Bursting Atlantal Fracture Associated with Rupture of the Transverse Ligament

Spence, Kenneth F.; Decker, Scott H.; Sell, Kenneth W.

doi:10.2106/00004623-197052030-00013

Cited by 283 publications

(121 citation statements)

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“…Combined injuries in the UCS can be made up of several unstable injuries, of one unstable and one or several stable injuries, or of only stable injuries. Injuries that usually require surgical treatment in the UCS are Anderson & D'Alonzo type II and some type III dens fractures [13], types II and III traumatic spondylolistheses of the axis according to Levine and Edwards [18], and transverse atlantal ligament injuries with an atlas-dens interval of more than 5 mm [21,28]. Injuries that may require surgical treatment in the LCS are disc and soft tissue disruption showing instability, bilateral or unilateral facet dislocation and fracture-dislocation, lateral mass separation fracture [20], comminuted burst fracture of the vertebral body and teardrop fractures [29].…”

Section: Surgical Managementmentioning

confidence: 99%

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Gleizes

Jacquot

Signoret

et al. 2000

European Spine Journal

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Section: Surgical Managementmentioning

confidence: 99%

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Gleizes

Jacquot

Signoret

et al. 2000

European Spine Journal

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“…9 Spence et al studied the axial load of lateral mass displacement required to disrupt the TAL in 10 human specimens. 20 They suggested that, if the sum of the displacement of lateral masses of the atlas exceeded 6.9 mm with respect to the C-2 lateral edges in the presence of an atlas burst fracture, the TAL could plausibly be torn. Their suggestion was based on the assumption that an intact TAL would not be associated with lateral mass spread.…”

Section: Discussionmentioning

confidence: 99%

“…Spence et al 20 proposed that the lateral spread of the atlantal lateral masses with respect to the lateral limits of C-2 as measured on a transoral radiograph could be used to infer impairment of the TAL. Their criterion for suspecting a ruptured TAL was a spread greater than or equal to 7 mm.…”

mentioning

confidence: 99%

Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 2: A new CT-based alternative for assessing transverse ligament integrity

Pérez-Orribo

Kalb

Snyder

et al. 2016

SPI

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OBJECTIVE The rule of Spence is inaccurate for assessing integrity of the transverse atlantal ligament (TAL). Because CT is quick and easy to perform at most trauma centers, the authors propose a novel sequence of obtaining 2 CT scans to improve the diagnosis of TAL impairment. The sensitivity of a new CT-based method for diagnosing a TAL injury in a cadaveric model was assessed. METHODS Ten human cadaveric occipitocervical specimens were mounted horizontally in a supine posture with wooden inserts attached to the back of the skull to maintain a neutral or flexed (10°) posture. Specimens were scanned in neutral and flexed postures in a total of 4 conditions (3 conditions in each specimen): 1) intact (n = 10); either 2A) after a simulated Jefferson fracture with an intact TAL (n = 5) or 2B) after a TAL disruption with no Jefferson fracture (n = 5); and 3) after TAL disruption and a simulated Jefferson fracture (n = 10). The atlantodental interval (ADI) and cross-sectional canal area were measured. RESULTS From the neutral to the flexed posture, ADI increased an average of 2.5% in intact spines, 6.25% after a Jefferson fracture without TAL disruption, 34% after a TAL disruption without fracture, and 25% after TAL disruption with fracture. The increase in ADI was significant with both TAL disruption and TAL disruption and fracture (p < 0.005) but not in the other 2 conditions (p > 0.6). Changes in spinal canal area were not significant (p > 0.70). CONCLUSIONS This novel method was more sensitive than the rule of Spence for evaluating the integrity of the TAL on CT and does not increase the risk of further neurological damage.

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“…He also stated that the odontoid was stable, and therefore the spinal cord had not been damaged, and the patient did not present with neurological disorders related to CNS lesions. These concepts related to odontoid mobility, which were clearly expressed by Quercioli and unknown at the time he wrote the paper, anticipating the conclusions reached in modern scientific literature; [1][2][3]11,12 that is, the integrity of the transverse ligament is important for deciding whether these lesions should be treated conservatively or surgically.…”

Section: Discussionmentioning

confidence: 99%

Vincenzo Quercioli (1876–1939), researcher and pioneer of the atlas fracture

Domenicucci¹,

D²,

Mancarella³

et al. 2015

SPI

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A review of early 20th century literature regarding fractures of the atlas led the authors to discover a paper written in Italian by Professor Vincenzo Quercioli in 1908, at that time an assistant surgeon at the University of Siena. The work was published in the journal Il Policlinico, which at that time was directed by Professor Francesco Durante. The paper described the first case of a quadripartite fracture of the atlas, and it accurately reported the mechanism of injury, symptoms, neurological examination, treatment, complications, and cause of death of the patient. Quercioli performed an autopsy on the patient and gave a detailed description of anatomopathological features. In particular, he identified the 4 symmetrical fracture lines related to the arches of the atlas and the substantial integrity of the atlantoaxial ligaments, particularly the transverse ligament. Based on those findings, Quercioli concluded that the mechanism of trauma was an axial force. This force passed through the center of the vertebral ring and caused symmetrical displacement and compression of the articular masses. These concepts of dynamic physics led Quercioli to conclude that, because the atlas is wedge shaped, the masses of the atlas reacted to stress by moving away from the center. This reaction resulted in stretching the front and rear arches, which then fractured at their 4 points of weakness. The integrity of the spinal cord was intact, based on a negative neurological examination for CNS lesions. Thus, he concluded that these injuries were not fatal and could be cured by appropriate treatment with a Minerva cast and, in the presence of swallowing disorders, with a nasogastric tube. The case described by Quercioli was later mentioned in two classic works on atlas fractures by Sir Geoffrey Jefferson, published in 1920 and 1927. In those works, Jefferson proposed his classification of 5 different anatomopathological classes; this work is widely cited in the literature and should be considered a classic. The patterns and deductions that Jefferson reported on these fractures appeared to draw upon the scientific experience of Quercioli and his description of the quadripartite atlas fracture, which appeared to be unique, even in Jefferson's review. Therefore, the authors believe that they have identified another scientist and pioneer of the atlas fracture in Professor Vincenzo Quercioli. With his brilliant insights, which remain useful and valid, Quercioli led the way to further research on the subject.

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Bursting Atlantal Fracture Associated with Rupture of the Transverse Ligament

Cited by 283 publications

References 0 publications

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 2: A new CT-based alternative for assessing transverse ligament integrity

Vincenzo Quercioli (1876–1939), researcher and pioneer of the atlas fracture

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