The provocative radiographic traction test for diagnosing craniocervical dissociation: a cadaveric biomechanical study and reappraisal of the pathogenesis of instability

Child, Zachary; Rau, Daniel; Lee, Michael J.; Ching, Randall; Bransford, Richard J.; Bellabarba, Carlo

doi:10.1016/j.spinee.2016.03.057

Cited by 22 publications

(13 citation statements)

References 12 publications

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“… 11 This has been challenged, as the only potentially relevant differentiator is whether there is craniocervical misalignment. 2 , 10 , 12 The mechanism of bilateral OCFs with clival involvement is debated. 4 , 9 Tanabe at al.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral occipital condyle fracture with an avulsion fracture of the foramen magnum: nonoperative care guided by a traction test. Illustrative case

Persad,

Liu,

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Bilateral occipital condyle fractures (OCFs) with involvement of the inferior clivus, otherwise known as “avulsion of the anterior foramen magnum,” are an exceedingly rare injury with only a few published reports. OBSERVATIONS A 24-year-old male presented with bilateral OCFs with involvement of the clivus after a motor vehicle accident. The patient had no neurological deficits and was successfully managed nonoperatively using a halo vest. The authors used a traction test to guide the duration of nonoperative care. The operative and nonoperative management of this rare injury is discussed with respect to other cases in the literature. LESSONS External immobilization through a halo vest is an effective treatment option for bilateral OCFs with clivus involvement. The traction test can be used, along with computed tomography, to guide the duration of treatment.

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Section: Discussionmentioning

confidence: 99%

“…Traction testing has been proposed as an ancillary test to assess the stability of the craniocervical junction, as surgical fusion has significant long-term functional consequences. 10 …”

mentioning

confidence: 99%

Bilateral occipital condyle fracture with an avulsion fracture of the foramen magnum: nonoperative care guided by a traction test. Illustrative case

Persad,

Liu,

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…Caused by the posterior surgical approach alar ligaments could not be severed. Thus, one of the major stabilizer of the C0/C1 level [ 41 , 42 ] is remaining in the described models limiting the created instability of the upper cervical spine. Furthermore, the current study is limited to some extend based on the study design: Analysis of the fluoroscopy images could not be blinded completely towards the CCJ condition since BDI and ADI values were too obvious.…”

Section: Discussionmentioning

confidence: 99%

“…Atlanto-occipital (C0/C1) articulation stability is maintained by the most upper crucial ligaments involving the alar ligaments, the tectorial membrane, and the atlanto-occipital joint capsule [ 41 , 42 ]. Disruption of these structures is required in AOD.…”

Section: Methodsmentioning

confidence: 99%

Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

et al. 2018

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BackgroundUnstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown.The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction.Methods and findingsLigamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system.In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure.ConclusionThe current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.

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“…The literature describes traumatic OCD as a rare injury associated with patients sustaining high-energy trauma, such as motor vehicle collisions, pedestrian versus car accidents, or falls from great heights [6]. The mechanism of traumatic OCD is poorly defined but is always associated with sudden, high-energy deceleration forces resulting in hyperextension, hyperflexion, translation, and/or rotation of the upper cervical spine causing the ligamentous disruption [3, 5, 22–25]. Our case is unique in that it represents the first published case of a patient who sustained an OCD after low-energy trauma.…”

Section: Discussionmentioning

confidence: 99%

Occipitocervical Dislocation in Low-Energy Trauma

Tavolaro

Bransford

Yerrapragada

et al. 2018

Case Reports in Orthopedics

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Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. We describe a case of OCD occurring in a patient who sustained a ground-level fall whose only clinical symptom was posterior neck pain without neurologic compromise. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe injury to the structurally important ligamentous complex that stabilizes the base of the skull to the spine, along with unstable fractures of the occipital condyle and C1. Emergent surgical instrumentation and fusion of occiput-C2 was performed. Postoperatively, neurologic integrity was maintained. This case illustrates that traumatic OCD is not exclusively secondary to high-energy mechanisms. It also demonstrates that severe neck pain as the only clinical manifestation in a patient with head or neck low-energy trauma is suggestive of a possible OCD. We highlight the importance of the use of head and neck CT as the first imaging-based diagnostic tool to aid in identifying this injury. Finally, surgical stabilization should be performed as soon as possible to minimize neurologic sequelae.

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The provocative radiographic traction test for diagnosing craniocervical dissociation: a cadaveric biomechanical study and reappraisal of the pathogenesis of instability

Cited by 22 publications

References 12 publications

Bilateral occipital condyle fracture with an avulsion fracture of the foramen magnum: nonoperative care guided by a traction test. Illustrative case

Bilateral occipital condyle fracture with an avulsion fracture of the foramen magnum: nonoperative care guided by a traction test. Illustrative case

Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

Occipitocervical Dislocation in Low-Energy Trauma

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