Although most patients with cervical fractures have damaged the lower cervical spine, there remain a significant number whose injury involve the atlanto-axial level. Since the diagnosis of fracture of he odontoid process was initially missed frequently, it is worth emphasizing the importance of adequate radiological studies for this potentially lethal lesion in head injury patient. The treatment for fractures of the odontoid process has consisted of reduction followed by immobilization using skeletal traction, a plaster case or halo device, or internal fixation by surgical intervention. The advantages of early surgical treatment to minimize external immobilization or prolonged bed confinement are generally accepted but the surgical techniques have varied widely. The authors have managed a case of traumatic atlanto-axial dislocation in a child combined with severe brain injury by internal fixation using wire only after reduction of the dislocation was accomplished by skeletal traction. The available literature regarding this injury is reviewed.
Brain Injuries ; Child* ; Craniocerebral Trauma ; Diagnosis ; Dislocations* ; Humans ; Immobilization ; Odontoid Process ; Spine ; Traction

Vascular injury presented immediately after the penetration, but delayed onset of vascular symptom caused by an embolism or vessel dissection after cervical fusion or traumatic event is extremely rare. We present a case of a 56-year-old woman who underwent an operation for cervical fusion for type II Odontoid process fracture. She presented symptoms of seizure with hemiparesis in 6 days after the operation. Multifocal acute infarction due to an embolism from the left VA (V3 segment) dissection was observed without a definite screw breach the transverse foramen. We hereby reported the instructive case report of delayed onset of vertebral artery dissection after posterior cervical fusion with type II odontoid process fracture patient. When a cervical operation performed in the cervical trauma patient, even if no apparent VA injury occurs before and during the operation, the surgeon must take caution not to risk cerebral infarction because of the delayed VA dissection.
Cerebral Infarction ; Embolism ; Female ; Humans ; Infarction ; Middle Aged ; Odontoid Process ; Paresis ; Seizures ; Vascular System Injuries ; Vertebral Artery Dissection*

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Odontoid Process ; injuries ; Perioperative Nursing ; Postoperative Care ; Spinal Fractures ; surgery

Axis, Cervical Vertebra ; injuries ; Cervical Atlas ; injuries ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Odontoid Process ; injuries ; Spinal Fractures ; diagnosis ; surgery ; Spinal Fusion

OBJECTIVETo investigate the mechanism, clinical features and treatment of odontoid fracture combined with lower cervical spinal injury.

METHODSFrom January 1999 to December 2004, 57 cases of type II or shallow type III odontoid fractures were studied retrospectively. Six cases were found combined with lower cervical injury, the mean age was 54 years, and 4 of the 6 cases were complicated with cervical spondylarthrosis or ankylosing spondylitis. For the lower cervical injury, fracture-dislocation was found in 2 cases, the disruption of disc and ligament was found in 4 cases among which 2 cases were suffered from incomplete spinal cord injury; Both were caused by lower cervical spinal injury. All of the 6 cases were performed with surgery in odontoid fracture and lower cervical spinal injury simultaneously; Lower cervical spinal injuries were stabilized firstly in 2 cases, which responsible for neurological involvement; For the other 4 cases without neurological involvement, stabilization was performed in odontoid fracture firstly in 2 cases, due to inability to achieve reduction of odontoid fracture preoperatively, however, for the another 2 cases with anatomic reduction of the odontoid fracture preoperatively, lower cervical injuries were stabilized firstly.

RESULTSAfter an average follow-up of 10 months, all cases were obtained solid fusion both in odontoid fracture and lower cervical spinal injury, and without the complications associated with operation and prolonged bed rest. Two cases with neurological defect improved 1 scale in Frankel score.

CONCLUSIONSThe incidence of odontoid fracture combined with lower cervical spinal injury is about 10.5% of the odontoid fracture, and it is vulnerable in the elderly patient with cervical spondylarthrosis. MRI should be used routinely for accurate diagnosis. Surgical stabilization is the choice of treatment due to facilitating early rehabilitation and reducing the complications. The surgical schedule is planned according to the fact of neurological involvement and the extent of stability between the odontoid fracture and lower cervical spinal injury.

