▪ Transverse Atlantal Ligament Disruption Associated with Odontoid Fractures

Greene, Karl A.; Dickman, Curtis A.; Marciano, Frederick F.; Drabier, Janine B.; Drayer, Burton P.; Sonntag, Volker K. H.

doi:10.1097/00007632-199410150-00010

Cited by 85 publications

(29 citation statements)

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“…Neurologic injury, if present, usually results in catastrophic or fatal consequences due to the high level of spinal cord involved. Concomitant spinal injuries are present in up to 34% of patients; 85% occurring in the cervical spine, with the atlas most commonly affected [5][6][7][8]. The number of associated injuries is significantly more common in younger patients.…”

Section: Introductionmentioning

confidence: 99%

The long-term functional outcome of type II odontoid fractures managed non-operatively

et al. 2010

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Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients [65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients\65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.

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Section: Introductionmentioning

confidence: 99%

The long-term functional outcome of type II odontoid fractures managed non-operatively

et al. 2010

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“…6 Ruptures of the cruciate ligament can be further classified as ligamentous disruption versus avulsion of the atlantal tubercle. 11,12,24 During in vitro testing, the cruciate ligament was found to be so taut that catastrophic failure occurs upon any tear, described as the "all or none" phenomenon. 10,12,31 Failure of the tectorial membrane has also been associated with flexion in front-end motor vehicle collisions 35 and may lead to dural tears, as the superior-most aspect is continuous with the dura.…”

Section: Biomechanics Of Simple Cvj Pathologymentioning

confidence: 99%

Anatomy and biomechanics of the craniovertebral junction

Lopez

Scheer

Leibl

et al. 2015

FOC

117

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The craniovertebral junction (CVJ) has unique anatomical structures that separate it from the subaxial cervical spine. In addition to housing vital neural and vascular structures, the majority of cranial flexion, extension, and axial rotation is accomplished at the CVJ. A complex combination of osseous and ligamentous supports allow for stability despite a large degree of motion. An understanding of anatomy and biomechanics is essential to effectively evaluate and address the various pathological processes that may affect this region. Therefore, the authors present an up-to-date narrative review of CVJ anatomy, normal and pathological biomechanics, and fixation techniques.

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“…20 In cases of Type II odontoid fracture, instability will persist even after successful bone fusion is achieved. 24 Therefore, disruption of the TAL is a contraindication for anterior screw fixation for odontoid fractures. The incidence of concomitant TAL disruption and odontoid fracture is low.…”

Section: Incompetence Of the Talmentioning

confidence: 99%

“…The incidence of concomitant TAL disruption and odontoid fracture is low. In a study of 30 patients with odontoid fractures, Greene et al 24 reported a 10% incidence of TAL injury and advocated the use of MR imaging to assess TAL integrity as a part of the initial evaluation of all odontoid fractures. In a study of 77 patients with odontoid fractures, however, Sayama et al 51 reported no cases of atlantoaxial instability, and these authors recommended MR imaging screening only if patients present with neurological deficits or widening of the atlantodental interval greater than 3 mm on radiographs or CT scans.…”

Section: Incompetence Of the Talmentioning

confidence: 99%

Avoiding pitfalls in anterior screw fixation for Type II odontoid fractures

Mazur

Mumert²,

Bisson³

et al. 2011

FOC

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Anterior screw fixation of Type II odontoid fractures provides immediate stabilization of the cervical spine while preserving C1–2 motion. This technique has a high fusion rate, but can be technically challenging. The authors identify key points that should be taken into account to maximize the chance for a favorable outcome. Keys to success include proper patient and fracture selection, identification of suitable screw entry point and correct screw trajectory, achieving bicortical purchase, and placing 2 screws when feasible and applicable. The authors review the operative technique and present guidance on appropriate patient selection and common pitfalls in anterior screw fixation, with strategies for avoiding complications.

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▪ Transverse Atlantal Ligament Disruption Associated with Odontoid Fractures

Cited by 85 publications

References 0 publications

The long-term functional outcome of type II odontoid fractures managed non-operatively

The long-term functional outcome of type II odontoid fractures managed non-operatively

Anatomy and biomechanics of the craniovertebral junction

Avoiding pitfalls in anterior screw fixation for Type II odontoid fractures

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