Dislocation Of Cervical Spine Research Articles

Use of cervical transpedicular fixation for fracture and dislocation of lower cervical spine

Objective To investigate the method and effect of treating fractures and dislocations of lower cervical spine utilizing cervical transpedicular fixation. Methods The 38 cases of fracture and dislocation of lower cervical spine who had been treated in our department from June 2003 to June 2006 were retrospectively analyzed.They were 27 males and 11 females,aged from 22 to 63 years(mean,44.3).Of them. 6 cases presented with fracture and dislocation of unilateral facet, 13 with fracture and dislocation of bilateral facets. 14 with fracture and dislocation of bilateral facets and compression fracture of vertebral body,and 5 with cervical burst fracture and dislocation.All of them had spinal injury in different degrees.According to American Spinal Injury Association(ASIA)grading system,18 cases were rated as grade A,12 as grade B,6 as grade C,and 2 as grade D. Results All the patients were followed up for 10 to 24 months,with a mean foilow-up of 11 months. In 4 to 6 months postoperatively,all the 38 cases achieved bony fusion and stable segmental fixation. Conclusions In treatment of fracture and dislocation of lower cervical spine,cervical transpedicular fxation is an effective and reliable method of rebuilding cervical stability,promoting fusion of bone graft.and maintaining postoperative physiological curvature of cervical spine.It also allows convenient nursing and early functional exercise. Key words: Cervical vertebrae; Fracture; Fracture fixation,internal

Fibular allograft and anterior plating for dislocations/fractures of the cervical spine

Background:Subaxial cervical spine dislocations are common and often present with neurological deficit. Posterior spinal fusion has been the gold standard in the past. Pain and neck stiffness are often the presenting features and may be due to failure of fixation and extension of fusion mass. Anterior spinal fusion which is relatively atraumatic is thus favored using autogenous grafts and cages with anterior plate fixation. We evaluated fresh frozen fibular allografts and anterior plate fixation for anterior fusion in cervical trauma.Materials and Methods:Sixty consecutive patients with single-level dislocations or fracture dislocations of the subaxial cervical spine were recruited in this prospective study following a motor vehicle accident. There were 38 males and 22 females. The mean age at presentation was 34 years (range 19-67 years). The levels involved were C5/6 (n = 36), C4/5 (n = 15), C6/7 (n = 7) and C3/4 (n = 2). There were 38 unifacet dislocations with nine posterior element fractures and 22 were bifacet dislocations. Twenty-two patients had neurological deficit. Co-morbidities included hypertension (n = 6), non-insulin-dependent diabetes mellitus (n = 2) and asthma (n = 1). All patients were initially managed on skull traction. Following reduction further imaging included Computerized Tomography and Magnetic Resonance Imaging. Patients underwent anterior surgery (discectomy, fibular allograft and plating). All patients were immobilized in a Philadelphia collar for eight weeks (range 7-12 weeks). Eight patients were lost to follow-up within a year. Follow-up clinical and radiological examinations were performed six-weekly for three months and subsequently at three-monthly intervals for 12 months. Pain was analyzed using the visual analogue scale (VAS). The mean follow-up was 19 months (range 14-39 months).Results:Eight lost to followup, hence 52 patients were considered for final evaluation. The neurological recovery was 1.1 Frankel grades (range 0-3) and two patients with root involvement recovered. At six months bony trabeculae at the graft-vertebrae interface were noted. There were 12 (20 %) cases of graft collapse and one case of angulation which showed no progression. At six months the VAS was 3 (range 0-6). There was no limitation of neck motion at six months in 47 patients.Conclusion:Fresh frozen fibular allografts are suitable and cost-effective for anterior fusion in cervical trauma.

