1
|
Gabada R, Harjpal P. Rapid Recuperation After Surgical Intervention and Rehabilitation in a Patient With Spinal Hemangioma: A Case Report. Cureus 2024; 16:e55114. [PMID: 38558742 PMCID: PMC10979247 DOI: 10.7759/cureus.55114] [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: 10/16/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
This case report describes the remarkable recovery journey of a 42-year-old male who suffered from neurological symptoms over three months, including tingling in both lower extremities. It was determined that a spinal hemangioma, a normally non-cancerous medical ailment, was the cause of these symptoms, which were also accompanied by difficulty walking and problems with bowel and bladder incontinence. A laminectomy and spinal cord decompression surgery were the two most significant medical procedures the patient underwent as part of his treatment, followed by a carefully structured rehabilitation program, as part of a holistic approach. Astoundingly, the patient's physical condition showed considerable improvements in several areas just one week after surgery. The reduction of pain, increased range of motion (ROM), and increased muscular strength were the aspects where these changes were most noticeable. This quick recovery reflects the benefit of combining surgical and rehabilitation techniques in these patients. The patient was prescribed a home exercise program (HEP) at the time of his discharge from the hospital so that he could continue his recovery independently in the comfort of his own home. This HEP was created to ensure that the patient could keep up and continue to make progress. This case report sheds light on the benefits of adopting a comprehensive strategy while treating spinal hemangiomas. The combined efforts of the surgical and rehabilitation therapy teams greatly improved the patient's prognosis. This aspect of synergy helped develop a whole treatment strategy that included both surgical tumor removal and crucial postoperative rehab for optimum healing and function.
Collapse
Affiliation(s)
- Rishika Gabada
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Singh P, Verma S, Agrawal M, Sawarkar D, Borkar S, Kumar A, Garg K, Agrawal D, Gupta D, Satyarthee G, Chandra S, Kale S. Use of Intraoperative Imaging to Preserve C1-C2 Mobility in Complex Atlas-Hangman Fractures. Neurol India 2022; 70:209-214. [DOI: 10.4103/0028-3886.336335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
3
|
|
4
|
Kumar JI, Yanamadala V, Shin JH. Operative Management of Spinal Injuries. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-015-0024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
5
|
Predictors of Vertebral Artery Injury in Isolated C2 Fractures Based on Fracture Morphology Using CT Angiography. Spine (Phila Pa 1976) 2015; 40:E713-8. [PMID: 25803220 DOI: 10.1097/brs.0000000000000893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database analysis. OBJECTIVE To determine C2 fracture patterns associated with vertebral artery injury (VAI) as assessed by computed tomography angiography. SUMMARY OF BACKGROUND DATA The incidence of C2 fracture hospitalizations has increased significantly in the last decade. The vertebral arteries are susceptible to injury as each courses through the C2 transverse foramen. Early screening for VAI to institute antithrombotic treatment is critical to prevent ischemic neurological sequelae. Imaging-based fracture classification schemes to determine which patterns are predictors of VAI in isolated C2 fractures using computed tomography angiography have not been described. METHODS Cervical spine computed tomographic (CT) scans at a level I trauma center were reviewed for isolated C2 fractures from 2004 to 2014 under institutional board review approval. Exclusion criteria included penetrating injury or additional cervical/occipital fractures. Fractures were classified using multiplanar CT scans into type I/II/IIa/III spondylolisthesis, type I/IIA/IIB/IIC/III dens, transverse foramen (displacement/comminution/intraforaminal fragments), and miscellaneous vertebral body fractures. Corresponding CT angiograms were assessed for VAI on the basis of the Denver grading criteria. Fisher exact test and Student t test were performed to determine predictors of VAI on the basis of fracture type. RESULTS Sixty-seven patients met inclusion criteria. Fracture pattern analysis revealed that the majority were dens fractures (50.8%) and traumatic spondylolisthesis (41.8%); 29.9% had miscellaneous coronal/sagittal fractures and 22.4% were a combination.VAI was identified in 37.3% of patients with isolated C2 fractures, and 88% of patients had transverse foramen involvement. Fracture patterns significantly associated with VAI were type III dens and transverse foramen fractures with intraforaminal fragments, with or without comminution. CONCLUSION The C2 fracture pattern most associated with VAI was comminuted transverse foramen fracture with intraforaminal fragments. Transverse foramen fracture alone was not found to be significant. These results help stratify patients with isolated C2 fractures who are at high VAI risk and should be further evaluated with computed tomography angiography. LEVEL OF EVIDENCE 3.
