Transorale Korrekturosteotomie einer in Fehlstellung verheilten transdentalen Luxationsfraktur

Seelig, M. G.; Roth, R; Wörsdörfer, O.; Keerl, R.

doi:10.1007/s001130050619

Cited by 3 publications

(2 citation statements)

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“…A meaningful number of subtypes of C2-fractures exists where complete reduction, normal C1-2 rotation and a physiological anatomy is difficult to restore [1,10,11,34,42,43,71,82]. Likewise, a non-anatomical posttreatment C2-alignment, resembling a malunion, can cause significant symptoms even indicating fusion C1-2 [13,26,30,42,47,51,52,67,70,71,78,79] as it had to be done in one of our cases (Fig. 3), two others being scheduled (Fig.…”

Section: Malunion Of C2mentioning

confidence: 88%

“…Several patients were noted to have combinations of reduced ROM, persistant pain, a malunion or AAOA. Müller [49] stressed the importance of anatomical alignment in C2-fractures and the findings of the current study give evidence that with an increasing number of C2-fragments, deformation of the C2 vertebral body and particularly fractures of the C2 lateral mass clinical outcome drops: Fractures involving the C2 articular pillar can be isolated articular or lateral mass fractures or extensions of vertebral body fractures [5,26] and were found to be prone to a high rate of nonanatomical union [21] frequently indicating secondary fusion of C1-2 [30,67,70]. Up to 50% of Hmfx involve the articular facets of C2 and in the largest sample regarding anterior fusion C2-3 for the treatment of unstable Hmfx, Koller [46] observed a decreased functional and clinical outcome with a subset of patients having reduced rotation C1-2 and motion induced C2-referred pain.…”

Section: Clinical Outcomementioning

confidence: 93%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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Section: Malunion Of C2mentioning

confidence: 88%

Section: Clinical Outcomementioning

confidence: 93%

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Die direkte Osteosynthese instabiler Atlasfrakturen Gehweiler Typ III

Böhm

Kayser²,

H³

et al. 2006

Unfallchirurg

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This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. We introduce a new technique of direct reconstruction of the atlas vertebra. This technique leads to a stable ring construct that allows compression osteosynthesis of the fracture. Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.

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Spinal Stenosis C1-2 Following Redo Surgery For Failed Odontoid Screw Fixation - Scrutinizing The Odontoid Fracture Classification

2007

IJSS

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There are sparse data concerning redo surgery for failed odontoid screw fixation and posttraumatic spinal stenosis C1-2. Also, a comprehensive classification of odontoid and C2-vertebral body fractures does not exist. We report on a referred patient with spinal stenosis C1-2 following anterior screw fixation for an alleged unstable odontoid type III fracture, secondary cutout of the odontoid screw, malunion at the fracture site, and uncommon redo anterior fusion C2-3. Utilizing static and dynamic X-rays, MRI, dynamic CT and MRI, and neurophysiological tests, the indications for revision surgery were worked up. Finally, surgical intervention in our patient was not performed. The patient remained free of symptoms in one-year follow-up. Spinal stenosis C1-2 following an odontoid type III fracture is discussed on a selected review of literature. The strictly applied classification in our case, as well as its definition of osseous instability is scrutinized. Full diagnostic work up and a review of literature supports approaching treatment solutions in failed odontoid surgery with spinal stenosis C1-2, but an individual biomechanically based approach to odontoid and vertebral body fractures of C2, and their failed surgery is still demanded.

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Transorale Korrekturosteotomie einer in Fehlstellung verheilten transdentalen Luxationsfraktur

Cited by 3 publications

References 2 publications

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Die direkte Osteosynthese instabiler Atlasfrakturen Gehweiler Typ III

Spinal Stenosis C1-2 Following Redo Surgery For Failed Odontoid Screw Fixation - Scrutinizing The Odontoid Fracture Classification

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