Hangman's fractures are located in the region between facets of the axis, which are accompanied by an increasing rate recently. However,there are no uniform standards for the treatment, especially for the treatment of fractures of types II and IIa because the operative approaches which include anterior and posterior are supported by different groups. The article tried to make an analysis on pathological anatomy, mechanism, types and surgical treatment of Hangman's fractures.
Cervical Vertebrae ; injuries ; surgery ; Humans ; Spinal Fractures ; classification ; surgery

OBJECTIVETo investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane.

METHODSFifteen preserved thoracolumbar spine specimens (T(11)-L(5)) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy-camille, Magerl, and authors' segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed.

RESULTSFour anatomic parameters at various segments showed significant differences (P<0.05). The drilling point by the Roy-camille's method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E-angles of the pedicles. The drilling point by Magerl's method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E-angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy-camille's method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.

CONCLUSIONSThe segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.

Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; Humans ; Lumbar Vertebrae ; injuries ; Spinal Injuries ; surgery

Cervical Cord ; Cervical Vertebrae/surgery* ; Humans ; Spinal Cord Injuries/etiology* ; Thyroidectomy/adverse effects*

OBJECTIVETo summarize and analyze the therapeutic effect of traumatic upper cervical instability and investigate therapeutic methods and effect.

METHODSThere were 19 patients with traumatic upper cervical instability (male 16, female 3), aged from 21 to 56 years,included 3 cases of atlas fracture, 10 cases of dens fracture, 3 cases of axis pedicle fracture, 3 cases of atlanto-axial subluxation. Among them, 6 cases included 1 case of dens fracture, 1 case of dens fracture affiliated with atlas fracture, 1 case of axis pedicle fracture, 3 cases of atlanto-axial subluxation were treated conservatively and the other 13 cases were treated by operations.

RESULTSNineteen cases were followed up for 1.8 years in average (6 months to 6 years). According to JOA standard for evaluation, the rate of improvement was 42.5% and 87.0% for conservative treatment and operation respectively.

CONCLUSIONTraumatic super cervical unsteadiness should be diagnosed and treated early. Under the condition of upper cervical vertebra being completely fixed,the function of cervical vertebra to maximum extent could be reserved when choosing operation method. Especially, the precise fusion of upper cervical vertebra plays a vital role of long-term efficacy.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Internal Fixators ; Joint Instability ; surgery ; Male ; Middle Aged

OBJECTIVETo explore clinical presentations and the operational opportunity of traumatic cervical disc herniation.

METHODSFrom June 2002 to June 2009,40 patients with traumatic cervical disc herniation were treated. There were 24 males and 16 females, with an average age of 43.2 years old ranging from 30 to 56 years. There were 36 patients with single intervertebral disc herniation and 4 patients with double. The injury level of those patients were at C3,4 in 16 cases, C4,5 in 10 cases, C5,6 in 12 cases and C6,7 in 6 cases. Among them, 18 patients showed spinal cord signal changes by MRI, 5 patients suffered from nothing but neck and shoulder pain, 8 patients with nerve root stimulation; 10 patients with spinal cord compression, and 17 patients had both nerve root stimulation and spinal cord compression symptoms. Conservative treatment were applied to 13 patients with neck and shoulder pain and nerve root stimulation, 5 cases of which were transferred to operation in case of poor effects, and Odom criteria were used to assess operational effects. Twenty-seven patients with spinal cord compression accepted operation from 1 to 27days after their trauma, 16 of which were operated in 5 days (early operational group with an JOA score of 11.3 +/- 2.8), other 11 cases were operated from 5 to 27 days (delayed operational group with an JOA score of 11.4 +/- 2.9 ), then functional assessment of spinal cord were assessed according to JOA criteria.

