H, Gao Y, Li M, Luo Z, Du J. Posterior atlantoaxial dislocation complicating odontoid fracture without neurologic deficit: a case report and review of the literature. Skeletal Radiol 2014; 43:1001-6. [PMID: 24469150 DOI: 10.1007/s00256-013-1809-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/15/2013] [Accepted: 12/22/2013] [Indexed: 02/02/2023]
Abstract
Traumatic posterior atlantoaxial dislocation associated with odontoid fracture is extremely rare, with only eight cases reported thus far in the English literature. This report concerns a 47-year-old female who presented with considerable pain and stiffness in the neck without a neurologic deficit after injury due to a fall. Radiographs, computed tomography, and magnetic resonance imaging demonstrated a posterior dislocation of the atlas with respect to the axis with an odontoid fracture. No cord compression or intramedullary cord signal abnormalities were detected at the level of the atlantoaxial dislocation. A pedicle screw fixation/fusion was performed via a posterior approach following successful closed reduction.
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Affiliation(s)
- Hao Meng
- Department of Orthopaedics, Military General Hospital of Beijing PLA, Beijing, 100700, China
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Abstract
BACKGROUND Majority of C1 fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods. MATERIALS AND METHODS A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C1 between July 2008 and December 2011 was performed. A steel plate and C1 lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years). RESULTS Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°), average extension 42° (range 30-48°). Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively). The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°). Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm), which improved to 3.5 mm after surgery (range 1-6.5 mm). The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm). CONCLUSIONS Transoral osteosynthesis of the anterior ring using C1 lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.
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Affiliation(s)
- Yong Hu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang Province, People's Republic of China
| | - Todd J Albert
- Department of Orthopaedic Surgery, Thomas Jefferson University and Rothman Institute, Philadelphia, Pennsylvania 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Thomas Jefferson University and Rothman Institute, Philadelphia, Pennsylvania 19107, USA
| | - Wei-Hu Ma
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang Province, People's Republic of China
| | - Zhen-Shan Yuan
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang Province, People's Republic of China
| | - Wei-Xin Dong
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang Province, People's Republic of China
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Ferro FP, Borgo GD, Letaif OB, Cristante AF, Marcon RM, Iutaka AS. Traumatic spondylolisthesis of the axis: epidemiology, management and outcome. ACTA ORTOPEDICA BRASILEIRA 2014; 20:84-7. [PMID: 24453586 PMCID: PMC3718423 DOI: 10.1590/s1413-78522012000200005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/05/2011] [Indexed: 01/24/2024]
Abstract
Objective To evaluate cases of traumatic spondylolisthesis of the axis and describe them in
relation to epidemiology, classification, neurological deficit, healing time and
treatment method. Method A retrospective analysis of the medical records of patients treated between 2002 and
2010 at IOT-FMUSP. Inclusion criteria: pars interarticularis fracture of C2. Results 68% were male patients, with a mean age of 39.1 years. We used the classification by
Effendi, modified by Levine-Edwards. Type I fractures were observed in five patients
(31.2%) and type II in eight patients (50%). Only three patients (18%) had type IIa
fracture. There were no cases of type III. Mechanism: Eight car accidents and four
falls. Other mechanisms: being run over, and diving accidents. Treatment with halo
traction was used in eleven patients, using minerva cast and halo-cast. Healing time:
3.6 months. Follow-up time: 9.6 months. Discussion In general, hangman fracture has a good prognosis, which is confirmed by our results.
There was no need for surgery in any of the cases. The incidence of neurological deficit
is low. No patient had unstable fracture (type III). Conclusion This paper suggests that traumatic spondylolisthesis of the axis continues to be an
injury that is successfully treated by conservative treatment in most cases.
Level of Evidence -IV, Case series.
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