Jefferson Fracture Resulting in Collet-Sicard Syndrome

Connolly, Brendon; Turner, C.B.; DeVine, John G.; Gerlinger, Tad L.

doi:10.1097/00007632-200002010-00023

Cited by 47 publications

(41 citation statements)

References 20 publications

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“…Quadriplegia and hemiparesis may occur for a few minutes, but most often these episodes rapidly fade away (11.7-33 % of patients) [20,21]. These neurologic deficits were reported most often when a concomitant fracture of the odontoid exists or with bilateral anterior arch fractures [20,22,23]. Cranial nerve palsies infrequently complicate Jefferson fractures; however, shifting of the lateral mass may contract the narrow space lateral to the transverse process of the atlas and medial to the styloid process of the skull, within which the 9th, 10th, 11th, and 12th cranial nerves pass [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…This space is only about 8-10 mm in diameter and may be nearly obliterated if the atlas is displaced laterally following fracture, giving rise to lower cranial nerve palsies [11]. Palsy of the lower four cranial nerves describes Collet-Sicard syndrome, which is a rare complication of Jefferson fractures [23]. Conversely, palsy of the greater occipital nerve with a Jefferson fracture is somewhat common (23.5 % of patients) [24].…”

Section: Discussionmentioning

confidence: 99%

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Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

et al. 2013

Eur Spine J

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Study design A retrospective study was conducted to evaluate anterior plate fixation of unstable atlas fractures using a transoral approach. Objective To further investigate the safety and efficacy of this surgical technique, as there is currently a paucity of available data. Summary of background data While most atlas fractures can be managed by external immobilization with favorable results, surgery is usually preferable in highly unstable cases. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1-C2 or C0-C2, but these techniques usually result in loss of joint function and cannot fully stabilize anterior arch fractures of the atlas. Although a transoral approach circumvents these issues, only nine cases were described in the literature to our knowledge. Methods Twenty patients with unstable atlas fractures were treated with this technique during a 6-year period. Screw and plate placement, bone fusion, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, strength, pain levels, and signs of infection were assessed clinically upon follow-up.Results There were no incidents of screw loosening or breakage, plate displacement, spinal cord injury, or vertebral artery injury. A total of 20 plates were placed and all 40 screws were inserted into the atlas lateral masses. CT scans demonstrated that two screws were placed too close to the vertebral artery canal, but without clinical consequences. Imaging demonstrated that bone fusion was achieved in all cases by 6 months postoperatively, without intervertebral instability. No plate-related complications were observed in any patients during the follow-up period. Conclusions C1 anterior plate fixation using a transoral approach appears to be a safe, reliable, and function-preserving surgical method for the management of unstable atlas fractures. For this type of fracture, a transoral approach with anterior fixation should be considered as an alternative to posterior approaches or conservative treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

et al. 2013

Eur Spine J

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“…We found only seven cases of Collet-Sicard syndrome following a blunt head injury reported in the readily available literature (Table 1). Cranial nerve palsies after head injuries occurred immediately in two cases, 5,8 and after several days in two other cases. 11,20 In three cases, initial neurological examination did not detect any cranial nerve palsy because of disturbance of consciousness.…”

Section: Discussionmentioning

confidence: 94%

“…14 Lower cranial nerve palsy following blunt head injury is relatively rare. 2,5,8,11,17,20,21 Here, we report a rare case of delayed lower cranial nerve palsy (Collet-Sicard syndrome) that developed 2 days after a head injury.…”

Section: Introductionmentioning

confidence: 95%

Delayed lower cranial nerve palsy (Collet–Sicard syndrome) after head injury

et al. 2006

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“…[3][4][5][6][7][8][9][10] There is only one reported case of atlas Jefferson fracture causing Collet-Sicard syndrome in the English language literature of the Medline database from 1966 to 2003. 11 Jefferson fractures are bursting injuries of the atlas, which rarely cause neurological deficits. This has been suggested to be a result of a greater transverse and sagittal diameter of the spinal canal at the first cervical spine, in addition to the mechanism of the lateral masses sliding away from the cord.…”

mentioning

confidence: 99%