Predictive value of sagittal craniocervical roentgenographic parameters for HRQOL after craniocervical fusion.

PURPOSE: Loss of "physiological" sagittal alignment following craniocervical fusion (CCF) for degenerative disease may be associated with loss of horizontal gaze, dysphagia and poor HRQOL. This study reports on sagittal craniocervical roentgenographic predictors of HRQOL (SF-36) in patients following uncomplicated CCF for fresh upper cervical traumatic (UCT) injuries. METHODS: Twenty-two consecutive adult patients (group P) aged 50 ± 16 years, who had undergone CCF for fresh unstable C1 and C2AO/type UCT injuries, were evaluated 39 ± 12 months postoperatively with upright lateral cervical roentgenograms and SF-36as HRQOL measure. Physiological data for cervical sagittal alignment and SF-36 were taken from an age-matched control group (C) of 30 individuals aged 52 ± 12 years. Several commonly used sagittal cervical roentgenographic parameters were tested as potential predictors of the SF-36 domains in both groups. Roentgenographic predictors for each of the nine SF-domains were calculated using stepwise multilinear regression analysis (MLRA). RESULTS: The roentgenographic predictors in patients included (1) the angle created by McGregor's line and the inferior surface of the axis (OC2a) for physical function (PF, P = 0.049), role limitations due to physical health (RLPH, P = 0.004),role limitation due to emotional problems (RLEP, P = 0.004), emotional functioning (EF) (P = 0.012), social functioning (SF) (P = 0.028) and general health (GH, P = 0.041). (2) The angle formed between a horizontal line and the superior endplate of T1-vertebra (T1-slope) was predictor for SF (P = 0.017) and pain (P = 0.021), and (3) the angle between McGregor's line and the line that links the center of the C1 anterior arch and the apex of cervical sagittal curvature (PIA) was predictor for health change (HC, P = 0.002). CONCLUSIONS: This study showed that postoperative OC2a, PIA and T1-slope safely predict HRQOL outcomes (SF-36) following CCF for fresh trauma. It seems theoretically that the adequate restoration of the upper cervical alignment including C1-C2 upper cervical lordosis (OC2a) and PIA, in interaction with T1-slope, is important for postoperative HRQOL scores close to physiological values. The authors speculate that C0-C4 fusion restores horizontal gaze and allows for painful regain of pre-trauma quality of life. Spine surgeons should realign and stabilize the craniocervical junction taking in consideration these roentgenographic predictors.

Atypical Occipitocervical Dissociation Associated with Ossification of the Posterior Longitudinal Ligament and Diffuse Idiopathic Skeletal Hyperostosis in Low-Energy Trauma.

INTRODUCTION: Traumatic posterior occipitocervical dissociation (OCD) is a rare injury, and only a few cases have been reported in the literature. The diagnosis can be delayed or even missed because of its uncommon presentation. We present this rare case report and its management to highlight this unusual injury to increase the awareness of the existence of this pathology and prevent delayed diagnosis and treatment. CASE REPORT: A 76-year-old man was brought to the emergency room with complaints of neck pain. There was a history of trivial trauma before this complaint. The cervical spine images revealed an anterior subluxation of the cervical spine with Jefferson burst fracture involving bilateral fractures of anterior and posterior arches, C5-6 transdiscal fracture, underlying ossification of the posterior longitudinal ligament (OPLL), and diffuse idiopathic skeletal hyperostosis (DISH). He was managed with closed reduction, occipitocervical fourth vertebra fusion (O-C4), and C1, C2 laminectomies with a good outcome. CONCLUSION: Traumatic OCD can result from low-energy trauma. We report a rare case of posterior OCD that was associated with Jefferson fracture and predisposing factors, including OPLL and DISH.

Traumatic occipito-cervical dissociation in adults: a Middle Eastern cohort study.

The objective of this study is to describe a series of cranio-cervical dissociation victims and evaluate their outcomes as well as discuss the clinical dilemmas we faced in the context of current literature evidence. This is a retrospective cohort study of traumatic occipito-cervical dissociation in five patients (three males and two females) encountered between 2010 and 2016 at a tertiary care facility in the Middle East region. All patients underwent occipito-cervical fusion using screws and rods system with mean postoperative follow-up period of 2.5 years. All patients survived, and four were independently mobile and one wheel chair bound. Most had some degree of neurological sequelae, often due to associated injuries and all complained of limited neck range of motion. Contemporary literature review shows that CT scan with MRI is often the best diagnostic modality. Surgery is usually indicated though rare cases treated conservatively have been reported. The commonest predictor of mortality is missed injury, associated head injury and wide separation between the skull base and C1 on imaging studies.

Clinical Analysis of Upper Cervical Spine Injuriesur

This review of upper cervical spine injuries includes 51 patients admitted to Korea University Hospital, Seoul during the period 1 Jan. 1990 to 31 Dec. 1994. The incidence of upper cervical injury was 13.6% in the 375 spine injury cases and 31.7% in the 161 cervical spine injuries. The most common type of injury was odontoid fracture, ie. 16 cases or 31.3%. The male-to-female ratio was 2.6:1 and the 4th decade showed peak incidence. 33 cases(64.7%) of the injuries were caused by traffic accidents. The chief complaints on admission were neck pain with limited range of motion in 39 cases(76.5%), motor weakness in 3 cases(5.9%), and sensory disturbance in 2 cases(3.9%). Operative treatment was performed in 23 patients resulted in neurologic improvement in 22 Cases(95.7%) and 28 patients were managed by conservative treatment with 25 cases(89.3%) of neurologic improvement. Mortality rate of the upper cervical spine injury was 3.9%. The above represents our experience with 51 patients suffering from upper cervical injuries. Management and follow-up guidelines are also reviewed.

Analysis of Upper Cervical Injuries

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.