Die instabile traumatische Spondylolisthese C2/3 - Ergebnisse und Empfehlungen nach operativer Stabilisierung in 34 Fällen und Literaturübersicht

Koller, Heiko; Daniaux, H.; Gruber, H.; Blauth, M.; Kathrein, A.

doi:10.1055/s-2005-865960

Cited by 12 publications

(10 citation statements)

References 130 publications

(343 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies concentrated on indications, complications, risk factors for and incidence of nonunion as well as the technical and biomechanical advantages of surgeries to stabilize C2-fractures [2, 3, 6, 19-21, 23, 24, 29, 33, 39, 45, 49, 55, 58, 63, 64, 67]. Although a number of practice guidelines have been developed [33], outcome measures seldom included patient's satisfaction or validated outcome measures, the incidence of long-term disability [1,9,19,20,39,63,67] or the quality of anatomical restoration achieved [1,[8][9][10]37]. Following nonsurgical treatment of C2-fractures, the fragments frequently yield fusion in a position of slight to severe malunion, a fact that is rarely recognized and underreported [26,31,46,49].…”

mentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Therefore, we intended to seek objective outcome data through assessment of validated outcome measures, functional outcome using dynamic CT-scanning, a detailed classification of fracture pattern and an analysis of posttreatment C2-alignment using a classification system based on valid measurements [44]. The efforts are indicated as there is no consensus on the ideal treatment for all subtypes of C2-fractures [2,29,43,46,62].…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen patients (51.4%) had a fracture pattern involving the vertebral body. Seven patients (20%), out of a total of 8 with an atypical Hmfx, had a vertebral body fracture separating the posterior axis wall [45,46]. In 11 patients (31.4%) the fracture Table 1 Physiological and pathological ranges of CT-and MRI-based atlantoaxial, subaxial and total neck rotation (in degrees) Out of 35 patients, 7 (20%) had a concomittant C1 fracture.…”

Section: Fracture Patternmentioning

confidence: 99%

“…Müller [49] stressed the importance of anatomical alignment in C2-fractures and the findings of the current study give evidence that with an increasing number of C2-fragments, deformation of the C2 vertebral body and particularly fractures of the C2 lateral mass clinical outcome drops: Fractures involving the C2 articular pillar can be isolated articular or lateral mass fractures or extensions of vertebral body fractures [5,26] and were found to be prone to a high rate of nonanatomical union [21] frequently indicating secondary fusion of C1-2 [30,67,70]. Up to 50% of Hmfx involve the articular facets of C2 and in the largest sample regarding anterior fusion C2-3 for the treatment of unstable Hmfx, Koller [46] observed a decreased functional and clinical outcome with a subset of patients having reduced rotation C1-2 and motion induced C2-referred pain. Similar to our study, several of these patients showed incongruency and deformity of the C1-2 joints and a positive correlative relationship between the severity of malunion C1-2 and reduced clincial outcomes.…”

Section: Clinical Outcomementioning

confidence: 99%

“…In contrast, there is a large body of literature concerning techniques, indications and union rates in C2-fractures [72], but data regarding the most important outcome measure, the functional and clinical outcome, are scant [24,68]. Currently, in addition to nonsurgical treatment including semirigid collars or the Halo-thoracic-vest (HTV), contemporary surgical techniques for the treatment of C2-fractures include anterior odontoid screw fixation (AOSF) [2,62], posterior and anterior transarticular screw fixation C1-2 [51], C1-lateral mass and C2-Isthmus/lamina fixation [32] and plated anterior discectomy and fusion for the unstable Hangman's fracture (Hmfx) [46,83]. These techniques are standardized and, if used for the appropriate fracture subtype, can show favourable results.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

View full text Add to dashboard Cite

Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

show abstract

Fractures of the Ring of Axis (Hangman Type Fractures)

Suchomel

Hradil

2010

Reconstruction of Upper Cervical Spine and Craniovertebral Junction

View full text Add to dashboard Cite

Die instabile traumatische Spondylolisthese C2/3 - Ergebnisse und Empfehlungen nach operativer Stabilisierung in 34 Fällen und Literaturübersicht

Cited by 12 publications

References 130 publications

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

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

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Fractures of the Ring of Axis (Hangman Type Fractures)

Contact Info

Product

Resources

About