Upper Cervical Trauma

Olinger, Catherine R; Bransford, Richard J.

doi:10.1016/j.ocl.2021.05.013

Cited by 11 publications

(4 citation statements)

References 71 publications

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“…Los mecanismos que producen estas lesiones son los accidentes automovilísticos, las caídas de altura, eventos deportivos. El tratamiento urgente con fijación rígida posterior del occipucio a la columna cervical ha resultado en una reducción sustancial de los retrasos en el manejo, lo cual varía entre una fijación occipitocervical y una fijación cervical alta [8,9] .…”

Section: Discussionunclassified

Experiencia en patología cervical alta en el Hospital Guillermo Almenara Irigoyen 2016-2021

et al. 2023

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Introducción: La patología cervical alta es poco frecuente. Las fracturas y dislocaciones de la columna cervical alta son lesiones ocurridas por un impacto traumático. La malformación de Chiari tiene mejoría clínica en más del 70% de pacientes con solo descompresión con o sin duroplastía. El compromiso de la columna cervical en artritis reumatoide incluye la subluxación atlantoaxial. La columna cervical es la localización del 10-17% de la enfermedad neoplásica de la columna. La osteoartritis puede afectar la columna cervical, pero en poca frecuencia C2-C3. Objetivo: Determinar las características epidemiológicas, clínicas y del tratamiento en la patología cervical alta. Materiales y métodos: Se incluyeron a todos los pacientes con diagnóstico clínico radiológico de alguna patología cervical alta que hayan sido sometidos a tratamiento quirúrgico entre 2016 y 2021 en el Hospital Almenara. Se usó el test “t” de student y de chi cuadrado. Se dividió a los pacientes en 5 grupos: congénita, traumática, inflamatoria reumática, degenerativa y neoplásica. Resultados: Se consideraron 31 pacientes, con una edad media de 51.16 años, siendo el 58.06% varones. La patología cervical alta más frecuente fue la traumática con el 35.48%. El déficit motor se presentó en el 51.61% y el déficit sensitivo se presentó en el 54.84%. La cirugía más frecuente fue la fijación cervical alta con el 43.89%. La tasa de complicaciones fue del 16.13% con una mortalidad del 0%. Conclusiones: La patología cervical alta es rara, pero un manejo oportuno y adecuado permite un mejor pronóstico funcional del paciente.

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Section: Discussionunclassified

Experiencia en patología cervical alta en el Hospital Guillermo Almenara Irigoyen 2016-2021

et al. 2023

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“…The lack of bony connection between the axis and the odontoid process can leads to atlantoaxial instability, and the long-term instability will trigger atlantoaxial dislocation (AAD), resulting in high cervical spinal cord compression and chronic upper motor neuron injury. In some patients, AAD complicated with acute injury can lead to death [4]. Therefore, it is widely accepted that OO patients with atlantoaxial instability or AAD should receive surgical treatment [5] to stabilize the upper cervical spine, to relieve spinal cord compression, and to avoid future neurological injury [6].…”

Section: Introductionmentioning

confidence: 99%

Analysis of surgical strategies and efficacy in the treatment of Os odontoideum with atlantoaxial dislocation

Yang

Teng

et al. 2023

J Orthop Surg Res

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Background There are many classification systems for atlantoaxial dislocation (AAD). Among these systems, the definitions of irreducible AAD remain vague, and its treatments are not unified. Objective To explore the surgical strategies and efficacy for the treatment of os odontoideum (OO) with AAD. Methods The clinical data of 56 OO patients with AAD who underwent surgery from January 2017 to June 2021 were retrospectively analyzed. AAD was classified into four types, Type I and type II were treated with posterior fixation and fusion. Type III received posterior fixation and fusion after irreducible dislocations were converted to reducible dislocations by translateral mass release or transoral release. Type IV required transoral release for conversion into reducible dislocations before posterior fixation and fusion. The operation time, blood loss, and complications were recorded. The preoperative and postoperative neurological function changes were assessed using the Japanese Orthopedic Association (JOA) score. Postoperative fusion status was assessed by X-ray. Results There were 40 cases of type I-II, 14 cases of type III, and two cases of type IV AAD. The operation times of single posterior fixation and fusion, combined translateral mass release and combined transoral release were 130.52 ± 37.12 min, 151.11 ± 16.91 min and 188.57 ± 44.13 min, the blood loss were 162.63 ± 58.27 mL, 235.56 ± 59.94 mL, 414.29 ± 33.91 mL, respectively. One patient with type III died, one with type III underwent revision surgery due to infection, and three patients with type I had further neurological deterioration after operation. fifty-five patients were followed up for 12–24 months. The follow-up results showed that enough decompression was achieved and that fixation and fusion were effective. The JOA score increased from 9.58 ± 1.84 points preoperative to 13.09 ± 2.68 points at 3 months after operation, 14.07 ± 2.83 points at 6 months and 14.25 ± 2.34 at 12 months after operation, all significant differences compared with preoperative results (P < 0.05). Conclusion OO patients with irreducible AAD can be treated by translateral mass release or transoral release combined with posterior fixation and fusion, while some of those with bony fusion can be treated by transoral release combined with posterior fixation and fusion.

