A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine

Allen, Ben L.; Ferguson, Ron L.; Lehmann, Thomas R.; O’Brien, Regina

doi:10.1097/00007632-198200710-00001

Cited by 556 publications

(207 citation statements)

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“…The types of fractures and dislocations were categorised according to the mechanistic classification of Allen et al [4]. Of the 144 cases, 81 were distractive flexion (DF) injuries, 25 were compressive flexion (CF), 27 were compressive extension (CE), 7 were vertical compression (VC) and 4 were distractive extension (DE).…”

Section: Patientsmentioning

confidence: 99%

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Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

et al. 2009

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Cervical pedicle screw fixation is an effective procedure for stabilising an unstable motion segment; however, it has generally been considered too risky due to the potential for injury to neurovascular structures, such as the spinal cord, nerve roots or vertebral arteries. Since 1995, we have treated 144 unstable cervical injury patients with pedicle screws using a fluoroscopy-assisted pedicle axis view technique. The purpose of this study was to investigate the efficacy of this technique in accurately placing pedicle screws to treat unstable cervical injuries, and the ensuing clinical outcomes and complications. The accuracy of pedicle screw placement was postoperatively examined by axial computed tomography scans and oblique radiographs. Solid posterior bony fusion without secondary dislodgement was accomplished in 96% of all cases. Of the 620 cervical pedicle screws inserted, 57 (9.2%) demonstrated screw exposure (\50% of the screw outside the pedicle) and 24 (3.9%) demonstrated pedicle perforation ([50% of the screw outside the pedicle). There was one case in which a probe penetrated a vertebral artery without further complication and one case with transient radiculopathy. Pre-and postoperative tracheotomy was required in 20 (13.9%) of the 144 patients. However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation. The placement of cervical pedicle screws using a fluoroscopy-assisted pedicle axis view technique provided good clinical results and a few complications for unstable cervical injuries, but a careful surgical procedure was needed to safely insert the screws and more improvement in imaging and navigation system is expected.

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Section: Patientsmentioning

confidence: 99%

“…A 38-year-old man incurred a C5-7 fracture and dislocation (CE stage 5, Allen classification [4]) and an ASIA A neurological deficit. Sagittal and axial CT images showed C5-7 lamina fracture, left C5 and right C6 pedicle fracture, and C7 vertebral body fracture (Fig.…”

Section: Illustrative Casementioning

confidence: 99%

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

et al. 2009

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“…There may be rotation of the articular mass in either the sagittal or the coronal plane with this injury resulting in characteristic findings on the radiographic examination. The mechanism of injury is hyperextension with rotation, although flexion and rotation has also been implicated [24,25,26,27]. This injury may be associated with other fractures and with contralateral facet dislocation.…”

Section: Traumatic Isolation Of the Articular Pillarmentioning

confidence: 99%

“…This injury results from a flexion and lateral rotation mechanism [26,30]. The most frequent levels of occurrence are C5±6 and C6±7, although this entity may be seen at other levels as well, even at C2±3 [31].…”

Section: Unilateral Interfacetal Dislocationmentioning

confidence: 99%

Rotational injuries of the cervical spine

Rhea

2000

Emergency Radiology

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Injuries which are caused in part by a rotational mechanism include atlantoaxial rotatory fixation (AARF), traumatic isolation of the articular pillar (TIAP), and unilateral interfacetal dislocation (UID). The anatomy, classification, radiographic findings, and frequency of neurological signs are reviewed. Key points include: AARF: (1) Mild injury is not diagnosed radiographically since the appearance is the same as for physiologic rotation. More significant injuries demonstrate widening of the atlanto-dens interval ( > 3 mm in adults) and/or abnormal rotation ( > 45 ) of C1 on C2.(2) AARF refers to an inability to return the head to a neutral position. This may be due to trauma resulting in subluxation or dislocation or may be due to muscle spasm in torticollis. TIAP: (1) Radiographic diagnosis depends on visualizing ipsilateral pedicle and lamina fractures.(2) Rotation of an articular mass from its normal orientation on radiographs implies the presence of this injury. However, rotation of the articular mass is not always present, and the ipsilateral pedicle and lamina fractures must be seen on radiographs or CT. UID:(1) Less rotational discrepancy than expected can occur in two circumstances: articular mass fracture with dislocation or significant subluxation on the contralateral side. (2) Less anterolisthesis than expected can occur if there is articular mass fracture with dislocation.

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“…As a first step, we began to quantify the stabilizing potential of ACFP depending on the extent of destruction of posterior ligaments [22].…”

Section: Introductionmentioning

confidence: 99%

Posterior Element Injury and Cervical Spine Flexibility Following Anterior Cervical Fusion and Plating

Pitzen¹,

Matthis²,

Steudel

2002

European Journal of Trauma

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Background: The purpose of this study was to quantify the stabilizing effect of anterior cervical fusion and plating (ACFP) on various grades of simulated flexion/distraction injuries to the human cervical spine. Material and Methods: A finite element approach was used. Digitized data from computed tomography of a human cervical spine were taken to generate a threedimensional, anisotrophic, linear finite element model (FEM) C4-C7. Based on this FEM of the intact segments (FEM 1), an additional model was generated: FEM with simulation of ACFP of C5/6 using bicortical screws (FEM 2). Loading of each FEM was simulated using pure moments of ± 2.5 Nm in flexion/extension, left/right axial rotation, and left/right lateral bending. For validation of the models, their predictions of range of motion (ROM) C5/6 were compared to the results of a previous, corresponding in vitro study, using human segments C4-C7 surgically altered with the same implants. Results: Results obtained by the FEM 1 and 2 for each loading case were within one standard deviation of the results of the corresponding in vitro study. Thus, alterations of FEM 2 were used in the following to predict the changes in flexibility C5/6 after stepwise transection of the posterior ligaments. An increase in ROM occurred in each loading case after transection of single components, which was pronounced in rotation and bending following removal of the capsules. Conclusions: ACFP may be sufficient for flexion-distraction injuries if the capsular ligaments and facets are not injured.

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A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine

Cited by 556 publications

References 0 publications

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

Rotational injuries of the cervical spine

Posterior Element Injury and Cervical Spine Flexibility Following Anterior Cervical Fusion and Plating

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