• U Vieweg, B Meyer, and J Schramm.
• Department of Neurosurgery, University of Bonn, Bonn, Germany.
• Surg Neurol. 2000 Sep 1;54(3):203-10; discussion 210-1.

BackgroundA single-institution series of injuries of the upper cervical spine are analyzed retrospectively and the literature relevant to the topic is reviewed.MethodsSeventy patients (34 female, 36 male, mean age 47 years) were admitted during a 5-year period for injuries of the upper cervical spine. Sixty-five were followed for a mean time of 18 months. Three isolated ligamentous instabilities, 6 isolated C1 fractures, 3 complex C2 fractures, 10 combined C1/C2, and 48 C2 fractures (17 hangman's, 31 odontoid) were diagnosed. Twenty-nine patients were treated conservatively and for 41 patients surgery was the primary treatment. Twenty-three ventral odontoid screw fixations, 8 ventral platings and 10 dorsal stabilizations were performed. Stability was evaluated using flexion-extension radiography. Pain levels and neurological outcome were assessed.ResultsOperative mortality and neurological morbidity were 0%. Two wound infections and 3 instabilities (17%) in odontoid Type II fractures primarily treated with ventral odontoid screw fixation needed dorsal restabilization. During follow-up examinations the neurological status of three patients was improved. In 62 patients preoperative status was attained. Six patients evaluated their pain as severe, two as disabling.ConclusionsCandidates for surgery as the primary treatment include those with isolated ligamentous instabilities, Type III hangman's fractures and Type II odontoid fractures with dislocation more than 5 mm. In combined C1/C2 fractures the axis fracture dictates the treatment strategy. Patients who undergo dorsal procedures and have involvement of C1 have a greater chance of developing persistent pain.

28 keywords...

hide…