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Objective:To compare Jefferson-fracture reduction plate (JeRP) and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures.Methods:From January 2008 to December 2020, 45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery, General Hospital of Southern Theatre Command. They were 24 males and 21 females, aged from 15 to 67 years. By the Gehweiler classification, 11 atlas fractures were type Ⅰ and 34 type Ⅲ; by the American Spinal Injury Association (ASIA) classification, the spinal cord injury was grade D in 7 cases and grade E in 38 cases; by the Dickman classification, the atlas transverse ligament injury was type Ⅰ in 4 cases and type Ⅱ in 11 cases. Of the patients, 26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate. The 2 groups were compared in terms of baseline data, operation time, blood loss, hospital stay, visual analog scale (VAS) for neck pain and atlas lateral mass displacement (LMD) before operation and at the last follow-up, and intraoperative and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). All patients were followed up for 12 to 55 months (mean, 21.8 months). Wound dehiscence or infection was observed in none of the patients after operation. About 12 months after operation, all fractures achieved bony union, neck pain basically disappeared, and neck movement had no obvious limitation. The hospital stay was (13.9±2.2) d for the JeRP group and (14.2±2.9) d for the micro titanium plate group, showing no significant difference between the 2 groups ( P>0.05). The operation time was (203.5±173.4) min and the blood loss (167.3±138.6) mL in the JeRP group, significantly more than those in the micro titanium plate group [(121.5±50.5) min and (98.4±57.2) mL] ( P<0.05). In the JeRP group, the preoperative LMD was (6.7±1.7) mm and the preoperative VAS score (6.8±1.0) points, significantly higher than the last follow-up values [(0.7±0.6) mm and (0.7±0.6) points] ( P<0.05). In the micro titanium plate group, the preoperative LMD was (6.6±1.5) mm and the preoperative VAS score (6.7±0.9) points, significantly higher than the last follow-up values [(0.9±0.6) mm and (0.8±0.7) points] ( P<0.05). However, there was no significant difference in the preoperative or the last follow-up comparison between the 2 groups ( P>0.05). Implant loosening was observed in one patient in the JeRP group while foreign body sensation in the throat was reported in one patient after operation in the micro titanium plate group. Conclusions:Both JeRP and micro titanium plate in the transoral single-segment fixation can lead to effective treatment of unstable atlas fractures. Compared with JeRP, the micro titanium plate can effectively shorten operation time and reduce blood loss due to its smaller size and lower incision.
ABSTRACT
Objective To establish the finite element model of upper cervical vertebrae C0-3 with Jefferson fracture, and to analyze the influence of posterior atlantoaxial fusion (PSF) and occipitocervical fusion (OCF) on biomechanical properties of the vertebral body and mechanical conduction of the screw-rod system. Methods Based on CT images, the C0-3 segment Jefferson fracture model of human upper cervical spine was established. PSF, OCF1 and OCF2 internal fixation were performed according to surgical plan in clinic, and 50 N concentrated force and 1.5 N·m torque were applied to bottom of the occipital bone. The stress distribution and range of motion (ROM) of the cervical vertebral body, the maximum stress of the screw-rod system and the stress distribution of the intervertebral disc for C0-3 segment during flexion, extension, bending and rotation of the upper cervical spine were studied. Results Compared with PSF, the ROM of OCF1 and OCF2 vertebral bodies increased, and the stress of the nail rod decreased. OCF had a better fixation effect. Conclusions PSF, OCF1 and OCF2 fixation method can reduce the upper cervical ROM and restore stability of the upper cervical spine, which make stress distributions of the vertebral body and intervertebral disc tend to be at normal level. The research result can provide a theoretical basis for clinical surgery plan.
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El síndrome de Collet - Sicard consiste en una afectación unilateral y combinada de los nervios craneales bajos, originado por lesiones en la base craneal. CASO CLÍNICO: Paciente masculino con antecedentes de sufrir accidente del tránsito. A su llegada al hospital refiere dolor cervical alto, voz apagada y dificultad para tragar. Al examen físico se contacta paresia de pares craneales bajos. Se realizan Rx de columna cervical y tomografía axial de región cráneo espinal. Se diagnostica una fractura de los cóndilos occipitales y una fractura tipo II del atlas. Se coloca un Halo chaleco. Se consulta al paciente al final del primer mes de tratamiento con alivio del dolor cervical y sin empeoramiento neurológico. CONCLUSIONES: La afectación de pares craneales bajos puede ser la forma clínica de presentación de las lesiones traumáticas de la región cráneo espinal. Su reconocimiento temprano favorece el pronóstico de estos pacientes
Collet syndrome - Sicard is a combined unilateral involvement and lower cranial nerves, caused by damage to the cranial base. Case report. Male patient with a history of developing traffic accident. Upon arrival at the hospital referred high cervical pain, muffled voice and difficulty swallowing. Physical examination contact lower cranial nerve paresis. Rx are performed CT cervical spine and skull spinal region. Was diagnosed with a fracture of the occipital condyles and type II fracture of the atlas. Place a Halo vest. They see patients at the end of the first month of treatment with cervical pain relief without neurological deterioration. CONCLUSIONS: The lower cranial nerve involvement may be the clinical presentation of traumatic injuries of the skull spinal region. Its early recognition and the prognosis of these patients.
