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Abstract
Upper cervical spine injuries, including atlantooccipital articulation, are being recognized more commonly and there is an increasing number of reports of patients surviving with injuries previously thought to be fatal. The bony elements of the upper cervical spine consist of the occiput, atlas and axis. The nature of their articulations provides no inherent stability, but rather relies on ligaments to maintain the structural integrity. Some upper cervical injuries, occipitocervical injuries, and isolated mid-substance transverse ligament ruptures, are usually unstable and frequently result in neurological injury or death. Therefore, these injuries warrant early instrumented posterior arthrodesis. Most upper cervical spine injuries can be treated non-surgically and heal readily. Implementation of a diagnostic algorithm consisting of screening parameters gathered from the plain radiographs as well as routine CT and MRI scans in high risk patients should reduce the occurrence of missed injuries.
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Fig. 1.
17 year-old man sustainted a type IIb occitocervical dislocation in motor vehicle accident. (A) Initial lateral plain radiograph shows isolated C1-2 dislocation with 11mm of vertical C1-2 gap and 10mm of ADI. (B) Noncontrast T1-weighted sagittal MRI shows vertical migration and anterior displacement of atlas. (C) He was immobilized in halo vest and posterior arthrodesis between C1-2. (D) One year after operation, he had satisfactory alignment and solid fusion.
Fig. 2.
(A) Lateral spine radiograph showing the anterior displacement of C4 on C5 body. (B)Anteroposterior, open-mouth radiograph showing asymmetric interval between odontoid process and lateral mass of atlas. (C) Axial image of CT showing avulsion fracture of lateral mass of atlas at the attached site of transverse alar ligament. (D, E) Treated in halo vest immobilization for 3 months and anerior interbody fusion at C4-5, 6months after completing treatment, flexion-extension radiographs were done and showed restoration of stability
Fig. 3.
(A) Lateral spine radiograph shows anteriorly displaced odontoid fracture. (B) Coronal CT scan demonstrates the fracture line extended to C2 body. (C) Treated in halo vest immobilization for 3 months. (D, E) Lateral radiograph and CT scan show complete healing of odontoid in anatomical position.
Fig. 4.
(A) Lateral spine radiograph shows anterior displaced type II odontoid fracture. (B) Reduction was achieved using halo traction and was fixed with one screw. (C) At 4 months, the fracture appeared healing.
Fig. 5.
(A) This 38-year-old man sustained a type II traumatic spondylolisthesis of axis in motor vehicle accident. (B) Reduction was achieved using halo traction. (C) He had halo traction and treated in halo vest immobilization for 3 months. (D, E) One year after completing treatment, flexion-extension roentgenograms were done and showed restoration of stability.
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