Advance Neurosurgery Brain & Spine Center

ADVANCE NEUROSURGERY

BRAIN & SPINE CENTER

Premier Center for Minimally Invasive Brain & Spine

High Cervical Traumatic Injury


Introduction

A variety of traumatic insult can affect the upper cervical spine. These include Traumatic Atlanto Occipital Dislocation, Occipital condyle fracture, Atlas fractures, Odontoid process fractures, Fractures of the Ring of Axis, Traumatic Atlanto Axial Dislocation and Atlas axis fracture combination. Between 25 to 40 % of patients with upper cervical spine injury die at the scene of the accident; however approximately 90% of surviving patients have no major neurological deficit.

Atlanto Occipital Dislocation (AOD) is a rare and highly unstable injury of the craniovertebral junction and as such is associated with high mortality and neurological morbidity. Though rare it is found in almost 90% of fatal cervical spine injury. It is primarily a ligamentous injury. AOD treatment is either conservative and relies on external immobilization or surgical in which case the mainstay is posterior occipito cervical fusion.

Occipital Condyle fracture is a rare entity caused secondary to extreme axial load in combination with bending or rotational force. This type of injury is encountered in about 0.1% - 0.4% cases admitted with traumatic injuries. Neurological disability is rare in isolated condylar fractures. Nonspecific pain on head movement or rarely hypoglossal injury is the only symptom. Treatment is conservative in vast majority of cases. Surgical decompression is undertaken only if the dislocated fragment causes compression on a neurological structure.

Fracture of the Atlas (Jefferson fracture) comprises approximately 2-13% of cervical spine injuries. Jefferson fracture is the burst fracture of the atlas. Vehicle accidents, fall from height and heavy object falling on the head are the common causes. Isolated atlas fractures are usually not responsible for mortality. Upto 25% C1 fractures are missed on plain radiographs. Spiral CT can pick most of such injuries. Goal of therapy in such fractures is to achieve bone healing, maintain atlanto axial stability and prevent any neurological sequelae. Philadelphia collar for 12 weeks is sufficient to immobilize anterior arch fractures. C1 fractures with atlanto axial instability or documented transverse atlantal ligament tear merit Atlanto axial fixation.

Odontoid process fractures represent 50 -60% of all fractures of the axis and about 10 to 15% of all cervical spine fractures. Type 2 is the most frequent form of fracture. Type 1 and undisplaced type 3 fracture can be successfully managed conservatively using Philadelphia collar. Anterior osteosynthetic screw is used for type 2 fractures or type 3 displaced fractures with sufficient bone at the base. However if the anterior procedure is not possible secondary to barrel chest, fracture site communition or failed anterior procedure, a posterior Goel - Harms technique for atlanto axial fixation is undertaken. If cord compression exists on MRI a transoral decompression is undertaken with posterior fixation.

Hangman Type Fracture (Fracture of the ring of Axis) is an eponym referring to bilateral fracture of C2 pars interarticularis. Axis fractures consist of approaximately 20% of all acute cervical spine fractures. In isolated hangman's fracture, the symptoms are often limited to neck pain, stiffness or transientelectricity like whole body irritations. Permanent neurological deficits are rare. Management is dependent on the stability of the dislocated fragment. If there is less than 3mm of interfragmental distance than hard cervical collar is recommended for 3 months. For displaced fractures with more than 3 mm displacement initial traction is followed by stabilization. Reducible cases are treated with anterior discectomy and fusion of C2 and C3. Posterior approach is reserved for complicated cases irreducible by simple traction and more complex C1 C2 injury.

Acute Traumatic Atlanto Axial Dislocation (AAD). Following traumatic impact the atlas can get displaced in any direction in respect to C2 vertebra. It is frequently accompanied by a fracture of the odontoid process but other upper cervical spine fractures can also be present. Traumatic AAD secondary to pure ligamentous injury is very rare. It is the fracture pattern that determines whether conservative or operative treatment should be undertaken. If TAL is damaged, majority of surgeons perform posterior AA fusion. The controlled traction - reduction nearly always precedes the final surgical procedure.



Postal Address

Advance Neurosurgery
Brain & Spine Center

Beside Aditya Super Speciality Hospital, MLB School Road, Napier Town, Jabalpur (Central India) 482002

Clinic Timings

Morning: 12:00pm - 02:00pm
Evening: 5:30pm - 7:00pm
Sunday : Closed

Google Map