Collapse
|
6
|
Abstract
ABSTRACTObjective:A full understanding of an injury event and the mechanical forces involved should be important for predicting specific anatomical patterns of injury. Yet, information on the mechanism of injury is often overlooked as a predictor for specific anatomical injury in clinical decision-making. We measured the relationship between mechanism of injury and risk for cervical spine fracture.Methods:Our case-control study is a secondary analysis of data collected from the Canadian C-Spine Rule (CCR) study. Data were collected from 1996 to 2002 and included patients presenting to the emergency departments of 9 tertiary care centres after sustaining acute blunt trauma to the head or neck. Cases are defined as patients who were categorized in the CCR study with a clinically important cervical spine fracture. Controls had no radiologic evidence of cervical spine injury. Bivariate and multivariate unconditional logistic regression models were used. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).Results:Among the 17 208 patients in the CCR study, 320 (2%) received a diagnosis of a cervical spine fracture. Axial loads, falls, diving incidents and nontraffic motorized vehicle collisions (e.g., collisions involving snowmobiles or all-terrain vehicles) were injury mechanisms that were significantly related to a higher risk of fracture. For motor vehicle collisions, the risk of cervical spine injury increased with the posted speed, being involved in a head-on collision or a rollover, or not wearing a seat belt (p< 0.05). The occurrence of cervical spine fracture was negligible in simple rear-end collisions (1 in 3694 cases; OR 0.015, 95% CI 0.002–0.104]).Conclusion:Our study quantitatively demonstrates the relationship between specific mechanisms of injury and the risk of a cervical spine fracture. A full understanding of the injury mechanism would assist providers of emergency health care in assessing risk for injury in trauma patients.
Collapse
|
7
|
Dreizin D, Letzing M, Sliker CW, Chokshi FH, Bodanapally U, Mirvis SE, Quencer RM, Munera F. Multidetector CT of Blunt Cervical Spine Trauma in Adults. Radiographics 2014; 34:1842-65. [DOI: 10.1148/rg.347130094] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro AR, Patel AA. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med 2014; 37:139-51. [PMID: 24559418 PMCID: PMC4066422 DOI: 10.1179/2045772313y.0000000158] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT 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. OBJECTIVE To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. METHODS 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 - patients with clear ligamentous injury and Group 2 - patients with fractures without ligament disruption. RESULTS Injuries with ligamentous disruption, suggesting surgical treatment, include: atlanto-occipital dislocation, mid-substance transverse ligament injury, and C1-2 and C2-3 ligamentous injuries. In contrast, condyle, atlas, and axis fractures without significant displacement/misalignment can be initially treated using external orthoses. Odontoid fractures with risk factors for non-union are an exception in Group 2 once they are better treated surgically. Patients with neurological deficits may have more unstable injuries. CONCLUSIONS Ascertaining the status of relevant ligamentous structures, fracture patterns and alignment are important in determining surgical compared with non-surgical treatment for patients with UCI.
Collapse
Affiliation(s)
- Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil,Correspondence to: Andrei F. Joaquim, Neurosurgery Division, State University of Campinas, 13083-970, Campinas-SP, Brazil. E-mail:
| | - Enrico Ghizoni
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Helder Tedeschi
- Department of Neurosurgery, State University of Campinas, UNICAMP, Campinas-SP, Brazil
| | - Brandon Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Darrel S. Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| |
Collapse
|
9
|
Marchiori DM. Trauma. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
Fogeltanz KA, Ditty MD, Pursel KJ. Hangman’s fracture presenting to chiropractic clinic as benign neck pain: a case report. J Chiropr Med 2013; 12:201-6. [DOI: 10.1016/j.jcm.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/16/2013] [Accepted: 08/15/2013] [Indexed: 11/16/2022] Open
|
11
|
Hayashi T, Hartwig S, Tsokos M, Oesterhelweg L. Postmortem multislice computed tomography (pmMSCT) imaging of hangman’s fracture. Forensic Sci Med Pathol 2013; 10:3-8. [DOI: 10.1007/s12024-013-9430-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2013] [Indexed: 11/28/2022]
|
12
|
|
13
|
Dolinak D. Low Force Fracture of the Odontoid, with Discussion of High Force Cervical Fracture. Acad Forensic Pathol 2012. [DOI: 10.23907/2012.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cervical fracture may occur with a high force mechanism of injury such as a motor vehicle crash, or with a low force mechanism of injury such as a ground level fall. To better characterize and understand low force cervical fractures and their significance, case files from the Travis County Medical Examiner's office covering a 5-year time period were retrospectively reviewed for fatal cervical fracture occurring with an accidental ground level fall. Thirty such fatal cervical fractures were identified, all occurring in elderly individuals (>65 years of age), with odontoid type 2 fracture of the C2 vertebra identified as the most frequent type of fracture. Odontoid fracture should be included in the list of craniocervical injury that may result from not only motor vehicle crashes and other high force mechanisms of injury, but also low force mechanisms of injury such as a ground level fall with head impact in an elderly individual.
