Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Treatment of Atlantoaxial Fractures

제1,2경추골절의 치료

  • Jin, Sung-Chul (Department of Neurosurgery, Ewha Womans University College of Medicine, Mokdong Hospital) ;
  • Kim, Sang-Jin (Department of Neurosurgery, Ewha Womans University College of Medicine, Mokdong Hospital)
  • 진성철 (이화여자대학교 의과대학 목동병원 신경외과학교실) ;
  • 김상진 (이화여자대학교 의과대학 목동병원 신경외과학교실)
  • Received : 2006.10.31
  • Accepted : 2006.12.19
  • Published : 2006.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.

Keywords

References

  1. Bedi A, Hensinger RN. Congenital anomalies of the cervical spine In: Rothman-Simeone: The Spine. Vol 2. 5th ed. Philadelphia: WB Saunders, 2006:630-74
  2. Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg (Am) 1978;60:279-84 https://doi.org/10.2106/00004623-197860030-00001
  3. Nickel VL, Perry J, Garrett A, Heppenstall M. The halo. A spinal skeletal traction fixation device. J Bone Joint Surg (Am) 1968;50:1400-9 https://doi.org/10.2106/00004623-196850070-00009
  4. Apostolides PJ, Theodore N, Karahalios DG, Sonntag VKH. Triple anterior screw fixation of an acute combination atlas-axis fracture. Case report. J Neurosurg 1997;87:96-9 https://doi.org/10.3171/jns.1997.87.1.0096
  5. Lipson SJ. Fractures of the atlas associated with fractures of the odontoid process and transverse ligament ruptures. J Bone Joint Surg (Am) 1997; 59:940-3
  6. Hadley MN, Browner C, Sonntag VKH. Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 1985;17:281- 90 https://doi.org/10.1227/00006123-198508000-00006
  7. Spivak JM, Weiss MA, Cotler JM, Call M. Cervical spine injuries in patients 65 age older. Spine 1994; 19:2302-6 https://doi.org/10.1097/00007632-199410150-00009
  8. Weller SJ, Malek AM, Rossitch E, Sonntag VKH, Imana R. Cervical spine fractures in the elderly. Surg Neurol 1997;47:274-81 https://doi.org/10.1016/S0090-3019(96)00362-X
  9. Parke WW, Bono CM, Garfin SR. Applied anatomy of the spine In: Rothman-Simeone: The Spine. Vol 1. 5th ed. Philadelphia: WB Saunders, 2006:16-54
  10. Holness RO, Huestis WS, Howes WJ, Langille RA. Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Neurosurgery 1984;14:318-22 https://doi.org/10.1227/00006123-198403000-00010
  11. Botte MJ, Byrne TP, Abrams RA, Grafin SR. Halo skeletal fixation. Technique of application and prevention of complications. J Am Acad Orthop Surg 1996;4:44-53 https://doi.org/10.5435/00124635-199601000-00006
  12. Dormans JP, Criscitiello AA, Drummond DS, Davidson RS. Complications in children managed with immobilization in a halo vest. J Bone Joint Surg(Am) 1995;77:1370-3 https://doi.org/10.2106/00004623-199509000-00013
  13. Glaser JA, Whitehill R, Stamp WG, Jane JA. Complications associated with halo-vest. A review of 245 cases. J Neurosurg 1986;65:762-9 https://doi.org/10.3171/jns.1986.65.6.0762
  14. Garfin SR, Lee TQ, Roux RD, Silva FW, Ballock RT, Botte MJ, et al. Structural behavior of the halo orthosis pin-bone interface: biomechanical evaluation of standard and newly designed stainless steel halo fixation pins. Spine 1986;11:977-81 https://doi.org/10.1097/00007632-198612000-00001
  15. Gallie WE. Fractures and dislocations of cervical spine. Am J Surg 1939;46:495-9 https://doi.org/10.1016/S0002-9610(39)90309-0
  16. Perry J, Nickel VL. Total cervical spine fusion for neck paralysis. J Bone Joint Surg (Am) 1959;41:37- 60 https://doi.org/10.2106/00004623-195941010-00006
  17. Goodman ML, Nelson PB. Brain abscess complicating the use of a halo orthosis. Neurosurgery 1987; 20:27-30 https://doi.org/10.1227/00006123-198701000-00007
  18. Madawi AA, Solanki G, Casey ATH, Crockard HA. Variation of the groove in the axis vertebra for the vertebral artery: Implications for instrumentation. J Bone Joint Surg Br 1997;79:820-3 https://doi.org/10.1302/0301-620X.79B5.7566
  19. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: Longterm evaluation of results and efficacy. Neurosurgery 1995;37:688-92 https://doi.org/10.1227/00006123-199510000-00012
  20. Grob D, Jeanneret B, Aebi M, Markwalder TM. Atlantoaxial fusion with transarticular screw fixation. J Bone Joint Surg Br 1991;73:972-6
  21. Farey ID, Nadkarni S, Smith N. Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion: Disorders of the cervical spine. Clin Orthop 1999;359:126-35 https://doi.org/10.1097/00003086-199902000-00013
  22. Madawi AA, Casey ATH, Solanki GA, Tuite G, Veres R, Crockard HA. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 1997;86:961-8 https://doi.org/10.3171/jns.1997.86.6.0961
  23. Wright NM, Lauryseen C. Vertebral artery injury in C1-C2 transarticular screw fixation: Results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg 1998;88: 634-40 https://doi.org/10.3171/jns.1998.88.4.0634
  24. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 2001;26: 2467-71 https://doi.org/10.1097/00007632-200111150-00014
  25. Bohler J. Anterior stabilization for acute fractures and nonunions of the dens. J Bone Joint Surg (Am) 1982;64:18-27 https://doi.org/10.2106/00004623-198264010-00004
  26. Chang KW, Liu YW, Cheng PG, Chang L, Suen KL, Chung WL et al. One Herbert double-threaded compression screw fixation of displaced type II odontoid fractures. J Spinal Disord 1994;7:62-9 https://doi.org/10.1097/00002517-199407010-00009
  27. Dickman CA, Sonntag VKH, Papadopoulos SM, Hadley MN. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 1991;74:190-8 https://doi.org/10.3171/jns.1991.74.2.0190
  28. Cybulski GR, Stone JL, Crowell RM, Rifai MH, Gandhi Y, Glick R. Use of Halifax interlaminar clamps for posterior C1-2 arthrodesis. J Neurosurg 1988;22:429-31 https://doi.org/10.1227/00006123-198802000-00030
  29. Margel F, Seeman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation In: Kerhr P, Weidner A eds: Cervical spine I. Vienna : Springer-Verlag, 1987:322-7