Adolescent ; Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Odontoid Process ; injuries ; Retrospective Studies ; Spinal Fractures ; diagnosis ; surgery ; Treatment Outcome ; Young Adult

Adult ; Atlanto-Axial Joint ; surgery ; Bone Screws ; Female ; Fractures, Bone ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Odontoid Process ; injuries ; Tomography, X-Ray Computed

Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
Cell Body ; Cervical Cord ; Demyelinating Diseases ; Facial Pain ; Head ; Humans ; Neck ; Odontoid Process ; Pons ; Spinal Cord ; Spinal Injuries ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia

OBJECTIVE: To evaluate diagnostic value of spiral CT reconstruction in atlantoaxial injuries. METHODS: The images of 25 cases of spiral CT reconstruction were analyzed and compared with images of CT scan and X-ray. RESULTS: In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan. CONCLUSION Spiral CT reconstruction can provide the most accurate and integrity imaging information and is very useful in the diagnosis of atlantoaxial injuries and deformity.
Accidents, Traffic ; Adolescent ; Adult ; Atlanto-Axial Joint/injuries* ; Cervical Atlas/injuries* ; Child ; Female ; Forensic Medicine/methods* ; Humans ; Joint Dislocations/diagnostic imaging* ; Male ; Middle Aged ; Odontoid Process/injuries* ; Retrospective Studies ; Spinal Injuries/diagnostic imaging* ; Tomography, Spiral Computed/methods* ; Young Adult

OBJECTIVETo evaluate the value of multi-spiral CT thinner scanning and three-dimensional and multi-planar reconstruction in the diagnosis of atlantoaxial fracture and dislocation.

METHODSSixty-nine patients suffered from atlantoaxial injuries included 54 males and 15 females with an average age of 46.5 years ranging from 17 to 73. Roentgenograph, multi-spiral CT thinner scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) were applied for patients before and after surgery.

RESULTSMulti-spiral CT thinner scanning and reconstruction provided clear images for all subjects. There were 49 odontoid bone fractures (Anderson type II 35, type III 14), 9 cases combined injuries of C1 and C2 (Jeffson's fracture associated with Hangman fracture), 6 of C1 burst fractures and 5 of C2 vertebral body fractures. While only 38 cases (38/69) were correctly diagnosed according to roentgenographs, 23 missed diagnosis, 6 couldn't be diagnosed clearly and 2 misdiagnosis. The position of internal fixation could be seen clearly in CT imaging after surgery. There were two screws perforated the lateral wall of C1 and three perforated the superior wall.

CONCLUSIONThe multi-spiral CT thinner-scanning, three dimensional reconstruction (3D) and multi-planar reconstruction (MPR) provide clear imagings to diagnose the details of atlantoaxial fractures and dislocations, and to select the therapeutic regimen. It can also be used to check the position of the internal fixation after surgeries. So it can be the first eikonic choice for atlantoaxial injuries.

Adolescent ; Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Cervical Atlas ; injuries ; Female ; Fracture Fixation, Internal ; Humans ; Image Processing, Computer-Assisted ; methods ; Internal Fixators ; Male ; Middle Aged ; Multi-Institutional Systems ; Odontoid Process ; injuries ; Spinal Fractures ; therapy ; Tomography, Spiral Computed ; methods ; Young Adult

STUDY DESIGN: Retrospective review. PURPOSE: We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. OVERVIEW OF LITERATURE: Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. METHODS: Between January 1, 1998 and March 2011, 30 patients (23 males, 7 females; mean age, 70.43 years; range, 45 to 95 years) with the radiographic diagnosis of AS of the spinal column had 42 fractures. Eight patients presented with significant trauma, 17 after falls, and 5 after minor falls or no recorded trauma. Eleven patients presented with a neurological injury, ranging from mild sensory loss to quadriplegia. RESULTS: There were 16 compression and 10 transverse fractures, two Jefferson's fractures, one type II and two type III odontoid process fractures, and five fractures of the posterior spinal elements (including lamina and/or facet, three spinous process fractures, three transverse process fractures). Twenty-four fractures affected the craniocervical junction and/or cervical vertebrae, 17 were thoracic, and one involved the lumbar spine. The most affected vertebrae were C6 and T10. The mean follow-up was 29.9 months. One patient was lost to follow-up. Eighteen patients were treated conservatively with bed rest and bracing. Twelve patients underwent surgery for spinal stabilization either with an anterior, posterior or combined approach. CONCLUSIONS: Nonsurgical treatment can be considered especially in the elderly patients with AS and spinal trauma but without instability or major neurological deficits. The nonfusion rate in conservatively treated patients is low. When treatment is selected for patients with spinal fractures and AS, the pattern of injury must be considered and the need for individualized treatment is paramount.
Accidental Falls ; Aged ; Bed Rest ; Braces ; Cervical Vertebrae ; Diagnosis ; Epidemiology ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Mortality ; Odontoid Process ; Quadriplegia ; Retrospective Studies ; Spinal Fractures ; Spinal Injuries* ; Spine ; Spondylitis, Ankylosing*