Fractures of the cervical spine (original) (raw)
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Upper cervical spine injuries: a management of a series of 70 cases
The Pan African medical journal, 2013
Traumatic injuries of the upper cervical spine are often encountered, and may be associated to severe neurological outcome. This is a retrospective study of 70 patients, admitted over a 14 years period (1996 to 2010), for management of upper cervical spine injuries. Data concerning epidemiology, radiopathology and treatment was reviewed, and clinical and radiological evaluation was conducted. Men are more affected than women, with traffic accidents being the major traumatic cause. A cervical spine syndrome of varied intensity was found in about 90% of patients; neurological deficit was noted in 10 patients (21%). Radiological analysis discovered varied and many combined lesions: C1-C2 dislocation (7 cases), C2-C3 dislocation (9 cases), C1 fracture (10 cases) and C2 fracture (44 cases) including 28 odontoid fractures. Orthopedic treatment was carried out exclusively for 31 patients, and surgical treatment for 38 patients. One patient died before surgery because of a polytraumatisme. ...
Cervical Spine Injuries and Management: Experience with 235 Patients in 10 Years
min - Minimally Invasive Neurosurgery, 1999
During the past lO-year period 235 patients with ceıvical injury were inç|uded ln tİıis study, ln İh;s pape, we present our clinical experiences in patients with cervical spine injury treated surgically and conservatively and their outcome. Only few data exist on the treatment of cervical spine injuries-The principles of the management are still controversial. The 235 patients with cervicaİspine injury admitted to our department were as,essed with Frankel's grading scale and treated.surgically and İonservatlvely according to the type and leveJ of İl," lnjr.v; 172 patlents were treated surgically., and 63 patient § were managed conservatively. The neurological state of the patients and the treatment modality are summarized in ln the upper cervicai injury, except type ıı oJontoid fracture with a dislocation of more than 6 **, .onru*ative treatment modalities were performed, ln the iower cervical injury, an anterior approach with discecto-v "na anterior fusion were performed if there was spinal İoİd comp."srion anteriorly. Otheı-wise a posterior apjroach wlth decomp.ession and a varlety of posterior fuslon technlqru, *uru ,r"d.
Injuries of the upper cervical spine: A series of 28 cases
Indian Journal of Orthopaedics, 2007
Background: There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. Materials and Methods: Twenty eight patients (20 males, 8 females) with upper cervical spine injury (including Occiput, Atlas and Axis) were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative) as well as the fi nal clinical and radiological outcome. Results: The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. Conclusion: Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome.
Early outcome of surgical intervention in subaxial cervical spine injuries
Journal of the Pakistan Medical Association
Objective: To determine the surgical outcome of patients with axial cervical spine fractures. Methods: The study was conducted at the Spine Unit of Hayatabad Medical Complex, Peshawar, and Aman Hospital, Peshawar, from January 2012 to March 2013. Patients with sub-axial cervical spine fractures were treated surgically. The outcome was measured using Visual Analogue Score, Neck Disability Index, by neurology and on the basis of complications. SPSS 16 was used for statistical analysis. Results: Of the 50 patients in the study, 7(14%) were females, while 43(86%) were male. Overall mean age was 30.3±7.9 years (range: 18-60 years). Major cause of injury was road traffic accidents in 29(58%). A total of 29(58%) patients had dislocation of the spine which was successfully reduced in 22(75.9%). Mean postoperative visual analogue score was 2.9±1.5 (range: 1-7) at last follow-up. Mean neck disability index score was 10.9±5.2 (range: 4-26). Dysphagia was the most common complication in 12(24%). Conclusion: Majority of the sub-axial fractures can be treated effectively with good outcome through anterior approach. Gradual axial skull traction is an easy and safe method for reduction of cervical fracture dislocations.
