Osteosintesis directa para tratar la espondilolistesis traumatica del axis. Reporte de un caso y revision bibliografica / Direct osteosynthesis to treat traumatic spondylolisthesis of the axis. Case report and literature review

La espondilolistesis traumática del axis representa un 5% de las fracturas cervicales y es definida por una fractura de la pars interarticularis de la segunda vértebra cervical. El mecanismo de esta fractura, en general, implica fuerzas de hiperextensión. Los aspectos más importantes relacionados con el pronóstico y tratamiento son el compromiso discal C2-C3, el compromiso neurológico y la presencia de luxación facetaria. En relación con los tratamientos conservador o quirúrgico en patrones no desplazados, la cirugía podría determinar una recuperación precoz. Por otro lado, se han descrito buenos resultados con el uso del halo chaleco. Se presenta un caso de espondilolistesis traumática del axis tratado con osteosíntesis directa a través de un abordaje posterior en un paciente que rechazó el tratamiento conservador.

Traumatic spondylolisthesis of the axis accounts for 5% of all cervical spine fractures and is defined as a pars interarticularis fracture in the second cervical vertebra. Its mechanism usually involves hyperextension forces. The most important aspects related to prognosis and treatment are C2-C3 disk injury, neurological involvement, facetary dislocation and displacement. As regards the conservative or surgical management in non-displaced patterns, surgical management could result in an early recovery; however, there are good results with halo vest immobilization. We present a case with C2 direct crew osteosynthesis through a posterior approach in a patient who refused conservative treatment.

Analysis of early complications after using Vertex technique in treating Dens axis fracture with atlantoaxial dislocation / 中国矫形外科杂志

[Objective]To discuss the causes and preventive measures of early complications after using Vertes technique in treating dens axis fracture with atlantoaxial dislocation.[Method]Eighteen cases performed Vertex technique were included in this study.The early complications(postoperative or at surgery) included vertebral artery injury(2 cases),logagnosia(1 case),anopsia(1 case),hematorrhea(1 case) and wrong instrumentation(1 case).The causes of these complications and how to prevent were analyzed.[Result]All these complications were treated in time,and no sequela was found.[Conclusion]The early complications of Vertex technique in treating dens axis fracture with atlantoaxial joint dislocation can be prevented.The timely treatment must be performed when it occurs,and the effect would be satisfactory.

Clinical Analysis of Axis Fracture

This retrospective analysis describes the clinical characteristics, treatment, and long-term outcome of 30 patients with axis fracture admitted to our institution between January 1991 and December 1995. The incidence of axis fracture was 27.2% in the 110 cervical spine fractures. Among these, odontoid process fracture was the most common type, 19 cases(63%) followed by 8 hangmans fractures(27%), 3 miscellaneous fractures(10%). Hangman's fractures, odontoid type III fractures and miscellaneous fractures were treated with external immobilization devices. Remaining 11 odontoid type II fractures, and six patients with dens dislocation of 6 mm or greater were initially treated by early surgical stabilization. Individuals with dens dislocated less than 6 mm were treated by external immobilization only. Among the nonoperative group of acute axis fractures, there was no fusion failure. In the early operated group, all patients were stable clinically or radiologically. But three patients with posterior wiring and bone graft complained of their neck motion limitation.

Comparison of Clinical Findings and Results of Treatment According to Classification of C-2 Fractures

There are some debates on the best method of treatment of C-2 fractures. Clinical findings and results of treatment were evaluated in forty-three patients with C-2 fractures. These fractures were classified into five types according to the classification by Benzel4);1) odontoid fractures(14), 2) horizontal C-2 body fractures(13), 3) sagittally oriented vertical C-2 body fractures (2), 4) coronally oriented vertical C-2 body fractures(8), 5) traumatic spondylolisthesis of the axis(6). Primary fusion appears to be justified in odontoid process fractures due to a high rate of non-union. In horizontal C-2 body fractures, unilateral facet dislocation was visible in six patients which was the cause of malalignment in closed reduction. In sagittally oriented vertical C-2 body fractures, combined facet fractures were always visible because the mechanism of injury was axial compression. The choice of management schemes may depend on the mechanism of injury and fracture type defined by Benzel.

Clinical Review of the Isolated Acute Axis Fracture

A series of 26 patients of acute axis fractures were treated at the Wonkwang Medical Center, Wonkwang University between January, 1988 and December, 1992. The medical records and roentgenograms of these 26 patients were reviewed in detail. Follow-up data were available for all of the cases. for a median duration of 25.6 months(range 3 months to 5years). There were 8 hangman's fractures(31%), 10 odontoid type II fractures(38%), 6 odontoid type III fractures(23%), 2 miscellanous fractures(8%). The odontoid type II fracture was the most common axis fracture and the most common cause of injury was motor-vehicle accident followed by fall, Hangman's fracture, odontoid type II, miscellanous fracture were effectively treated with external stabilization. In the 10 odontoid type II fractures, 7 patients were treated by external stabilization and 3 were by early surgical stabilization. Among the external stabilization group, the fusion failure occured 2 of the displacement of 4mm or greater in the initial treatment.

Fracture and Dislocation of the Upper Cervical Spine: A Review of 42 Cases

This review of high cervical spine injuries includes patients admitted to Paik Hospital, Seoul during the period 1981 to 1990. 250 patients had cervical fractures or instability. 42 had involvement of the high cervical spinal column and 13 had neurological deficits. 20 had odontoid fracture. Patients with combination C1-2 fracture-subluxation injuries should be studied with thin section computed tomogram or conventional tomogram. Appropriate treatment is determined by the type of axis fracture and includes surgical and nonsurgical strategies. An experience with 42 patients with high cervical fracture and dislocation is presented as management and follow-up guidelines are reviewed.