Conservative and Operative Treatment in Extension Teardrop Fractures of the Axis

Hu, Yong; Kepler, Christopher K.; Albert, Todd J.; Hann, Shannon; Ma, Weihu; Yuan, Zhenshan; Dong, Weixin; Xu, Rongming

doi:10.1097/bsd.0b013e31828984f9

Cited by 12 publications

(29 citation statements)

References 14 publications

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“…Furthermore, the HTDFA could cause the compression of esophagus and induce the dysphagia during conservative treatment in some patients [11]. Hu et al retrospectively reviewed 16 patients with tear drop fracture of the axis and considered that large fragment size, displacement or angulation, intervertebral disc injury, neurologic deficit, or signs of instability were reasonable indications for surgical treatment [5]. Regardless of anterior or posterior approach, the surgical strategy should be aimed at restoring stability and cervical alignment by adopting C2/3 fusion in previous papers.…”

Section: Discussionmentioning

confidence: 99%

“…Prevertebral soft-tissue (PVST) swelling for this patient was diffuse ( Figure 3). After reviewing the literature, we found that only a dozen cases of HTDFA were reported in previous studies and the methods of operation were almost adopted C2-3 fusion surgery [3][4][5][6][7][8][9]. Considering the patient's age (42y) and his significant degeneration of C5/6, C6/7 and poor cervical curvature, C2-3 fusion surgery might accelerate the lower cervical degeneration.…”

Section: Case Reportmentioning

confidence: 99%

“…Due to questioning the stability of this injury by certain authors, the treatment strategy of teardrop fracture of the axis remains controversial and individualized [2]. However, for a huge and significant displaced fragment, especially combined with intervertebral disc injury and/or instability of C2-3, almost all authors chose C2/3 fusion surgery regardless of anterior or posterior approach in previous studies [3][4][5][6][7][8][9]. Almost no literature has been reported about no-fusion surgery method to treat huge teardrop fracture of the axis [HTDFA] with intervertebral disc injury and/or instability of C2-3.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Hollow Screw Fixation Combined with Posterior Lateral Mass Screws Fixation to Treat A Huge Tear Drop Fracture of The Axis

Lian¹,

Zhu²,

Guo³

et al. 2019

SCR

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Teardrop fracture of axis is rarely seen, especially the huge type. The surgical approach is controversial and individualized in the literature. We reported a special case to share our experience of anterior hollow screw fixation combined with posterior unilateral lateral mass screws fixation to treat a huge teardrop fracture of the axis (HTDFA). A 42-year-old male was referred to our department; he presented neck pain after a vehicle accident. Neck movement was limited with no neurological compromise. Cervical x-rays showed a huge tear drop fracture of the anterior–inferior corner of the axis，the lower cervical spine degeneration and poor cervical curvature. Cervical CT confirmed the avulsed ratio of inferior endplate of axis up to 62%. Cervical MRI showed the anterior longitudinal ligament disruption associated with disk injury and instability of C2-3. In order to save the motion segment of C2-3 and decrease the possibility of lower cervical degeneration if C2-3 fusion occurs, a surgical plan involving anterior reduction, hollow screw fixation combined with posterior unilateral mass screws fixation was performed. The 3 months postoperative x-ray and CT scan showed the tear drop fragment had completely healed. The internal fixations were removed timely for 6 months after surgery. The patient had an excellent function of cervical spine without any clinical symptoms. The 12 months postoperative X-ray showed radiographic union of the bony fragment and a good motion range without any instability. We conclude that anterior hollow screw fixation combined with posterior unilateral lateral mass screws fixation can be the treatment of choice for HTDFA

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior Hollow Screw Fixation Combined with Posterior Lateral Mass Screws Fixation to Treat A Huge Tear Drop Fracture of The Axis

Lian¹,

Zhu²,

Guo³

et al. 2019

SCR

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show abstract

“…Hu et al retrospectively reviewed 16 patients with tear drop fracture of the axis and concluded that most patients with an extension tear drop fracture of the axis can be treated conservatively but large fragment size, displacement or angulation, intervertebral disc injury, neurologic deficit, or signs of instability are reasonable indications for surgical treatment. 11 Opinions from the spinal surgeons in our department can also be grouped into three strategies: conservative treatment, anterior approach, or posterior approach. Some surgeons in our department preferred conservative treatment as they believed that the cervical spine was almost stable because its posterior structure remained undamaged; a halo-vest or skull traction was enough to prevent hyperextension; some surgeons in the department preferred the anterior approach because they believed that the large fragment (as in this case) was associated with C2/3 intervertebral disc injury and anterior stabilization was therefore a better method because it allowed direct reduction of the fracture fragment; some surgeons in the department suggested the posterior approach because they believed that posterior fixation may provide better stability.…”

Section: Discussionmentioning

confidence: 99%

Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis

Yang²,

Gong³

et al. 2016

Medicine

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Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA.A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (–), and Babinski sign (–). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior–inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment.Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other complex fractures, such as fracture of the posterior structure, an anterior and posterior union surgery is recommended.

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“…Five-year follow-up radiograph of bending and extending showed that the range of motion of the cervical was normal. Hu et al [20] reported 16 patients with tear-drop fracture, in which six patients underwent surgery, whereas 10 patients underwent Halo-vest immobilization. axis who all received conservative treatment; Vialle et al [17] reported an adult with tear-drop fracture of the axis receiving posterior fixation with C 2-3 arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Tear-drop fracture of the axis in a child with an 8-year follow-up

Bao

et al. 2014

Journal of Pediatric Orthopaedics B

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We reported a 12-year-old boy with neck pain and dysphagia 6 days after his neck being tied by another boy's arms from the back. The boy was found to have a tear-drop fracture of the axis in both radiograph and MRI, which was a rare case in children. He was placed in a cervical traction with Glisson belt and received transfusion for 2 weeks until his neck pain and dysphagia were released. Thereafter, an operation of anterior fusion and fixation was chosen to ensure further stability of the cervical spine and replacement of the fracture fragment. An 8-year follow-up examination showed a satisfactory range of motion of the cervical spine, fusion at C2-3 intervertebral space, and normal signal of C3-4 intervertebral disk. We conclude that tear-drop fractures of the axis in children may be caused by extension injury without a high-energy trauma, and operation of anterior fusion and fixation can be the treatment of choice.

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Conservative and Operative Treatment in Extension Teardrop Fractures of the Axis

Cited by 12 publications

References 14 publications

Anterior Hollow Screw Fixation Combined with Posterior Lateral Mass Screws Fixation to Treat A Huge Tear Drop Fracture of The Axis

Anterior Hollow Screw Fixation Combined with Posterior Lateral Mass Screws Fixation to Treat A Huge Tear Drop Fracture of The Axis

Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis

Tear-drop fracture of the axis in a child with an 8-year follow-up

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