Subject(s)
Humans , Male , Adult , Cervical Atlas/injuries , Cranial Nerve Diseases , Cranial Nerve Diseases/diagnosis , Cranial Nerve Diseases/etiology , Cranial Nerve Diseases/rehabilitation , Cranial Nerve Diseases/therapy , Accidents, Traffic , Deglutition Disorders , DysphoniaABSTRACT
Las Fracturas por estallido del atlas (fracturas de Jefferson: Nombrada así por Sir Geoffrey Jefferson1) se producen cuando una fuerza axial se transmite a través de la unión occipito-cervical, causando que el atlas sea comprimido entre la superficie articular de la angulación del Axis y los cóndilos occipitales. Las fuerzas de impacto causan una propagación hacia el exterior de las masas laterales de C1. El resultado es una fractura del atlas en cuatro partes, dos en el arco posterior y dos en el arco anterior2. Y la fractura de apófisis odontoides principalmente por flexion que es el mecanismo más común que produce el daño con el consecuente desplazamiento anterior de la apófisis de la primera vértebra cervical (C1) sobre la segunda (C2). Debido a extensión sólo ocasionalmente se producen FAPO (fractura de apófisis Odontoides), usualmente asociadas con desplazamiento posterior5,9. La frecuencia de accidentes fatales como consecuencia directa de esta lesión es desconocida pero se estima entre un 25 a un 40 por ciento6,7. El manejo de esta es aún controvertido. La mayoría son relativamente estables y no se asocia con deficiencias neurológicas y pueden ser tratadas mediante inmovilización externa con resultados satisfactorios9. Las fracturas inestables de Jefferson reflejan una lesión más grave del atlas que se producen cuando el ligamento transverso también se rompe, secundario a la extensión de la propagación del arco de Cl. Estas fracturas son más difíciles de tratar debido a la inestabilidad atlantoaxial. Muchos cirujanos recomiendan la estabilización quirúrgica de estas fracturas de Jefferson inestables.
The atlas burst fractures (Jefferson fractures: Named after Sir Geoffrey Jefferson1) occur when an axial force is transmitted through the occipito-cervical junction, causing the atlas is compressed between the articular surface of the Axis and angle of the occipital condyles. Impact forces cause an outward propagation of the lateral masses of C1. The result is a fracture of the atlas into four parts, two in the posterior arch and two in the anterior arch2. And the odontoid fracture mainly by flexion is the most common mechanism that causes the damage with the resulting anterior displacement of the apophysis of the first cervical vertebra (C1) on the second (C2). Because there are only occasional extension FAPO (odontoid fracture), usually associated with posterior displacement5,9. The frequency of fatal accidents as a direct result of this injury is unknown but is estimated between 25 to 40 percent6,7. Managing this is still controversial Most are relatively stable and is not associated with neurological deficits and can be treated by external immobilization with satisfactory results9. Unstable fractures of Jefferson reflect a more serious injury of the atlas that occur when the transverse ligament also ruptures secondary to the extent of spread of the arch of Cl These fractures are more difficult to treat due to atlanto-axial instability. Many surgeons recommend surgical stabilization of these unstable Jefferson fractures.
Subject(s)
Humans , Male , Middle Aged , Odontoid Process/injuries , Cervical Atlas/surgery , Cervical Atlas/injuries , Fractures, Compression , Joint Instability , Ligaments, Articular , Diagnostic ImagingABSTRACT
Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofluoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jefferson fracture.
Subject(s)
Humans , Middle Aged , Aspirations, Psychological , Atrophy , Cranial Nerve Injuries , Cranial Nerves , Deglutition , Deglutition Disorders , Esophageal Sphincter, Upper , Muscles , Paralysis , Physical Examination , Reflex , TongueABSTRACT
Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with aflantoaxial instability.Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1-C2 pedicle screw fixation in our department from January 2006 to December 2009.There were eight males and three females at age range of 20-52 years(mean 36 years).There were eight patients with fresh fractures,three with old fracture and three complicated with odontoid process fracture.The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck,with no spinal dysfunction in all patients.X-ray,CT scan,three-dimensional reconstruction,MRI scan and skull traction were performed in all patients before operation.Then,the patients were treated with C1-C2 pedicle screw fixation without fusion between C1-C2 under general anesthesia.Results The atlantoaxial dislocation was reduced completely and the patients could move from bed,wearing the neck collar.There was no injury of vertebral artery,spinal cord or nerve roots during operation,but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze.Eleven patients were followed up for 6-24 months(average 15 months),which showed bone union,with no internal fixation breakage,loosening or dislocation.The internal fixation was removed from seven patients 15 months after operation,with mild limitation of the cervical vertebra torsion(90°-135°,average 115°)but with no limitation of obvious extension-flexion motion.Conclusion C1-C2 pedicle screw fixation has features of simple operation,short segment fixation,solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlantoaxial instability.
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During the past five years we have treated twenty-seven cases of upper cervical injury among total three hundred and seventeen spine injuries. A follow-up study has done on twenty-one upper cervical injuries and the result is reported. The incidence of upper cervical injury was 8.5% of the total spine injury and 17.5% of the cervical injury. Almost all of the injuries(95.2%) were caused by traffic accidents and falls. The types of injury were odontoid fracture(38.1%), hangman's fracture(28.6%), atlanto-axial instability(19.1%), tear drop fracture of the axis(9.5%), and Jefferson's fracture(4.8%). Chief complaints on admission were motor weakness(57.1%), neck pain with limitted range of motion(42.9%), and sensory disturbance was noted in six cases of the motor weakness group(28.6%). Out of twenty-one cases, operative fixation was performed in eight cases with good result in five(62.5%) and thirteen patients were treated conservatively with eleven cases(84.6%) of good result. In chronic nonunited or malnunited cases, it seems to be safer to fuse the level both by anterior and posterior routes than by either route alone because it is not always stable and needs long period of immobilization.