Collapse
|
14
|
C3-C4 spondyloptosis without neurological deficit-a case report. Spine J 2010; 10:e16-20. [PMID: 20620981 DOI: 10.1016/j.spinee.2010.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/17/2010] [Accepted: 05/02/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic spondyloptosis of the cervical spine is usually associated with a complete, or rarely a partial, neurological deficit. Traumatic spondyloptosis with bipedicular fracture of the C3 vertebra is uncommon. To the best of the authors' knowledge, there is no report in the literature of bipedicular fracture of C3 with spondyloptosis of C3 over C4 with no neurological deficit. Literature is not clear about the role of preoperative traction in neurologically intact patients, and most authors advise both anterior and posterior fixation for cervical spondyloptosis. PURPOSE To report a case of C3-C4 spondyloptosis with C1 and C2 posterior arch fractures with no neurological deficit and its management strategy and underline the fact that closed reduction and limited anterior fusion can preserve the motion segment of cervical spine at other fractured levels and give a stable cervical column with good long-term results. STUDY DESIGN A case report with review of the literature. METHODS A 35-year-old man fell from a height with hyperextension-compression injury to the cervical spine. The patient suffered fracture of the posterior elements of C1-C3 along with spondyloptosis of C3 over C4 without any neurological deficit. The patient was treated with an awake nasotracheal intubation with gradual cervical traction under fluoroscopic guidance to acceptable alignment followed by anterior cervical fusion at C3-C4. RESULTS At 24 months' follow-up, the C3-C4 level fused completely with fracture healing at C1 and C2. The patient remained asymptomatic with normal neurological examination and near complete cervical motion. The patient returned to his preinjury job and recreational activities. CONCLUSIONS A case of C3-C4 spondyloptosis with associated C1-C2 posterior arch fracture is reported. The patient can present without neurological deficit if associated with a fracture of the posterior elements. Spondyloptosis without neurological deficit can be treated with gradual reduction under fluoroscopic guidance. A limited anterior-only fusion at the spondyloptosis level can provide good long-term results with preservation of other motion segments.
Collapse
|
15
|
Abstract
BACKGROUND Traumatic fractures of the second cervical vertebra are common, representing nearly 20% of all acute cervical spinal fracture-dislocation injuries. They are divided into 3 distinct injury patterns: odontoid fractures, hangman's fracture injuries, and fractures of the axis body, involving all other fracture injuries to the C2 vertebra. OBJECTIVE An evidence-based overview of the medical and surgical treatment strategies for each axis fracture injury sub-type. RESULTS Current medical and surgical management of traumatic fractures of the axis.
Collapse
Affiliation(s)
- David M Pryputniewicz
- Division of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-3410, USA
| | | |
Collapse
|
16
|
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. SUMMARY OF BACKGROUND DATA Vertebral artery injuries (VAI) occur commonly after cervical spine trauma. No study has yet examined the association between VAI and specific variants of C2 fractures. OBJECTIVE To evaluate the incidence of VAI (as defined by magnetic resonance imaging/angiography [MRI/A]) in subtypes of C2 fractures. To define the association between the incidence, morphology, and severity of C2 fractures, based on fracture angulation and comminution, and the occurrence of VAI. METHODS Patients admitted to the hospital with C2 fractures between October 2006 and December 2008 to a tertiary care referral center were identified through a prospectively maintained database. Computed tomography (CT) and MRI/A studies were individually reviewed to evaluate the specific C2 fracture type and the occurrence of VAI. Fracture displacement and angulation were measured. Incidence of VAI was compared between different types and subtypes of C2 fractures. The effects of displacement and angulation of the fracture, morphology of foramen transversarium fracture, patient age, and patient gender on VAI were also analyzed. RESULTS One hundred one patients were identified with C2 fractures that met inclusion criteria, and 18 (17.8%) had VAI by MRI/A. There was no correlation between fracture types and VAI. However, in subtype analysis, there was a correlation of VAI with traumatic spondylolisthesis of axis (TSA) and greater degree of angulation (P = 0.0023), communition fracture (P = 0.0341), and presence of bone fragment(s) within the foramen transversarium (P = 0.0075). Multivariate logistic regression indicated that age, gender and the presence of fragments within foramen transversarium were associated with greater risk of VAI. CONCLUSION Vertebral artery injuries are more likely to occur in C2 fractures with comminuted fractures involving the foramen transversarium, with fractures manifesting bony fragment(s) within the foramen transversarium, or with fractures having greater angulation. These risk factors should be considered when a patient presents with isolated axis fracture.
