Traumatic Atlantooccipital Dislocation

Koller, Heiko; Holz, U.; Assuncao, Allan; Oberst, Michael D.; Ulbricht, D.

doi:10.1007/s00068-006-5004-5

Cited by 4 publications

(1 citation statement)

References 33 publications

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“…1) [42,46,67], the primary stabilizing component against translational forces at C1-2 [21]. The main auxiliary restraints include the tectorial membrane, the crucial ligament, the alar ligaments and the capsular ligaments as well as the apical odontoid ligament, and the atlantoaxial anterior and posterior membranes with descending order of importance [21,32,34,46,47,65,67]. Based on the previous biomechanical studies that were performed to identify the failure loads of the TAL and displacement at failure [19,21,28,49,57,63], most physicians assumed that traumatic disruption of the TAL causes translational instability of C1-2 that places the spinal cord at risk [13,15,27,37,39,56].…”

Section: Discussionmentioning

confidence: 99%

A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament

et al. 2010

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Nonsurgical treatment of Jefferson burst fractures (JBF) confers increased rates of C1-2 malunion with potential for cranial settling and neurologic sequels. Hence, fusion C1-2 was recognized as the superior treatment for displaced JBF, but sacrifies C1-2 motion. Ruf et al. introduced the C1-ring osteosynthesis (C1-RO). First results were favorable, but C1-RO was not without criticism due to the lack of clinical and biomechanical data serving evidence that C1-RO is safe in displaced JBF with proven rupture of the transverse atlantal ligament (TAL). Therefore, our objectives were to perform a biomechanical analysis of C1-RO for the treatment of displaced Jefferson burst fractures (JBF) with incompetency of the TAL. Five specimens C0-2 were subjected to loading with posteroanterior force transmission in an electromechanical testing machine (ETM). With the TAL left intact, loads were applied posteriorly via the C1-RO ramping from 10 to 100 N. Atlantoaxial subluxation was measured radiographically in terms of the anterior antlantodental interval (AADI) with an image intensifier placed surrounding the ETM. Load-displacement data were also recorded by the ETM. After testing the TAL-intact state, the atlas was osteotomized yielding for a JBF, the TAL and left lateral joint capsule were cut and the C1-RO was accomplished. The C1-RO was subjected to cyclic loading, ramping from 20 to 100 N to simulate post-surgery in vivo loading. Afterwards incremental loading (10-100 N) was repeated with subsequent increase in loads until failure occurred. Small differences (1-1.5 mm) existed between the radiographic AADI under incremental loading (10-100 N) with the TAL-intact as compared to the TAL-disrupted state. Significant differences existed for the beginning of loading (10 N, P = 0.02). Under physiological loads, the increase in the AADI within the incremental steps (10-100 N) was not significantly different between TAL-disrupted and TAL-intact state. Analysis of failure load (FL) testing showed no significant differences among the radiologically assessed displacement data (AADI) and that of the ETM (P = 0.5). FL was Ø297.5 +/- 108.5 N (range 158.8-449.0 N). The related displacement assessed by the ETM was Ø5.8 +/- 2.8 mm (range 2.3-7.9). All specimens succeeded a FL >150 N, four of them >250 N and three of them >300 N. In the TAL-disrupted state loads up to 100 N were transferred to C1, but the radiographic AADI did not exceed 5 mm in any specimen. In conclusion, reconstruction after displaced JBF with TAL and one capsule disrupted using a C1-RO involves imparting an axial tensile force to lift C0 into proper alignment to the C1-2 complex. Simultaneous compressive forces on the C1-lateral masses and occipital condyles allow for the recreation of the functional C0-2 ligamentous tension band and height. We demonstrated that under physiological loads, the C1-RO restores sufficient stability at C1-2 preventing significant translation. C1-RO might be a valid alternative for the treatment of displaced JBF in comparison to fusion of C...

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Section: Discussionmentioning

confidence: 99%

A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament

et al. 2010

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Occipitocervical fixation in the management of craniocervical instabilities

Zidan

Fouad

2011

Alexandria Journal of Medicine

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In Vivo Analysis of Atlantoaxial Motion in Individuals Immobilized With the Halo Thoracic Vest or Philadelphia Collar

Koller¹,

Zenner²,

Hitzl³

et al. 2009

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Under the extremes of flexion and extension bendings, the current study demonstrated that there was no significant difference in restriction of sagittal motion at C1-C2 when using the PC instead of the HTV in a group of 20 young normal adults. In light of the current biomechanical data and a selected review of literature, it is concluded that the use of a PC is sufficient for the treatment of stable odontoid fractures.

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Traumatic Atlantooccipital Dislocation

Cited by 4 publications

References 33 publications

A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament

A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament

Occipitocervical fixation in the management of craniocervical instabilities

In Vivo Analysis of Atlantoaxial Motion in Individuals Immobilized With the Halo Thoracic Vest or Philadelphia Collar

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