Complete Atlantoaxial Dislocation After Odontoid Synchondrosis Fracture: A 2-Year Follow-up Study: A Case Report

Clinical epidemiology, management and outcomes of traumatic cervical spinal-cord and spine injuries: a systematic review of 1645 pooled cases

INTRODUCTION

Cervical spine (mostly atlanto-axial) accounts for over half of the acute traumatic disruptions of the spinal cord and its coverings; alongside its persisting neurological deficits. Two-thirds of the etiology were fairly evenly distributed between traffic crashes, falls, assault and other occupation-related injuries. We described the etiological mechanisms, neuro-anatomical level, severity, treatment and outcomes of traumatic cervical spinal-cord and spine injuries (C-SCI+SI).

EVIDENCE ACQUISITION

We systematically reviewed PubMed and Cochrane CENTRAL on 16th May 2023, using a prospectively registered protocol (CRD42023417530). The search strategy combined search words (from the keywords; "cervical spinal cord injury," "conservative" and "operative" "treatment") using Boolean operators. These yielded 787 and 55 records from PubMed (then 223 after delimiting to 10 years) and CENTRAL respectively; after records screening, 106 and 1 record were relevant respectively. Seventy-six reports were recruited for the quasi-quantitative synthesis following full-text review and methodological quality/bias assessment (using Joanna Briggs Institute critical appraisal tools).

EVIDENCE SYNTHESIS

Seventy-six reports yielded 1645 pooled cases. Weighted-mean age (N.=1512) was 46.3 years, with male (70.2%; gender N.=1525) preponderance. C-SCI+SI were mostly caused (N.=1079) by falls (42.1%) and road traffic crashes (42.2%); presenting(N.=178) with neck pain (71.4%) mostly and under one-fifth had neurological deficits (-plegias or -paresis, 11.8%; radiculopathy, 6.2%). The commonest vertebral levels (N.=1525) were 23.9% for the second cervical vertebra (c2), c5(20.4%) and c6(20.0%). Treatment (N.=1297) was combined pre-operative non-operative [skull traction (72.0%/842), cervical collar (13.9%/163)] in 90.2%, with solely non-operative (33.9%/439) options also used. Operative implant-based arthrodeses (66.2%/858) were done, using anterior (68.5%), posterior (20.2%/173) and combined (10.4%/89) approaches. Good bony fusion (89.0%) and clinical improvements (43.2%) were reported.

CONCLUSIONS

Mostly low-level evidence showed C-SCI+SI occurring more amongst the middle-aged and men; following falls or road traffic crashes. The second, fifth and sixth cervical levels are mostly affected; with excellent post-intervention bony-union, with neurological improvements in two-fifths. Better international reporting standards are advocated.

Surgical Treatment for Displaced Odontoid Synchondrosis Fracture: A Retrospective Case Series Study

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

Odontoid synchondrosis fracture is rare, and there is a paucity of literature on its surgical treatments. This case series study analyzed patients treated with C1 to C2 internal fixation with or without anterior atlantoaxial release and discussed the clinical effectiveness of the procedure.

METHODS

Data were retrospectively collected from a single-center cohort of patients who had undergone surgical treatments for displaced odontoid synchondrosis fracture. The operation time and blood loss volume were recorded. Neurological function was assessed and classified using the Frankel grades. The odontoid process tilting angle (OPTA) was used to evaluate fracture reduction. Fusion duration and complications were also analyzed.

RESULTS

Seven patients (1 boy and 6 girls) were included in the analysis. Three patients underwent anterior release and posterior fixation surgery, and the other 4 underwent posterior-only surgery. The fixation segment was C1 to C2. The average follow-up period was 34.7 ± 8.5 months. The average operation time was 145.7 ± 45.3 min, with an average blood loss volume of 95.7 ± 33.3 mL. The OPTA was corrected from 41.9° ± 11.1° preoperative to 2.4° ± 3.2° at the final follow-up (P < .05). The preoperative Frankel grade of 1 patient was grade C, of 2 patients was grade D, and of 4 patients was grade E. The neurological function of the patients in grade C and grade D recovered to grade E at the final follow-up. None of the patients developed a complication. All the patients achieved odontoid fracture healing.

CONCLUSION

Posterior C1 to C2 internal fixation with or without anterior atlantoaxial release is a safe and effective method for treating young children with displaced odontoid synchondrosis fracture.

Upper Cervical Trauma

Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.