Collapse
|
17
|
Koller H, Acosta F, Tauber M, Komarek E, Fox M, Moursy M, Hitzl W, Resch H. C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:978-91. [PMID: 19225813 PMCID: PMC2899576 DOI: 10.1007/s00586-009-0900-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 11/09/2008] [Accepted: 01/24/2009] [Indexed: 12/13/2022]
Abstract
Pertinent literature exists concerning indications, techniques, complications of treatment, and risk factors for nonunion in axis and odontoid fractures; however, there are scarce data regarding the incidence and definition of malunion in these fractures. As a prerequisite for the study of anatomical alignment following surgical and nonsurgical treatment of C2-fractures, an understanding of normal C2 anatomy is essential. Therefore, the authors intended to evaluate morphometrical dimensions of the C2 vertebra. The purpose was to provide normalized quantitative data to enable assessment of malalignment following the treatment of C2-fractures within a classification system. Using digitized cervical spine lateral and transoral odontoid radiographs of 100 consecutive patients without any evidence of traumatic or neoplastic disorders, the authors performed measurements on distinct anatomical structures and investigated morphometrical dimensions of the normal axis vertebra. The incidence of atlantoaxial arthritis was also evaluated. In addition, with the assessment of twenty arbitrarily chosen sets of radiographs by three different observers we calculated the interobserver reliability in terms of intraclass correlation coefficients for each parameter. With calculation of SD and 95% confidence limits, pathological cut-offs were reconstructed from measurements performed resembling non-physiological and pathological limits. Distinct parameters were selected to form a new classification system for radiographical follow-up that focuses on the quantitative C1-2 vertebral alignment. The measurement process resulted in 2,400 data points. Distinct morphometrical parameters, such as a quantitative characterization of the sagittal atlantoaxial congruency, the lateral mass inclination and the type of degenerative changes at the atlantoaxial joint could be demonstrated to be valuable and reliably used within a proposed classification for C2-malunions following C2-fractures. The current study offers a template including recommended radiological measurements for further research on the study of clinical outcome and posttraumatic alignment following C2-fractures.
Collapse
Affiliation(s)
- Heiko Koller
- Department for Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Müllner Hauptstrasse, Salzburg, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Inaoka T, Ohashi K, El-Khoury GY. A single fracture in the ring of vertebrae below the atlas: report of four cases. Emerg Radiol 2007; 14:449-52. [PMID: 17453258 DOI: 10.1007/s10140-007-0614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 04/03/2007] [Indexed: 11/24/2022]
Abstract
A single fracture of the ring of a vertebra is a rare injury of the spine. In this report, we present five single fractures of the posterior ring of the cervical spine below the atlas from four patients after motor vehicle accidents. Initial radiographs failed to show any of these fractures; all were detected by computed tomography. Single ring fractures are stable and none of our patients presented with a neurological deficit. Patients were treated conservatively with a cervical collar or a cervicothoracic brace. They all recovered without any neurological abnormalities.
Collapse
Affiliation(s)
- Tsutomu Inaoka
- Department of Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | | | | |
Collapse
|
19
|
Bibliography. Neurosurgery 2002. [DOI: 10.1097/00006123-200203001-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
20
|
Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC. Isolated fractures of the axis in adults. Neurosurgery 2002; 50:S125-39. [PMID: 12431297 DOI: 10.1097/00006123-200203001-00021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED FRACTURES OF THE ODONTOID: STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES Type II odontoid fractures in patients 50 years and older should be considered for surgical stabilization and fusion. OPTIONS Type I, Type II, and Type III fractures may be managed initially with external cervical immobilization. Type II and Type III odontoid fractures should be considered for surgical fixation in cases of dens displacement of 5 mm or more, comminution of the odontoid fracture (Type IIA), and/or inability to achieve or maintain fracture alignment with external immobilization. TRAUMATIC SPONDYLOLISTHESIS OF THE AXIS (HANGMAN'S FRACTURE): STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS Traumatic spondylolisthesis of the axis may be managed initially with external immobilization in most cases. Surgical stabilization should be considered in cases of severe angulation of C2 on C3 (Francis Grade II and IV, Effendi Type II), disruption of the C2--C3 disc space (Francis Grade V, Effendi Type III), or inability to establish or maintain alignment with external immobilization. FRACTURES OF THE AXIS BODY (MISCELLANEOUS FRACTURES): STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS External immobilization is recommended for treatment of isolated fractures of the axis body.