Anterior cervical fusion and locking plate stabilization for cervical fracture and dislocation

目的 观察颈椎骨折脱位前路减压、融合、带锁钢板螺丝钉内固定治疗的临床效果.方法 28例颈椎骨折脱位的患者均行前路减压、复位、植骨、带锁钢板内固定治疗,其中采用自体三面髂骨皮质骨23例,钛网植骨5例,神经功能按Frankel分级标准于术前及最后一次随访时进行评定.结果 全部病例获随访至少8个月,平均随访10个月,骨折脱位复位满意,植骨块均获融合,无钢板螺钉钛网松动、断裂、退出、下沉等并发症.术后最后一次随访Frankel分级平均改善1.2级.结论 颈椎骨折脱位前路减压、复位、植骨、带锁钢板内固定治疗可获得满意复位和即刻稳定,有利于脊髓功能的恢复。

Fatal Birth Trauma Due to an Undiagnosed Abdominal Teratoma

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.

Surgery for fracture dislocation of lower cervical spine through combined anterior and posterior approaches

下颈椎骨折脱位是三柱均遭破坏的严重颈脊椎损伤.传统的方法是闭合大重量牵引复位,前路或后路减压、固定、植骨融合术.但对一些未能复位或合并椎间盘损伤压迫脊髓不适合闭合复位者,目前尚无统一的治疗模式.单纯的后路或前路手术,不能达到既减压充分又恢复脊柱序列和重建脊柱稳定性的目的。

Surgical strategy for severe cervical spine dislocations

To evaluate the rate of open reduction and surgical strategy of severe cervical dislocation. From March 2001 to March 2006, the data of 92 cases of cervical dislocation over 1/2 were retrospectively studied. Garden Well traction with 1 - 3 kg weight were performed before operation. The patients were performed with diskectomy and reduction with anterior approach initially, for those that can not be reduced, corpectomy were performed and reduction procedures were repeated. The posterior reduction and fixation were followed when reduction can not be reached with anterior approach only. The succeed rate of reduction, rate of tracheotomy were recorded and fusion rate, Frankel score and visual analog scale (VAS) were evaluated. Reduction succeed in 38 cases after diskectomy, 44 after corpectomy and 7 after combined anterior-posterior-anterior procedure. Three cases got incompleteness reduction. Tracheotomy was done in 29 cases. The Frankel score increased 0.5 degree and VAS was 2 averagely at the last follow-up. The succeed rate of anterior open reduction was 89.2%, and only 10.8% patients needs an additional combined posterior and anterior approach. For patients with completed spinal cord injury with dislocation above C(4), or with dislocation below C(5) but the edema on MRI T2 image are above C(4) level need tracheotomy. The operation be done until respiratory function stable. For patients with completed spinal cord injury with dislocation below C(4) and uncompleted spinal cord injury with dislocation above C(4), the rate of tracheotomy is relatively lower and early operation is recommended.

The Management of Bilateral Interfacetal Dislocation with Anterior Fixation in Cervical Spine : Comparison with Combined Antero-Posterior Fixation

Combined antero-posterior fixation has been a standard method for bilateral interfacetal dislocation in cervical spine. The purpose of this study is to evaluate the efficacy and complication of anterior cervical stabilization in treatment of bilateral interfacetal dislocation. A total of 65 cases of traumatic bilateral interfacetal dislocation in cervical spine who were managed in our institution, from Mar. 1997 to Feb. 2006, were included in this study. Closed reduction was tried in all cases before operation. If closed reduction was accomplished successfully, only anterior cervical fixation was performed (Group I), and attempted to place screws bicortically as possible with unicortical screws. If failed, posterior open reduction with fixation was first tried, followed by anterior cervical fixation (Group II). All patients were evaluated for neurological outcome and radiological evidence of healing. The Group I included 47 patients and the Group II, 18 patients. The improvement of Frankel grade and increase of mean cervical lordosis angles were not statistically different between two groups. Screw-plate system used did not influence the outcome. On follow up, solid bone fusion was evident and there were no cases of instability in both groups. Our study demonstrated that anterior cervical fixation on BID is safe and effective in comparison with combined antero-posterior cervical fixation.

