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Trauma of the upper cervical spine

Trauma of the upper cervical spine. Dr. J. VAN LERBEIRGHE AZ ST LUCAS GENT. Upper cervical spine. Atlantooccipital junction C1-C2 trauma. Upper cervical spine. 1/3 of all injuries of the cervical spine High-energy trauma, polytrauma Often demanding diagnostic work out.

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Trauma of the upper cervical spine

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  1. Trauma of the upper cervical spine Dr. J. VAN LERBEIRGHE AZ ST LUCAS GENT Orthopedica Belgica Antwerpen

  2. Upper cervical spine • Atlantooccipital junction • C1-C2 trauma Orthopedica Belgica Antwerpen

  3. Upper cervical spine • 1/3 of all injuries of the cervical spine • High-energy trauma, polytrauma • Often demanding diagnostic work out Orthopedica Belgica Antwerpen

  4. Indication fot surgery ? • Understanding of the mechanism • Stability classification Orthopedica Belgica Antwerpen

  5. Upper cervical spine • ½ of the flexion- extension between C0-C1 • ½ of the rotation between C1-C2 • = High kinematic demands Orthopedica Belgica Antwerpen

  6. OBJECTIVES OF TREATMENT • Prevent or reverse neurologic deficit • Restore spinal stability • Prevent deformity or restore normal alignment • Allow early mobilisation Orthopedica Belgica Antwerpen

  7. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  8. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  9. Atlantooccipital dislocations • TYPE I • Anterior dislocation is the most common form • TYPE II • Longitudinal dislocation without anterior or posterior shifting • TYPE III • Posterior dislocation ( very rare) • TYPE IV • Lateral dislocation Orthopedica Belgica Antwerpen

  10. Atlantooccipital dislocations Orthopedica Belgica Antwerpen

  11. Learning points C0-C1 dislocation Orthopedica Belgica Antwerpen

  12. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  13. Fractures of the occipital condyles Orthopedica Belgica Antwerpen

  14. Fractures of the occipital condylesLearning points Orthopedica Belgica Antwerpen

  15. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  16. Fractures of the atlas Orthopedica Belgica Antwerpen

  17. Atlas Fractures Orthopedica Belgica Antwerpen

  18. Atlas fracture • Type I • Isolated fracture of the anterior ring • Type II • Isolated fracture of the posterior ring • Type III • Combined fracture of the anterior and posterior arch (Jefferson fracture) • Type IV • Isolated fracture of the lateral mass • Type V • Fracture of the transverse process Orthopedica Belgica Antwerpen

  19. Fractures of the atlas Orthopedica Belgica Antwerpen

  20. Atlas fractureNon-operative treatment • Minimal dislocation of only one lateral mass • No Instability on flexion extension X-Ray • 12 weeks orthosis followed by physical therapy Orthopedica Belgica Antwerpen

  21. “Jefferson” fractureslearning points Orthopedica Belgica Antwerpen

  22. “Jefferson” fractureOperative treatment Orthopedica Belgica Antwerpen

  23. “Jefferson” fractureOperative treatment Orthopedica Belgica Antwerpen

  24. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  25. Atlanto-axial instability • Type A: Anterior atlantoaxial instability • Type B: Posterior atlantoaxial instability • Type C: Rotatory atlantoaxial instability Orthopedica Belgica Antwerpen

  26. Atlanto-axial instability • Type A: Anterior antlantoaxial instability • Flexion injury • Adults > 3.5 mm atlantodental distance • Children > 5 mm atlantodental distance • Due to rupture or bony avulsion of the transverse ligament Orthopedica Belgica Antwerpen

  27. Atlanto-axial instability • Type A: Anterior antlantoaxial instability Orthopedica Belgica Antwerpen

  28. Atlanto-axial instability • Type B : Posterior atlantoaxial instability • Probably hyperextension • The tectorial as well as the alar ligaments must be torn Orthopedica Belgica Antwerpen

  29. Atlanto-axial instability • Type B : Posterior atlantoaxial instability • Probably hyperextension • The tectorial as well as the alar ligaments must be torn Orthopedica Belgica Antwerpen

  30. Atlanto-axial instability • Type C : Rotatory atlantoaxial instability • Type I • Without anterior gliding • Type II • Atlantodental interval up to 5 mm • Type III • Atlantodental interval of > 5 mm Orthopedica Belgica Antwerpen

  31. Atlanto-axial instability • Type C : Rotatory atlantoaxial instability • Type I • Without anterior gliding Orthopedica Belgica Antwerpen

  32. Atlanto-axial instability • Type C : Rotatory atlantoaxial instability • Type II • Atlantodental interval up to 5 mm Orthopedica Belgica Antwerpen

  33. Atlanto-axial instability • Type C : Rotatory atlantoaxial instability • Type III • Atlantodental interval of > 5 mm Orthopedica Belgica Antwerpen

  34. Atlantoaxial sagittal instabilitylearning points Orthopedica Belgica Antwerpen

  35. Atlanto-axial instability • Possibility of tetraplegia after another accident > prevention surgery • Possibility of slow onset myelopathy due to repeated trauma to the cord. Orthopedica Belgica Antwerpen

  36. Type C : Rotatory atlantoaxial instability • Skull traction • Stiff collar or Halo vest for 6-8 weeks • Manipulation under anesthesia? • Anterior transoral release and rotation under traction > C1-C2 fusion Orthopedica Belgica Antwerpen

  37. Type C : Rotatory atlantoaxial instabilitylearning points Orthopedica Belgica Antwerpen

  38. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  39. Traumatic SpondylolisthesisHangman’s Fracture • Type I • Stable undislocated. C2-C3 disc is intact and C2-C3 is stable ( 65%) • Type II • Unstable. The C2-C3 disc is torn and anteriorly displaced. • Type III • Type II injury with additional unilateral dislocation. Orthopedica Belgica Antwerpen

  40. Traumatic SpondylolisthesisHangman’s Fracture Orthopedica Belgica Antwerpen

  41. Traumatic SpondylolisthesisHangman’s Fracture Orthopedica Belgica Antwerpen

  42. Traumatic SpondylolisthesisHangman’s Fracturelearning points Orthopedica Belgica Antwerpen

  43. Traumatic SpondylolisthesisHangman’s Fracturesurgical treatment rationale Orthopedica Belgica Antwerpen

  44. Traumatic SpondylolisthesisHangman’s Fracturesurgical treatment rationale Orthopedica Belgica Antwerpen

  45. Atypical hangman’s fracture • Spinal stenosis • Trough the posteror body of C2 ! • Surgical treatment after reduction to maintain stability Orthopedica Belgica Antwerpen

  46. Upper cervical spine • Atlantooccipital dislocation • Fractures of the occipital condyles • Fractures of the ATLAS, Jefferson # • Atlantoaxial instability, fixed rotatory subluxation • Traumatic spondylolisthesis of the AXIS, Hangman’s # • Odontoïd fractures. Orthopedica Belgica Antwerpen

  47. Odontoïd fracturesAnderson and D’Alonzo • Type I • Tip of the dens • Type II • Fracture of the dens itself • Type III • Fracture of the dens with extension into the vertebral body Orthopedica Belgica Antwerpen

  48. Odontoïd fractures Orthopedica Belgica Antwerpen

  49. Roy Camilletype II • HORIZONTAL • OBAV • OBAR Orthopedica Belgica Antwerpen

  50. Odontoïd fracturessurgical treatmentodontoïd fixation ( 2 screws) Orthopedica Belgica Antwerpen

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