Upper Cervical Spine Injuries

Jackson, Robert S.; Banit, Daxes M.; Rhyne, Alfred L.; Darden, Bruce V.

doi:10.5435/00124635-200207000-00005

Cited by 77 publications

(44 citation statements)

References 38 publications

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“…This observation has also been described by Jackson et al 19 , suggesting that ligamentous injuries should be better managed surgically. Based on these, we have to answer a critical question to propose a rational approach to upper cervical trauma: what is the status of the ligamentous complex in the occipito-cervical junction, in the atlantoaxial complex, and in the C2-3 complex compromised?…”

Section: Discussionsupporting

confidence: 81%

“…Consequently, surgical treatment of spinal injuries should have three main goals: (i) prevent further neurological injury, (ii) reduce and stabilize the injured segment, and (iii) provide long-term stability and/or prevent deformity. 19 A vast number of classification systems for upper cervical spine injuries have been published. 9,11,18,21,32 That this large body of literature and wide array of classification systems exists is an attestation to the variation and the controversies surrounding their evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of a TL injury can be based on measurement of the atlanto-dens interval (>3.5 mm), lateral displacement of the lateral mass of the atlas greater than 6.9 mm (the "rule of Spence"), or with CT and MRI imaging, probably the gold standard. 18,19 This injury requires surgical stabilization of C1-2 to restore spinal stability (Fig. 2).…”

mentioning

confidence: 99%

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Upper cervical injuries – A rational approach to guide surgical management

Joaquim

Ghizoni

Tedeschi

et al. 2013

The Journal of Spinal Cord Medicine

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Context:The complex anatomy and the importance of ligaments in providing stability at the upper cervical spine region (O-C1-C2) require the use of many imaging modalities to evaluate upper cervical injuries (UCI). While separate classifications have been developed for distinct injuries, a more practical treatment algorithm can be derived from the injury pattern in UCI. Objective: To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. Methods: A literature review was performed on the Pubmed database using the following keywords: (1) "occipital condyle injury"; (2) "craniocervical dislocation or atlanto-occipital dislocation or craniocervical dislocation"; (3) "atlas fractures"; and (4) "axis fractures". Just articles containing the diagnosis, classification, and treatment of specific UCI were included. The data obtained were analyzed by the authors, dividing the UCI into two groups: Group 1 -patients with clear ligamentous injury and Group 2 -patients with fractures without ligament disruption. Results: Injuries with ligamentous disruption, suggesting surgical treatment, include: atlanto-occipital dislocation, mid-substance transverse ligament injury, and C1-2 and C2-3 ligamentous injuries. In contrast, condyle, atlas, and axis fractures without significant displacement/misalignment can be initially treated using external orthoses. Odontoid fractures with risk factors for non-union are an exception in Group 2 once they are better treated surgically. Patients with neurological deficits may have more unstable injuries. Conclusions: Ascertaining the status of relevant ligamentous structures, fracture patterns and alignment are important in determining surgical compared with non-surgical treatment for patients with UCI.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Upper cervical injuries – A rational approach to guide surgical management

Joaquim

Ghizoni

Tedeschi

et al. 2013

The Journal of Spinal Cord Medicine

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“…16 In our results, there is no significant difference among the study (both the aAAA and nAAA groups) and control groups, probably due to the stronger consistency of the ligament and being less susceptible to pannus erosion or wearing. 17 Facet displacement of the lateral atlantoaxial joint has been proposed as a useful sign for diagnosing AAA subluxation by using conventional or 3D CT. 18 In our results, a mild trend of facet displacement was observed in the nAAA subluxation group (data not shown) with a modest statistical difference (P ϭ .14). Nevertheless, MR imaging provides more information about the facet joints beyond displacement.…”

Section: Discussionmentioning

confidence: 99%

Revisiting Anterior Atlantoaxial Subluxation with Overlooked Information on MR Images

Hung¹,

Wu²,

Guo³

2009

AJNR Am J Neuroradiol

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“…In the latter, there is an increase in the number of children with complaints of discomfort in the cervical spine, headaches and dizziness, which neurologists and pediatricians are regarded as a manifestation of vegetative-vascular dystonia. However, these complaints can be caused by functional and organic changes, bone and soft tissue structures of the cervical spine [3].…”

