OBJECTIVE: To investigate the possible mechanism and fracture stability of subtypes of type B Hangman's fracture by using imaging observation. METHODS: Patients with type B Hangman's fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients' age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C _{2, 3} instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C ₂ vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability. RESULTS: A total of 86 cases of type B Hangman's fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups ( P>0.05). However, the incidence of spinal cord injury in POA group was the highest ( P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest ( P<0.05). The incidences of vertebral arch floating and C _{2, 3} instability in IAP group were the highest ( P<0.05). There were significant differences in SAFA and VBRA between groups ( P<0.05). There was no significant difference in SAFD between groups ( P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant ( P<0.05). There were 78 cases of unstable Hangman's fracture, including 2 cases of simple C _2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. CONCLUSION The mechanism of different subtypes of type B Hangman's fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C _{2, 3} intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
Humans ; Spinal Fractures/surgery* ; Male ; Female ; Cervical Vertebrae/diagnostic imaging* ; Middle Aged ; Adult ; Tomography, X-Ray Computed ; Aged ; Odontoid Process/injuries* ; Fracture Fixation, Internal/methods* ; Young Adult

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

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*

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*

OBJECTIVETo summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.

METHODSFrom March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.

RESULTSThe mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.

CONCLUSIONPatients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.

Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Loose Bodies ; complications ; surgery ; Male ; Middle Aged ; Odontoid Process ; pathology ; Spinal Fusion ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the therapeutic effects of atlantoaxial pedicle screw in treating odontoid process fracture by location through inferior and inner wall of atlas and superior and inner wall of axis.

METHODSFrom June 2006 to September 2010, 12 patients with odontoid process fracture were treated with the atlantoaxial pedicle screw fixation by location through inferior and inner wall of atlas and superior and inner wall of axis. There were 8 males and 4 females, ranging in age from 18 to 62 years, with an average of 37.9 years. According to classification of Anderson, type II was in 10 cases and type III was in 2 cases. Fresh fracture was in 9 cases and old fracture was in 3 cases. All patients had symptoms such as cervical pain, stiffness and limitation of activity and 9 cases with symptoms were found physical signs of cervical spinal injury. According to grade of ASIA, grade C was in 4 cases and grade D was in 5 cases.

RESULTSThere were no severe complications such as injuries of vertebral artery, nerve root and spinal cord during operation. The mean time of follow-up was 14 months (6 to 24 months). The X-ray film and CT scanning showed that all patients had steady bony union and all screws were in the proper position, no screws loosening or breaking were found. Clinical symptoms of all patients improved significantly. Nine patients with spinal injury before operation, of which nerve function obtained improvement, grade C was in 1 case, grade D was in 2 cases and grade E was in 6 cases according to grade of ASIA.

CONCLUSIONLocation through inferior and inner wall of atlas and superior and inner wall of axis is an effective method for the atlantoaxial pedicle screw implantation; atlantoaxial pedicle screw could be accurately and safely implanted thought this way.

Adolescent ; Adult ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Odontoid Process ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Recovery of Function ; Spinal Fractures ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the efficacy of anterior percutaneous screw fixation in the treatment of odontoid process fractures in aged people.

METHODSFrom February 2001 to April 2009, 15 elderly patients with odontoid fracture were treated with anterior percutaneous screw fixation,including 13 males and 2 females; the average age was 69.3 years (ranged, 60 to 86 years). According to Anderson classification, there were 10 patients with type II fractures (type II A in 7 cases, type II B in 3 cases, based on Eysel and Roosen classification), 4 patients with shallow type III fractures, 1 patient with deep type III fractures. Thirteen patients were fresh fractures, 2 patients were obsolete fractures. All patients had varying degrees of neck or shoulder pain, and limit activity of neck. There were 4 patients with neural symptoms including 2 grade D and 2 grade C according to Frankel classification. All the patients were followed up and were assessed by radiology. Clinical examination included neck activity, neurological function and the degree of neck pain. Radiology examinations including anteroposterior, lateral, open mouth position and flexion-extension radiographs of cervical vertebra were performed.

RESULTSAfter surgery, all patients were followed up,and the duration ranged from 6 to 60 months (averaged 31.3 months). Two patients died of other diseases during the follow-up period (18 and 22 months after surgery respectively). All patients got satisfactory results, and all screws were in good position. As the screw was too long, esophagus was compressed by screw tail in one case. One case showed fibrous union, 12 cases had achieved solid bony union, 2 cases showed nonunion without clinical symptoms. The rotation of neck in 3 cases was mildly limited,the neck function of the remaining patients were normal. Four patients with symptoms nerve injuries improved after operation (Frankel E in 3 cases, Frankel D in 1 case). The symptom of neck pain had a significant improvement after surgery (P < 0.001). The VAS score decreased from preoperative (6.07 +/- 1.44) (4 to 8 scores),to postoperative (1.13 +/- 0.92) (0 to 3 scores). And there were no severe postoperative complications.

CONCLUSIONThe anterior percutaneous screw fixation is less traumatic than conventional approaches for aged people in dealing with odontoid process fractures. Most patients will achieve satisfactory clinical results, as long as the general conditions of them are comprehensively assess. However, this procedure should not be used in patients with comminuted odontoid fractures or severe osteoporosis.

Aged ; Aged, 80 and over ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Odontoid Process ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Skin ; Tomography, X-Ray Computed

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

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

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