C2 Fractures in the Elderly: Single-Center Evaluation of Risk Factors for Mortality

Seo

et al. 2021

JCM

Spine surgeons often confuse C2 pedicle fractures (PFs) with pars interarticularis fractures. In addition, little information is available about the characteristics and treatment strategies for C2 PFs. We sought to investigate the characteristics of C2 PFs and to propose an appropriate treatment strategy. A total of forty-nine patients with C2 PFs were included in this study. We divided these patients into unilateral and bilateral C2 PF groups. The incidence rates and characteristics of other associated C2 and C2-3 injuries, and other cervical injuries, were evaluated. In addition, treatment methods and outcomes were analyzed. Twenty-two patients had unilateral C2 PFs and twenty-seven patients had bilateral C2 PFs. Among the cases of unilateral C2 PFs, all patients had one or more other C2 fractures, and twenty patients (90.9%) had one or two C2 body fractures. Meanwhile, among the cases of bilateral C2 PF, all patients had two or more other C2 fractures and one or two C2 body fractures. In unilateral C2 PFs, three patients with C2-3 anterior slip or adjacent cervical spine (C1-3) injury underwent surgery and nineteen patients (86.4%) were treated with conservative methods. In bilateral C2 PFs, three patients with C2-3 anterior slip or SCI at C2-3 underwent surgery and twenty-four patients (88.9%) were treated with conservative methods. Our results showed that C2 PFs do not occur alone and are always accompanied by other associated C2 injuries. C2 PFs should, generally, be thought of as a more complex fracture type than hangman’s fracture or dens fracture. Despite the complex fracture characteristics, most C2 PFs can be managed with conservative treatment. However, surgical treatments should be considered if the C2 PFs are accompanied by the C2-3 anterior slip and adjacent cervical spine injury.

Section: Discussionmentioning

confidence: 99%

“…C2 pedicle fracture (PF) is not an uncommon injury but has been given less attention than dens fractures or hangman's fractures [1][2][3][4][5][6][7]. The pedicle in the lumbar and thoracic spine is an important component that helps to maintain the stability of the spine, and this is similar in the cervical spine.…”

Section: Introductionmentioning

confidence: 99%

Proposal of Treatment Strategy for Pedicle Fractures of the C2: An Analysis of 49 Cases

Seo

et al. 2021

JCM

“…Tear drop (TD) fractures of the C 2 are rare traumatic injuries of the upper cervical spine, representing about 9%–12% of upper cervical spine injuries and 1%–3% of all cervical spine injuries 1 , 2 , 3 , 4 , 5 , 6 . Tear drop fractures of the C 2 axis differ in several ways from TD fractures in the lower cervical spine.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes for C₂ Tear Drop Fractures: Clinical Relevance to Hangman's Fracture and C_2‐3 Discoligamentous Injury

Rhee

et al. 2021

Orthopaedic Surgery

Objective:To analyze characteristics of surgically managed tear drop (TD) fractures of the C 2 axis associated with other injuries such as hangman's fracture and C 2-3 discoligamentous injury as well as treatment outcomes.Methods: A total of 14 patients (eight men and six women) with TD fractures of the C 2 , who were surgically treated at four national trauma centers of tertiary university hospitals from January 2000 to December 2017, were included in this retrospective study. The mean age of the patients was 45.5 years (ranging from 19 to 74 years). The characteristics, surgical treatment methods (anterior fusion vs posterior fusion), and results of 14 TD fractures of the C 2 were analyzed retrospectively. And the clinical relevance between C 2 TD fracture and hangman's fracture and C 2-3 discoligamentous injury was investigated through the co-occurrence between injuries. The mean follow-up time after surgery was 22.6 months (ranging from 12 to 60 months).Results: Among 14 patients with TD fracture of the C 2 , four patients (28.6%) had anterior TD fracture and 10 patients (71.4%) had posterior TD fracture. All 10 posterior TD fracture patients had anterior C 2-3 displacement. While two of four anterior TD fracture patients had posterior C 2-3 displacement, the remaining two did not. All 14 patients of TD fracture had at least two or more other associated C 2 injuries as well as C 2-3 discoligamentous injuries. About 92.9% (13/14) of the patients had typical or atypical hangman's fracture; 100% (10/10) of the posterior TD fracture patients had hangman's fracture, but 75% (3/4) of the anterior TD fracture had hangman's fracture. At admission, 13 patients were neurologically intact. However, the remaining patient had spinal cord injury with American Spinal Injury Association (ASIA) impairment scale B with C 2-3 bilateral facet dislocation. All four anterior TD fracture patients underwent posterior C 2-3 fusion. While four of 10 posterior TD fracture patients underwent C 2-3 anterior fusion, the remaining six underwent posterior fusion. At last follow-up, 100% (14/14) of the patients achieved solid fusion, and visual analog scale for neck pain was significantly improved (5.9 vs 2.2, P < 0.001). One patient with ASIA impairment scale B had significantly improved to scale D. No major complications occurred. Conclusion:Our study showed that surgically managed TD fractures of the C 2 showed a high incidence of other associated spine injuries including hangman's fracture and C 2-3 discoligamentous injury. Therefore, special attention and careful radiologic evaluation are needed to investigate the presence of other associated spine injuries including hangman's fracture and C 2-3 discoligamentous injury, which are likely to require surgery.

“…Anterior TD fractures of the C2 vertebra are a relatively rare cervical spine injury. Its incidence is about 9–12% of upper cervical spine injuries and 1–3% of all cervical spine injuries [ 1 , 2 , 3 , 4 , 5 , 6 ]. Anterior C2 TD fractures are commonly caused by extension injury that differs in several ways from TD fractures in the lower cervical spine.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Nonunion in Conservatively Managed Anterior Tear Drop Fractures of C2 Vertebra

Rhee

et al. 2021

JCM

Many anterior C2 (2nd cervical vertebra) tear drop (TD) fractures can be successfully managed with conservative treatment. However, due to the occurrence of nonunion, large-sized or complex anterior C2 TD fractures undergo surgical treatment. To date, no surgical treatment guidelines are available about anterior C2 TD fractures. Therefore, we performed this study to investigate the factors that may affect nonunion for anterior C2 TD fractures and to suggest surgical treatment guidelines. Thirty-three patients with anterior C2 TD fractures, who underwent conservative treatment and had a minimum 1-year follow-up, were divided into union (N = 26) and nonunion (N = 7) groups. Their radiological and clinical data were analyzed retrospectively and compared between the two groups. The avulsion fracture ratio (29.5% vs. 43.3%, p < 0.05) and fracture displacement (3.6 mm vs. 5.1 mm, p < 0.05) were higher in the nonunion group compared to the union group. Incidence of associated C2 injury was higher in the nonunion group compared to the union group (15.4% vs. 57.1%, p < 0.05). Union status was negatively correlated with associated C2 injury (correlation coefficient, CC = −0.398, p < 0.05). Our results suggest that surgical treatment could be considered for anterior C2 TD fractures with an avulsion fracture ratio > 43%, fracture displacement > 5 mm, or associated C2 injury.