Fractured odontoid with fractured superior articular process of the axis. Report of three cases

Signoret, F.; Feron, J.-M.; Bonfait, H.; Patel, A.D.

doi:10.1302/0301-620x.68b2.3957998

Cited by 22 publications

(7 citation statements)

References 7 publications

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“…4,5 If there are no contraindications to choosing anterior or posterior fusion of C1-2, the best stabilization for an odontoid fracture is screw fixation. 6,30,31 The indication for operative stabilization in fractures of the vertebral body of C2 depends on the remaining structural stability. Miscellaneous fractures inside the axis cause different fragment angulations and sizes.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Anterior Arthrodesis C2-3 and Anterior Odontoid Screw Fixation for Stabilization of a 4-Part Fracture of the Axis—A Technical Description

Koller

Assuncao²,

Kammermeier³

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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Multiple fractures of the axis are rare and present challenging patterns of instability in cervical spine surgery. Once a surgeon is faced with a combination of fractures in the axis vertebra, including stable and unstable components, a sound treatment concept must be worked out to achieve primary stability, early mobilization, and superior outcome. We demonstrate an operative technique for the stabilization of a 4-part fracture of the axis. Utilizing anterior odontoid screw fixation and C2-3 arthrodesis, an unstable traumatic spondylolisthesis with fracture of the odontoid type IIA, and lateral mass of C2 was successfully stabilized at once. The technique enabled early postoperative mobilization of our patient, who, after 1 year, showed a favorable outcome with a pain-free range of motion. The basic thoughts guiding to treatment options in multiple fractures of the axis are discussed and our therapy concept is presented.

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Section: Discussionmentioning

confidence: 99%

Simultaneous Anterior Arthrodesis C2-3 and Anterior Odontoid Screw Fixation for Stabilization of a 4-Part Fracture of the Axis—A Technical Description

Koller

Assuncao²,

Kammermeier³

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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“…Traumatic spondylolisthesis of the axis was first described by Cornish [6], and was classified by Effendi et al [7] with special reference to combined injuries. [26]. Conversely, only limited statistical data are available concerning combinations.…”

Section: Frequencymentioning

confidence: 99%

“…Articular process fractures may be combined to an unstable dens fracture, making operative treatment desirable. Moreover, occipito-cervical arthritis may be a complication [26]. Fixation of the fractured dens alone is not sufficient; C1-C2 posterior screw fixation necessitates insertion of a screw in the fractured articular process, and is not a desirable option.…”

Section: Combined Upper Cervical Spine Injuriesmentioning

confidence: 99%

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Gleizes

Jacquot

Signoret

et al. 2000

European Spine Journal

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“…A meaningful number of subtypes of C2-fractures exists where complete reduction, normal C1-2 rotation and a physiological anatomy is difficult to restore [1,10,11,34,42,43,71,82]. Likewise, a non-anatomical posttreatment C2-alignment, resembling a malunion, can cause significant symptoms even indicating fusion C1-2 [13,26,30,42,47,51,52,67,70,71,78,79] as it had to be done in one of our cases (Fig. 3), two others being scheduled (Fig.…”

Section: Malunion Of C2mentioning

confidence: 89%

“…Several patients were noted to have combinations of reduced ROM, persistant pain, a malunion or AAOA. 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.…”

Section: Clinical Outcomementioning

confidence: 94%

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

et al. 2009

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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

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Fractured odontoid with fractured superior articular process of the axis. Report of three cases

Cited by 22 publications

References 7 publications

Simultaneous Anterior Arthrodesis C2-3 and Anterior Odontoid Screw Fixation for Stabilization of a 4-Part Fracture of the Axis—A Technical Description

Simultaneous Anterior Arthrodesis C2-3 and Anterior Odontoid Screw Fixation for Stabilization of a 4-Part Fracture of the Axis—A Technical Description

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

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

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