Traumatic Instability in the Previously Fused Cervical Spine

Millan, Michael Mac; Es, Stauffer

doi:10.1097/00002517-199112000-00007

Cited by 27 publications

(21 citation statements)

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“…The cervical region is the most vulnerable part of the spinal column because of increased mobility, small vertebral bodies, oblique articular facets and the mobility of the heavy skull on the cervical spine [103,129]. Mac Millan et al [69] stated that traumatic fractures in patients with a partially fused spine tend to occur adjacent to the fused segments, rather than through the fused region itself. Paley et al [88] also reported fractures to occur at the junction of the mobile and the fused spine.…”

Section: Discussionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.

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Section: Discussionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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“…There are few additional reports in the published literature of traumatic fractures adjacent to a fused cervical spine. Mac Millan and Stauffer outlined four such cases in patients with prior upper-level fusions (C2-C3 or C3-C4) and subsequent type 3 odontoid fractures [2]. In addition, two of the patients had posterior C1 arch fractures.…”

Section: Discussionmentioning

confidence: 99%

“…The highest fractures or dislocations described were C4-C5 facet dislocations [3-4]. Mac Millan and Stauffer reported four patients with C2 fractures, but those were adjacent to single-level fusions [2]. …”

Section: Discussionmentioning

confidence: 99%

“…Four cases, including ours, were treated with various types of fusions [3, 5-6], one of which included an anterior plate fixation [4]. Notably, patients with adjacent C2 fractures were treated with external immobilization rather than surgery to protect cervical motion [2]. However, the long-term outcomes for both surgical or conservative treatments are unknown.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Fracture/Subluxation in a Patient with a Prior C2-Sacrum Fusion: Case Report and Review of Literature

Chen

Chan

Kumar

et al. 2016

Cureus

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Traumatic injury to an adjacent segment of a previously fused spine is a rare complication of scoliosis surgery. The adjacent spinal segments may be more vulnerable to traumatic fracture or dislocation due to increased strain. We present a patient with prior C2 to sacrum fusion who suffered a C2 fracture/dislocation after falling. A 52-year-old female with a previous C2 to the sacrum fusion for idiopathic scoliosis presented with severe and progressively worsening neck pain after multiple falls. Imaging showed anterior displacement of the C2 vertebral body, fracture of C2, and anterior subluxation of the C1-2 complex on C3. The patient underwent posterior occiput to cervical fusion and reduction of the C1-C2 complex. Our case describes a potential complication of long-segment fusion. Adjacent segments may be more prone to fracture-dislocation because of increased intradiscal pressure and strain. Clinicians should have a high suspicion of fractures in patients with prior spinal fusions in the setting of trauma.

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“…Biomechanical analysis in cadaveric specimens subjected to fi xation and anterior cervical plating demonstrated increased intradiscal pressures and increased segmental motion at adjacent levels during normal ranges of motion. 32 In vivo, fusion has been shown to alter the likelihood and type of acute traumatic instability at adjacent levels in the cervical spine 33 and has been implicated in the progression of degenerative cervical disc disease. Radiographic evidence of degeneration at levels above and below an ACDF has been reported in between 0% and 81% of cases, 19,21,[34][35] with such changes often becoming evident within 12-24 months following surgery.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cervical Corpectomy and Fusion Accelerates Degenerative Disease at Adjacent Vertebral Segments

Pickett¹,

Duggal²,

Theodore³

et al. 2008

SAS Journal

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BackgroundAnterior cervical corpectomy provides the most direct and thorough surgical approach for anterior decompression when spinal cord compression is found directly behind the vertebral body. However, anterior cervical fusion has been shown to be associated with the development of new degenerative changes at levels immediately adjacent to the fused segments. Th e incidence of adjacent segment disease (ASD) following anterior cervical corpectomy has not been widely reported. We set out to determine the incidence of clinical ASD following anterior cervical corpectomy. MethodsWe retrospectively reviewed all available medical charts and radiographic studies of all cases of anterior cervical corpectomy performed at the Barrow Neurological Institute over a 4-year period with a minimum 24-month follow-up. Factors assessed included the success of arthrodesis, the presence of degenerative changes on serial follow-up radiographs, and the development of new neurological symptoms. ResultsSeventy-six patients met the criteria for inclusion: 54 had undergone a 1-level corpectomy, 18 underwent a 2-level corpectomy, and 4 underwent a 3-or 4-level corpectomy. Arthrodesis was performed with either allograft or autograft and anterior cervical plating. All patients achieved successful fusion. Follow-up was available for a minimum of 2 years in all cases, with a mean length of 3.6 years. Sixteen patients (21%) eventually developed radiological and clinical evidence of degenerative changes at adjacent levels. In 10 of 11 patients who developed clinical symptoms within 2 years, the changes represented progression of pre-existing, asymptomatic degenerative disease. Five patients developed degenerative changes more than 5 years after surgery; these were all associated with an unrelated new insult to the cervical spine such as trauma. ConclusionsAnterior cervical corpectomy with fi xation can accelerate degenerative changes identifi ed preoperatively at adjacent, asymptomatic levels of the cervical spine. Level of EvidenceRetrospective cohort study (level 2b).

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Traumatic Instability in the Previously Fused Cervical Spine

Cited by 27 publications

References 0 publications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Cervical Fracture/Subluxation in a Patient with a Prior C2-Sacrum Fusion: Case Report and Review of Literature

Anterior Cervical Corpectomy and Fusion Accelerates Degenerative Disease at Adjacent Vertebral Segments

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