Collapse
|
21
|
Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC. Management of combination fractures of the atlas and axis in adults. Neurosurgery 2002; 50:S140-7. [PMID: 12431298 DOI: 10.1097/00006123-200203001-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS Treatment of atlas-axis combination fractures based primarily on the specific characteristics of the axis fracture is recommended. External immobilization of most C1--C2 combination fractures is recommended. C1--Type II odontoid combination fractures with an atlantodens interval of 5 mm or more and C1--hangman's combination fractures with C2--C3 angulation of 11 degrees or more should be considered for surgical stabilization and fusion. In some cases, the surgical technique must be modified as a result of loss of the integrity of the ring of the atlas.
Collapse
|
22
|
Verheggen R, Jansen J. Hangman's fracture: arguments in favor of surgical therapy for type II and III according to Edwards and Levine. SURGICAL NEUROLOGY 1998; 49:253-61; discussion 261-2. [PMID: 9508111 DOI: 10.1016/s0090-3019(97)00300-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal therapy for traumatic fractures of the neural arch of the axis, the so-called hangman's fractures, is still controversial. Indications for surgery depend on the type of hangman's fracture and/or additional injuries of the intervertebral disc or ligaments. METHODS Sixteen patients sustaining fractures of the neural arch of the axis were treated by the screw fixation technique evolved by Judet. The passive mobility of the cervical spine was analyzed postoperatively by the radiographic evaluation method of Dvorak and coworkers and Penning. The angulation and anterior translation of C2 on C3 was measured before and after surgery. RESULTS Follow-up investigations 3, 12, and in some cases 45 months later confirmed sufficient functional results especially regarding the mobility of the upper cervical spine. Comparison of pre- and postoperative angulation and anterior translation of C2 on C3 revealed a significant improvement especially in cases with type IIa fractures. CONCLUSION The stabilization technique of Judet facilitates an exact reconstruction of anatomical conditions thereby preserving the atlantoaxial rotational mobility. A negligible hypomobility of the C2-C3 segment was observed on average 18 months after surgery.
Collapse
Affiliation(s)
- R Verheggen
- Clinic of Neurosurgery, University Hospital and School of Medicine, Göttingen, Germany
| | | |
Collapse
|
23
|
Choi WG, Vishteh AG, Baskin JJ, Marciano FF, Dickman CA. Completely dislocated hangman's fracture with a locked C2-3 facet. Case report. J Neurosurg 1997; 87:757-60. [PMID: 9347986 DOI: 10.3171/jns.1997.87.5.0757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report a rare case of a hangman's fracture involving complete dislocation of C-2 onto C-3, accompanied by a C2-3 locked facet and asymptomatic bilateral vertebral artery injuries. The patient, a 25-year-old man who sustained a neck injury in an industrial accident, presented with a mild central spinal cord syndrome. His initial lateral cervical radiograph showed complete anterior dislocation of the C-2 body onto C-3, bilateral neural arch fractures, and a unilateral locked facet. The mechanism was likely flexion and compression. The grossly unstable spine and the locked facet were treated by posterior decompression, reduction, and C1-3 fixation. The patient recovered in several days and is without neurological deficit.
Collapse
Affiliation(s)
- W G Choi
- Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix 85013-4496, USA
| | | | | | | | | |
Collapse
|
24
|
Kathol MH. CERVICAL SPINE TRAUMA. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Erb RE, Schucany WG, Shanmuganathan K, Mirvis SE, Nance EP. Extension corner avulsion fracture of the cervical spine. Emerg Radiol 1996. [DOI: 10.1007/bf02440027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Matsumoto S, Yamamoto T, Ban S, Tsuiki H. An unusual type of Hangman's fracture with cord compression: a case report. SURGICAL NEUROLOGY 1994; 41:322-4. [PMID: 8165504 DOI: 10.1016/0090-3019(94)90183-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An unusual case of hangman's fracture with neurologic sequelae is described in a 43-year-old woman. The fracture involved the body of C-2 with gross dislocation of the anterior part of C-2 and C-1 forward on C-3, associated with severe cord compression. The patient was successfully treated with a decompression of the foramen magnum and C-1 laminectomy, accompanying in situ fusion. The images obtained by computed tomography and magnetic resonance imaging were useful in understanding the true nature of the injury and planning the appropriate surgical treatment.