RESULTSThree patients who were transferred from conservative treatment recovered excellently according to Odom criteria and the other 2 were good at final followed-up. JOA score of early operational group increased from (11.3 +/- 2.8) to (15.3 +/- 1.8) one week after operation (P < 0.01), and (15.9 +/- 1.4) at final followed-up (P < 0.01). JOA score of delayed operational group increased from (11.4 +/- 2.9) to (14.0 +/- 2.6) one week after operation (P < 0.01), and (15.3 +/- 1.5) at final followed-up (P < 0.01). The recovery ratio of JOA score of early operational group were (74.6 +/- 16.8)% 1 week after operation,and increased to (85.6 +/- 13.6)% at final followed-up; while that of delayed operational group were (50.9 +/- 17.5)% and (68.2 +/- 21.5)%, and there were significant difference between early operational group and delayed operational group both at 1 week postoperation and final followup (P < 0.05).

CONCLUSIONThere are some difference in pathological segment and imaging manifestation between traumatic cervical disc herniation and cervical spondylosis. Early operation is favorable to the recovery of neurological function in patients with spinal cord compression.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Male ; Middle Aged

Humans ; Joint Dislocations/surgery* ; Spinal Fractures/surgery* ; Anesthesia, General ; Cervical Vertebrae/injuries* ; Spinal Fusion

OBJECTIVETo summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.

METHODSFrom January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.

RESULTSThe average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.

CONCLUSIONCervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS).

METHODSThirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed.

RESULTA total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation.

CONCLUSIONThis study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; diagnosis ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnosis ; surgery ; Spondylitis, Ankylosing ; complications ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo study the outcomes of surgeries for acute central cervical spinal cord injury without cervical spine fracture or dislocation in young and middle-aged patients.

METHODSThe clinical data of 58 young and middle-aged patients with acute central cervical spinal cord injury treated in our hospital between August 2005 and August 2009 were analyzed retrospectively. Of these patients, 33 (24 males and 9 females) received surgical treatment and 25 (17 males and 8 females) had conservative therapy. The ASIA grade and ASIA motor and sensory score were used for evaluation at admission and at 14 days and 1 year after the treatment. The neurological symptoms and treatment outcomes in the two groups were evaluated.

RESULTSThe proportion of patients with ASIA grade D-E and the ASIA motor and sensory scores were all significantly higher in the surgical group than in the non-surgical treatment group (P<0.05).

CONCLUSIONFor young and middle-aged patients with central cervical spinal cord injury, immediate surgery can relieve the pressure on the injured spinal cord and improve the micro-circulation to promote functional recovery of the spinal cord.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Neck Injuries ; surgery ; Retrospective Studies ; Spinal Cord Injuries ; surgery ; Spinal Fractures ; surgery ; Young Adult

OBJECTIVETo discuss the clinical characteristic and surgical treatment of cervicothoracic spine fracture complicated with spine cord injury.

METHODSThirty-eight patients with cervicothoracic fracture and spine cord injury were retrospectively analyzed from January 1998 to January 2007. There were 29 males and 9 females with an average age of 36.4 years ranging from 18 to 58 years. All patient suffered from pain and limitation of motion on cervicothoracic junction. According to American Spinal Injury Association (ASIA) grades, 4 cases were in grade A, 13 cases in grade B, 10 cases in grade C, 7 cases in grade D and 4 cases in grade E. All patients were treated with anterior decompressed, bone graft and Zephir plate fixation in cervicothoracic spine.

RESULTSAll patients were followed up for 1 to 10 years, the mean followed up time was 4.5 years. And all patients got complete bone fusion within 4 to 6 months postoperatively. There were no pull-out and breakage of screws or plates. Spinal cord functional recovery improved on average 3.8 degree according AISA standard. Two patients appeared transient hoarse voice after surgery, the symptoms were alleviated from 3 to 6 months after operation. Seven patients were complicated with Horner syndrome preoperatively, and the symptoms were disappeared after operation.

CONCLUSIONThe clinical situation of cervicothoracic spine fracture with spine cord injury is complicated. And anterior decompressed, bone graft and internal fixation performed on cervicothoracic spine fracture can achieve an efficient and safe clinical outcome.

Adolescent ; Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; complications ; surgery ; Thoracic Vertebrae ; injuries ; surgery