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“…Most other cervical spine injury classification systems only include subaxial injuries 16. More recent classifications of upper cervical injuries are solely focused on specific levels, such as skull base, C1 ring, C2 odontoid process, and C2 ring 17–19. These include, for example, the Harborview classification and the Anderson and D’Alonzo classifications 13,14,16,20,21…”

mentioning

confidence: 99%

“…16 More recent classifications of upper cervical injuries are solely focused on specific levels, such as skull base, C1 ring, C2 odontoid process, and C2 ring. [17][18][19] These include, for example, the Harborview classification and the Anderson and D'Alonzo classifications. 13,14,16,20,21 A new upper cervical injury classification system (UCCS) was recently developed and validated by the AO Spine Classification Group (https://aospine.aofoundation.…”

mentioning

confidence: 99%

The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study

O'Neill

Miller

et al. 2023

Journal of Pediatric Orthopaedics

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Background: There is no uniform classification system for traumatic upper cervical spine injuries in children. This study assesses the reliability and reproducibility of the AO Upper Cervical Spine Classification System (UCCS), which was developed and validated in adults, to children. Methods: Twenty-six patients under 18 years old with operative and nonoperative upper cervical injuries, defined as from the occipital condyle to the C2–C3 joint, were identified from 2000 to 2018. Inclusion criteria included the availability of computed tomography and magnetic resonance imaging at the time of injury. Patients with significant comorbidities were excluded. Each case was reviewed by a single senior surgeon to determine eligibility. Educational videos, schematics describing the UCCS, and imaging from 26 cases were sent to 9 pediatric orthopaedic surgeons. The surgeons classified each case into 3 categories: A, B, and C. Inter-rater reliability was assessed for the initial reading across all 9 raters by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals. One month later, the surgeons repeated the classification, and intra-rater reliability was calculated. All images were de-identified and randomized for each read independently. Intra-rater reproducibility across both reads was assessed using Fleiss’s kappa. Interpretations for reliability estimates were based on Landis and Koch (1977): 0 to 0.2, slight; 0.2 to 0.4, fair; 0.4 to 0.6, moderate; 0.6 to 0.8, substantial; and >0.8, almost perfect agreement. Results: Twenty-six cases were read by 9 raters twice. Sub-classification agreement was moderate to substantial with ακ estimates from 0.55 for the first read and 0.70 for the second read. Inter-rater agreement was moderate (kF 0.56 to 0.58) with respect to fracture location and fair (kF 0.24 to 0.3) with respect to primary classification (A, B, and C). Krippendorff’s alpha for intra-rater reliability overall sub-classifications ranged from 0.41 to 0.88, with 0.75 overall raters. Conclusion: Traumatic upper cervical injuries are rare in the pediatric population. A uniform classification system can be vital to guide diagnosis and treatment. This study is the first to evaluate the use of the UCCS in the pediatric population. While moderate to substantial agreement was found, limitations to applying the UCCS to the pediatric population exist, and thus the UCCS can be considered a starting point for developing a pediatric classification. Level of Evidence: Level III.

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Upper Cervical Trauma

Cited by 11 publications

References 71 publications

Experiencia en patología cervical alta en el Hospital Guillermo Almenara Irigoyen 2016-2021

Experiencia en patología cervical alta en el Hospital Guillermo Almenara Irigoyen 2016-2021

Analysis of surgical strategies and efficacy in the treatment of Os odontoideum with atlantoaxial dislocation

The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study

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