Injuries of the Atlas and Axis

Grogono, B. J. S.

doi:10.1302/0301-620x.36b3.397

Cited by 58 publications

(12 citation statements)

References 3 publications

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“…Three of those patients were treated with collars, 1 with skull traction, and 1 with a Halo vest. The statement that an isolated fracture of the atlas is rather rare but by no means necessarily fatal (Jefferson, 1927;Hinchey and Bickel, 1945;Graubard and Ritter, 1949;Grogono, 1954;Seljeskog, 1978) accords with the present findings. The early statement by Jefferson in 1919 still holds: 'My first im pression was that a fracture of the atlas would be almost invariably followed by death.…”

Section: % (Amyes and Anderssonsupporting

confidence: 87%

“…Fractures of the neural arch, sometimes called Hangman's fracture or traum atic spondylolisthesis of the axis, are not very rare; they have a good prognosis and serious neurological damage is uncommon, 0-13 per cent, (Grogono, 1954;Schneider et ai., 1965;Cornish, 1968;Brashear et ai., 1975;Seljeskog, 1978;Effendi et ai., 1981). These results are also corroborated by the present investiga tion, with 1 % with serious neurological damage.…”

Section: % (Amyes and Anderssonmentioning

confidence: 99%

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Cervical spine injuries: a follow-up of 332 patients

1990

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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.

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Section: % (Amyes and Anderssonsupporting

confidence: 87%

Section: % (Amyes and Anderssonmentioning

confidence: 99%

Cervical spine injuries: a follow-up of 332 patients

1990

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“…The major part of occipital-C1-C2 motion is executed by the atlas and the axis, which form the center of motion between the head and the high cervical column, thus being vulnerable to traumatic injury [7].…”

Section: Discussionmentioning

confidence: 99%

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Botelho¹,

Palma

Abgussen

et al. 2000

European Spine Journal

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IntroductionThe stability of the atlantoaxial motion segment is unique. The lack of typical vertebral bodies and the arrangement of articular facets without protection against horizontal gliding make the articular system dependent mostly on the ligaments. Anterior C1-C2 dislocation is a rare and severe lesion in distraction caused by a predominantly ligamentous lesion, leading to displacement of the atlas on the axis [13].Vertebral displacements require reduction for neural decompression and stabilization. The most frequently used reduction mode is traction. This creates an unusual kind of stress in the craniocervical transition, called vertical distraction. Without ligamentous integrity, even a simple cranial traction can not be counterbalanced and may cause overdistraction among the vertebrae, with its consequences. Recently, traumatic vertical (longitudinal) dissociation between C1 and C2 has been described [8,15,19]. It is extremely difficult to predict which patient will develop this lesion after being subjected to the traction. Here, we describe the case of a patient with traumatic anterior atlantoaxial dislocation who developed a vertical dissociation after skull traction, studying its complications and how they are related to the skull traction. Case reportA 16-year-old female patient, E.C.S., who was run over by a vehicle on 5 May 1997, was immediately taken to the first aid clinic of Conjunto Hospitalar do Mandaqui, São Paulo, Brazil.Cardiorespiratory arrest was detected upon examination. She was submitted to resuscitation attempts. The patient was hemodynamically stabilized, and remained in a coma without opening her eyes and with no motor response, with a score of 3 on the Glasgow coma scale. She was submitted to computed axial tomography (CAT) of the skull, which permitted visualization of the high cervical column and identification of an anterior C1-C2 dislocation (scout view) (Fig. 1). The CAT scan showed a wide separation between the odontoid and the anterior C1 arch and a minimal bilateral displaced fracture of the anterior C1 arch (Fig. 2).Abstract Traumatic overdistraction between C1 and C2 may occur when all the ligaments connecting C2 to the skull are ruptured, and may be manifested when an attempt to reduce C1-C2 subluxation is made by means of traction. We describe here the case of a patient with traumatic anterior atlantoaxial dislocation, who developed atlantoaxial vertical dissociation after skull traction using a Gardner-Halo with lb 4.02 (1.5 kg) of weight. The identification of patients who are susceptible to this complication is difficult. In this case, it might have been prevented by avoiding spinal traction. The aim of this report was to show that vertical dissociation may occur in C1-C2 anterior dislocation submitted to spinal traction, and that other forms of reduction must be considered to treat these pathologies and avoid this potentially fatal complication.

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“…On recovering consciousness she complained of pain in the neck which was associated with spasm of the cervical muscles giving head tilt to the right. There was a grade 4 (MRC Scale) global weakness of the left arm with absent biceps and supinator reflexes, but no sensory loss. Standard antero-posterior and lateral cervical radiographs were reported as showing no abnormality.…”

Section: Case Reportsmentioning

confidence: 99%

Stable fractures of the atlas and axis in children.

Richards¹

1984

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY Three cases of stable fractures of the atlas and axis in children are presented. All patients presented with pain, spasm of neck musculature and head tilt along with a neurological deficit. All fractures were apparently stable; with conservative treatment all symptoms and signs resolved.Fractures of the atlas and axis without dislocation are rare, being particularly rare in children. Three cases are presented here along with discussion of their diagnosis and management. Case reportsCase I A 7-year-old girl was knocked down by a motorcycle in October 1981. She was unconscious for five minutes and suffered a simple, undisplaced fracture of the left ulna and a compound fracture of the left tibia. On recovering consciousness she complained of pain in the neck which was associated with spasm of the cervical muscles giving head tilt to the right. There was a grade 4 (MRC Scale) global weakness of the left arm with absent biceps and supinator reflexes, but no sensory loss. Standard antero-posterior and lateral cervical radiographs were reported as showing no abnormality. The symptoms and signs persisted for six weeks which led to investigation. Radiographs were repeated along with A-P and lateral tomography. These revealeil an abnormally high odontoid peg with tilting to the left, separation of the lateral masses of the atlas and a possible crush fracture of the right lateral mass of the axis (Fig). It was concluded that she had suffered a forced flexion injury on the right side, fracturing the anterior arch of the atlas and the right lateral mass of the axis. These injuries were thought to be associated with a mild traction injury of the left brachial plexus. She had been wearing a soft cervical collar from the time of injury which was replaced by a firm collar. She began to show signs of recovery of neck movements 8 weeks after injury. After supporting her neck in the firm collar for a further 3 weeks she was pain free with full neck mobility. During this period her arm weakness recovered completely. Examination revealed tendemess of the left upper cervical region with spasm of the cervical muscles and head tilt to the right. There was a grade 4+ (MRC Scale) right hemiparesis with normal reflexes and sensation. Cervical spine radiographs showed a compression fracture of the left lateral mass of the atlas with separation of the lateral masses. The odontoid was tilted to the right. As in case 1 it was felt that he had fractured the lateral mass and the anterior arch of the atlas. The hemiparesis was thought to be due to a mild cord contusion. He was placed in a firm cervical collar which was changed several days later to a plaster-of-Paris Minerva jacket. His hemiparesis rapidly recovered. The Minerva jacket was removed 6 weeks after injury and he was found to be pain free with no limitation of neck movement and no neurological signs.Case 3 A 4-year-old girl was knocked down by a car in May 1983. She was unconscious for a few minutes after impact but on admission to hospital was found to be fully alert with a l...

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Injuries of the Atlas and Axis

Cited by 58 publications

References 3 publications

Cervical spine injuries: a follow-up of 332 patients

Cervical spine injuries: a follow-up of 332 patients

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Stable fractures of the atlas and axis in children.

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