Cervical spine injuries: a follow-up of 332 patients

Abstract

SUlDlDaryA follow-up of 332 consecutive cervical spine injury patients is described. Treatment was with collars (47%), operation (6%), skull traction (24%) and Halo vest (23%).There was a large number of cervical spine injuries at the C2 level, and odontoid process fractures constituted 35% of all cervical spine injuries. The bad reputation of cervical spine injuries with high mortality rates, high non-union rates, and a high incidence of severe neurological impairment could not be confirmed. Traffic accidents affected the younger age categories, and injuries from falls the older ages. The accidents occurred in 95% during leisure, and at least 22% of the patients were under the influence of drugs and/or alcohol. Halo vest treatment gave a low complication rate, a low use of hospital bed days, sick leave and disability pension, compared with operations and skull traction treatment. The complication rate as sociated with the skull traction and operative treatment was unacceptably high. Key words: Cervical spinal injuries; Follow-up study.In the nineteenth century, the diagnosis of a cervical spine injury was made at autopsy in criminals with a fracture dislocation of the axis who had been ex ecuted by hanging. As non-invasive investigation methods such as radiography did not exist before 1895, cervical spine injuries were regarded as rare and fa tal. The interest of these injuries was initially focused on the upper cervical region (Mixter and Osgood, 19lO;Fritzsche, 1913;Jefferson, 1920;Osgood and Lund, 1928). They could only be diagnosed at post-mortem and therefore had a bad reputation.In later studies, however, mortality rates as low as 4% have been reported; 5/63 = 8% (Amyes and Andersson, 1956), 14/77 = 18% (Rogers 1957) and 1/26 = 4% (Nachemson 1960),3/68 = 4% (Althoff 1979).The first publication of a patient treated by an operation was a patient with delayed union of an odontoid fracture (Mixter and Osgood, 19lO). The posterior arch of the atlas was stabilised with the spinous process of the axis with silk.

Complications des traumatismes du rachis cervical supérieur chez les sujets âgés. Revue systématique de la littérature

“…Les lésions du RCS seraient plus fréquentes chez les plus de 74 ans avec une mortalité plus élevée [4,7,15,36]. Comme pour la plupart des traumatismes du sujet âgé, les études soulignent la responsabilité de la modification des structures anatomiques (ostéoporose, arthrose) associée à un traumatisme à faible énergie [3,6,7,10,43].…”

Traumatismos de la columna cervical alta: Clasificación tipológica, indicaciones terapéuticas y abordajes quirúrgicos (a propósito de 286 casos)

“…Alrededor de un 40% de las fracturas de la AO se asocian a otras fracturas del complejo C1-C2 29,44 . De éstas un 20% corresponden a fracturas del arco posterior de C1, impidiendo la aplicación de técnicas de fijación interlaminares, al menos en fases precoces.…”

C2 Trauma

“…Traumatic C2 fractures are reportedly the most common cervical spine injuries (17 to 25%). [5][6][7] These include fractures through the pars interarticularis (hang-The upper cervical vertebrae have a complex embryologic origin that allows for support of the head while still providing a wide range of motion. 1,2 The axis is a composite structure derived from three sclerotomes and four primary ossification centers.…”

“…Fractures at nonadjacent cervical levels occur in 9% of cases with C2 injuries and most often involve C5 or C6. 5,6 Many patients (22 to 56%) have concomitant head injuries, which make their primary evaluation more difficult and contribute significantly to their mortality. 6,7 PATIENT EVALUATION Evaluation of patients with suspected cervical injuries can be challenging in some circumstances.…”

“…5,6 Many patients (22 to 56%) have concomitant head injuries, which make their primary evaluation more difficult and contribute significantly to their mortality. 6,7 PATIENT EVALUATION Evaluation of patients with suspected cervical injuries can be challenging in some circumstances. The American Association of Neurological Surgeons (AANS) Section on Disorders of the Spine and Peripheral Nerves has recently released a compendium of guidelines for the management of acute cervical spine injuries.…”