Surgical Treatment of Upper Cervical Spine Injuries (C1-C2): Experience in 26 Patients
OBJECTIVE : To describe the spectrum of operations in unstable upper cervical spinal injuries in (atlanto-axial) region at our unit. Study Design: Quasi-experimental study. Place and duration: Spine Unit, Department of Orthopedics, Combined Military Hospital (CMH), Rawalpindi from Jan 2001 to Dec 2008. Patients and Methods: We reviewed frequency of different kind of operations in 26 patients operated for upper cervical spinal injuries. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Results: Average age of patients studied was 27 years with male dominance. 12(46%) patients had Atlanto-axial instability, 8(31%) had Hangman’s fracture and 6(23%) patients had odontoid peg fracture. 11(42%) patients had no neurological deficit according to American spinal injury association impairment scale (AIS-E) and 15(58%) had partial neurological deficit. The patients were divided into three groups. Group A had odontoid peg fracture, Group B h...
Upper cervical injuries - a rational approach to guide surgical management
The journal of spinal cord medicine, 2014
The complex anatomy and the importance of ligaments in providing stability at the upper cervical spine region (O-C1-C2) require the use of many imaging modalities to evaluate upper cervical injuries (UCI). While separate classifications have been developed for distinct injuries, a more practical treatment algorithm can be derived from the injury pattern in UCI. To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. A literature review was performed on the Pubmed database using the following keywords: (1) "occipital condyle injury"; (2) "craniocervical dislocation or atlanto-occipital dislocation or craniocervical dislocation"; (3) "atlas fractures"; and (4) "axis fractures". Just articles containing the diagnosis, classification, and treatment of specific UCI were included. The data obtained were analyzed by the authors, dividing the UCI into two groups: Group 1 -…
Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients
European Spine Journal, 2008
We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66-93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1-9 years) and mean in-hospital stay was 10 days (2-90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit. Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.
Journal of craniovertebral junction & spine, 2014
The Subaxial Injury Classification (SLIC) system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking. We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score. Patients with an SLIC of 1-3 points (conservative treatment) are neurologically intact with the spinous process, laminar or small facet fractures. Patients with compression and burst fractures who are neurologically intact are also treated nonsurgically. Patients with an SLIC of 4 points may have an incomplete spinal cord injury such as a central cord syndrome, compression injuries with incomplete neurologic deficits and burst fractures with complete neurologic deficits. SLIC of 5-10 points includes distraction and rotationa...
Cervical spinal injury: experience with 82 cases
International Congress Series, 2002
A retrospective study of 82 cases of cervical spinal injury was made. These patients were treated in Dhaka Medical College Hospital, Mitford Hospital, Dhaka, and in some private hospitals in Dhaka City during the last 10 years from January 1991 to December 2000. Sixty-eight patients (82.92%) were between 21 and 50 years of age. Male and female ratio was almost 6:1. The most common cause of cervical spinal injury was a fall (53.65%), which was followed by road traffic accident (24.39%). The most common presenting symptoms and signs were: pain in the neck in all cases, quadriplegia/quadriparesis in 56 (68.29%), temporary loss of consciousness in 20 (24.39%) and sphincter disturbances in 48 (58.53%) patients. Twenty-six (31.70%) cases were free from neurological deficit. Plain X-ray cervical spine was done in all cases. Radiological evidence was found of cervical spinal injury in all but six cases (7.31%). Cervical myelogram was done in 12 (14.63%) cases and MRI of the cervical spine was done in 24 (29.27%) patients. Commonly affected sites of cervical spinal injury were found at C4/C5 and C5/C6 levels (43.92%). Forty-three (52.45%) cases were treated conservatively by Tong Skull traction and immobilization, and 39 (47.55%) were operated upon. Anterior fusion was done in 25 cases (30.49%) and posterior fusion in 10 (12.19%). Results of treatment were: full recovery in 30 patients (36.57%), good recovery in 16 (19.52%), partial recovery in 26 (31.71%) and no change in neurological state in 6 (7.32%). Recurrence of dislocation and consequent neural compression was found in six (7.32%) cases of the conservative treatment group of patients. Mortality was three (3.66%), also in the nonoperative group of patients. It was seen that there were better treatment results in cases of surgical fusion in unstable cervical injury, and there was a chance of instability and delayed loss of neurological function in conservative treatment of unstable cervical spinal injury, which needed subsequent surgical fusion.