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

Xu, Guanhua; Li, Weidong; Bao, Guofeng; Sun, Yuyu; Wang, Lingling; Cui, Zhenggang

doi:10.1097/bpb.0000000000000038

Cited by 5 publications

(10 citation statements)

References 23 publications

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“…We found that only a few cases of HTDFA were reported in previous studies (Table 1 ). 5 – 7 , 9 – 12 Results from these case reports indicated that both conservative and surgical treatment methods seemed effective in the treatment of HTDFA. In addition, both anterior and posterior approaches were reported to be effective with regards achieving bone fusion.…”

Section: Discussionmentioning

confidence: 90%

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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Section: Discussionmentioning

confidence: 90%

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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“…Surgical approaches have proven to be successful in pediatric cervical injury cases. They have been used in cases of spinal fracture-dislocations, burst fractures, compression fractures with concomitant deformity, and atlanto-occipital dislocation (Table 1) [1,[6][7][8][9][10][11][12][13][14][15]. The most common surgical intervention approach is posterior cervical fusion and occipitocervical fusion using autograft or allograft (94% vs. 80% fusion rate) has an overall fusion rate of 93% based on a systemic literature review [16].…”

Section: Discussionmentioning

confidence: 99%

Cervical Pediatric Spine Trauma Managed With Open Spinal Fixation and Instrumentation and a Review of the Literature

Gigliotti¹,

Farou²,

Salyvia³

et al. 2021

Cureus

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Cervical spine injuries in the pediatric population are rare. Most injuries to the cervical spinal cord and vertebral column can be managed nonoperatively; however, surgical management may be required in certain clinical scenarios. A posterior surgical approach has been previously preferred; however, the utilization of anterior spinal fixation and instrumentation has been limited. We present a small case series of patients presenting with a traumatic cervical spine injury and detail the feasibility of craniocervical junction (CVJ) and subaxial spinal fixation in the pediatric population. We report four cases involving pediatric patients, all of whom presented with cervical spine injuries necessitating operative intervention using a combination of the anterior and posterior operative approaches. All four patients recovered well, did not require surgical revision, and were neurologically intact at the last follow-up. Therefore, we conclude that spinal arthrodesis is a safe, effective way to manage spinal injuries in the cervical spine following traumatic injury.

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“…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%

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

Cited by 5 publications

References 23 publications

Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation 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

Cervical Pediatric Spine Trauma Managed With Open Spinal Fixation and Instrumentation and a Review of the Literature

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

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