Collapse
Affiliation(s)
- S Matsumoto
- Department of Neurosurgery, Kobe City General Hospital, Japan
| | | | | | | |
Collapse
|
27
|
Pathria MN, Petersilge CA. Spinal Trauma. Radiol Clin North Am 1991. [DOI: 10.1016/s0033-8389(22)02087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Abstract
The "hangman's fracture" in infancy and childhood is a bilateral avulsion of the pedicles or their synchondroses from the C-2 vertebral body, frequently with anterior dislocation of C-2 or C-3. We present the case of the youngest infant in the medical literature with a hangman's fracture and discuss anatomy, kinematics of injury, radiographic diagnosis, and treatment.
Collapse
|
29
|
Renwick IG. The type III dens fracture and its associated soft-tissue injuries: a different form of Hangman's fracture. Br J Radiol 1990; 63:495-6. [PMID: 2379076 DOI: 10.1259/0007-1285-63-750-495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- I G Renwick
- Department of Diagnostic Radiology, General Infirmary, Leeds
| |
Collapse
|
30
|
|
31
|
Abstract
A retrospective analysis of 165 patients admitted to Hermann Hospital with acute injuries of the axis vertebra revealed 68 (41%) dens fractures, 62 (38%) cases of traumatic spondylolisthesis ("hangman's" fracture), 21 (13%) extension teardrop fractures, 10 (6%) hyperextension dislocations, and 2 (1.0%) fractures each of the laminae and spinous processes. Of the 68 dens fractures, none (0%) were of the Anderson and D'Alonzo Type I; 21 (31%) were Type II ("high"); and 47 (69%) were Type III ("low"). The 62 traumatic spondylolistheses included 13 (21%) Effendi type I, 35 (56%) type II and 3 (5%) type III. This review disclosed an additional 11 (18%) patients with an atypical variety of traumatic spondylolisthesis, not previously reported, in which one or both fractures involved the posterior cortex of the axis body. Of the axis injuries 31 (18%) were limited to the axis body alone. Of these, 21 (61%) were hyperextension teardrop fractures and 10 (32%) were hyperextension dislocations. Axis injuries were associated with acute injuries of other cervical vertebrae in 14 (8%) of the patients.
Collapse
Affiliation(s)
- J T Burke
- United General Hospital, Sedro Woolley, Washington
| | | |
Collapse
|
32
|
Tominaga S. Periodical, neurological-functional assessment for cervical cord injury. PARAPLEGIA 1989; 27:227-36. [PMID: 2762011 DOI: 10.1038/sc.1989.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The residual, reversible potentials of neurological-functional recovery in patients paralysed due to a cervical cord injury were periodically checked according to the various assessment methods from the initial period of 72 hours after injury to the final follow-up of 7 years. In our series, the data on the neurological changes were a little different from those reported in the literature. In the complete paralysis group, only 2 of the 30 patients showed slight functional recovery of less than 1 grade in the Frankel classification with descent of the cord lesion level. Twenty three patients showed descent of a half to one segment from the initial cord lesion level. The remaining 5 patients deteriorated because of ascent of a half to two segments from the initial cord lesion level. All patients with complete paralysis remained essentially unchanged. In the incomplete group, 58 of the 70 patients had significant recovery of more than 1 grade in the Frankel classification. The grade of neurological recovery was different in each patient. Patients with a central cord lesion showed remarkably better recovery of the cord function than those with other types of cord lesions. Nineteen of the 49 patients with a central cord lesion regained independent walking ability with or without aid. Neurological recovery in the incomplete paralysis group might be expected until approximately 6 months after injury. The early appearance of signs of recovery was an indication of better results. There was no difference in the neurological recovery between patients who had been realigned surgically and those who have been realigned non-surgically. Our neurological-functional assessment method reflecting the sectional and logitudinal cord level function and expressing more detailed information was demonstrated. Magnetic resonance imaging (MRI) was used to assess residual cord function. The area of abnormal signal intensity almost corresponded to the cord level diagnosed neurologically.
Collapse
Affiliation(s)
- S Tominaga
- Department of Orthopaedic Surgery, Shimane Prefectural Central Hospital, Izumo City, Japan
| |
Collapse
|