Section: Introductionmentioning

confidence: 99%

The Role of B-mode Ultrasonography in the Anatomical Evaluation of the Cervical Region of the Spine in Adolescents

Yr¹,

Kn²,

Vi³

et al. 2017

J Spine

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Objective: Ultrasonographic evaluation of the anatomy of the intervertebral discs, vertebral canal of the cervical spine in practically healthy adolescents. Materials and methods:The study included 72 healthy children with normal neurologic status, 35 of them aged 13-15 years, 37-16-18 years old. Ultrasonography (USG) was performed at the level of disks C 2 -C 3 , C 3 -C 4 , C 4 -C 5 , C 5 -C 6 , C 6 -C 7 , C 7 -Тh 1 in longitudinal and transverse projections. In the longitudinal projection, the height of the intervertebral discs (IVD) and vertebral bodies (V), their ratio (IVD/V), and in the transverse projection -the sagittal size of the IVD, the spinal canal (SC), their sagittal size ratio IVD/SC, the width of spinal nerve canals (NC), the yellow ligament thickness, the sagittal size of the anterior dural space (ADS), their ratio of the ADS and SC (ADS/ SC). In addition to the quantitative parameters of the IVD and SC, the echo structure of the nucleus pulpous (NP) and fibrous ring (FR) was also studied. Results:The highest sagittal size IVD and SC in the age groups 13-15 (15.6 ± 0.8 mm and 16.4 ± 0.9 mm) and 16-18 years (16.9 ± 0.7 mm and 17.3 ± 0.8 mm) was recorded at the level of C 2 -C 3 . Only in the age group 16-18 years were no significant differences (p<0.05) compared with the level of C 7 -Th 1 (17.3 ± 0.8 mm in front of 15.2 ± 0.7 mm). In both age groups, the height of the IVD was also the highest at C 2 -C 3 (4.2 ± 0.23 mm and 4.5 ± 0.37 mm), but no significant differences compared with the levels of C 2 -C 3 and C 7 -Th 1 has not been revealed. SC area was calculated from the linear dimensions and on the perimeter. At the level of C 2 -C 3 in 13-15 years, these figures were 188 ± 11 mm 2 and 287 ± 14 mm 2 , aged 16-18 years -and 195 ± 12 mm 2 312 ± 14 mm 2 . At the level of C7-Th1 these figures were 152 ± 8 mm 2 (p<0.05), 158 ± 7 mm 2 (p<0.01), 236 ± 12 mm 2 (p<0.001), 248 ± 9 mm 2 (p<0.001).The thickness of the yellow ligament (YL (TAR-reject) increases from top to bottom, it was the highest level of C 6 -C 7 in the age group 16-18 years and was 2.8 ± 0.24 mm significantly (p<0.05) higher than at the level of C 2 C 3 (2.1 ± 0.15 mm).Sagittal size anterior dural space (ADS) in all children at all levels of IVD profit lower than the rear PDS index ADS/PDS was lowest at C 4 -C 5 and was 0.82 ± 0.03. Conclusion:In adolescents, the sagittal size of the intervertebral disc and spinal canal, the height of the IVD, the frontal size, the area of the SC, the width of the spinal nerve canals, the dural spaces have the largest value at the C 2 -C 3 level, the smallest at the C 6 -C 7 and C 7 -Th 1 levels. The smallest ratio of IVD/SC is observed at the level of C 2 -C 3 . The maximum thickness of the yellow ligament is recorded at the level of C 6 -C 7 , the smallest sagittal dimension of the anterior dural space is determined at the level of C 6 -C 7 and C 7 -Th 1 .

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Upper Cervical Spine Injuries

Cited by 77 publications

References 38 publications

Upper cervical injuries – A rational approach to guide surgical management

Upper cervical injuries – A rational approach to guide surgical management

Revisiting Anterior Atlantoaxial Subluxation with Overlooked Information on MR Images

The Role of B-mode Ultrasonography in the Anatomical Evaluation of the Cervical Region of the Spine in Adolescents

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