Delayed Diagnosis of a Patient with Cervical Spine Injury resulting in Complete Cervical Spine Dislocation without Serious or Lingering Neurological Signs: A Case Report

Background: Following a car accident, patient complains of hip and neck pain, and weakness in the right upper extremity. Evaluation in the emergency room, as well as radiographs revealed a normal cervical spine with mild degenerative changes. The following day, the patient complained of neck pain and bilateral hand numbness. Preparation for flexion-extension radiograph led to a complete anterior dislocation at C5-C6. Results: Following anterior and posterior fusion of the cervical spine, Physical Therapy and Occupational Therapy evaluation revealed mild non-fatigable weakness of the bilateral upper extremities and negative neurological testing. Conclusion: Initial physical examination did not reveal cervical spine pathology. However, physical and neurological examinations were incomplete. A proper diagnostic exam, including a detailed physical and neurological examination, as well as a proper series of diagnostic tests may have eliminated the possibility that the cervical spine injured patient would face the dire consequences of a severely unstable cervical spine.

Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine

Traumatic facet dislocations and facet-fracture dislocations in the lower cervical spine (C2/C3 to C7/T1) are frequently associated with devastating neurological symptoms. A good outcome can only be achieved if the operator has wide and sound knowledge of reduction techniques and the best possible strategy is devised for the subsequent treatment of these severe lesions. Between 1973 and 1997 a total of 117 of our patients met at least one of the following inclusion criteria: unilateral locked facet dislocation (48%), bilateral locked facet dislocations (23%), unilateral "perched" facet subluxation (14%), bilateral perched facet subluxation (12%), uni- or bilateral dislocation/perched subluxation with facet fractures (3%). Most of the lesions were located at the levels of C5/C6 and C6/7 (n=46 for each). Associated neurological deficits were present initially in 65% of patients: 35% had complete or incomplete spinal cord injuries (tetraplegia), 2% were paraplegic, and 28% had cervical radiculopathies. Closed reduction (e.g. with the aid of a halo ring) should be carried out as soon as possible after lower cervical spine dislocation or facet-fracture dislocation, as both the success rate of reduction and the potential for recovery from neurological deficits are clearly higher when reduction is achieved within the first 4 h after the initial injury.

Anterior Reduction for Cervical Spine Dislocation

Retrospective analysis of a prospectively followed cohort. Long-term evaluation of patients with anterior stabilization for dislocations of the cervical spine. Level 1 trauma center. Anterior stabilization of unstable cervical spine injuries is gaining popularity. However, the method of open reduction is controversial. Forty-one consecutive patients with unstable dislocations/subluxations of the subaxial cervical spine were included. Closed reduction was attempted in all patients using Gardner-Wells traction. If this failed, an anterior open reduction was performed. Tricortical iliac crest autograft and anterior plating was used. Patients were assessed for: 1) rate of successful reduction and stabilization using only the anterior surgical approach; and 2) complications and long-term clinical and radiologic outcome. Two of eight (25%) anterior open reductions failed requiring posterior surgery. One of these patients had associated pedicle fractures with horizontal rotation of the lateral masses. All grafts had healed successfully at the most recent follow-up visit. Moderate neck discomfort was found in 5 of 41 patients. Significant neurologic improvement was observed. Most subluxations/dislocations of the subaxial cervical spine can be reduced using Gardner-Wells traction and successfully stabilized with anterior surgery alone. If closed reduction fails, anterior open reduction is successful in the majority of cases.

Missed diagnosis of cervical spine dislocation: A case report

Missed diagnosis of cervical spine dislocation: A case report

The selection of the surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury

To investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury. The clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach. All patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery. For lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.

Treatment of old dislocation of lower cervical spine by reduction with high weight traction and internal fixation of anterior fusion

目的 探讨大重量牵引复位前路融合内固定治疗陈旧性下颈椎脱位的价值和注意事项.方法本组 8例,男 5例,女 3例,受伤至入院时间 3周～ 6个月,平均 2.5个月,入院后行颅骨牵引,逐渐增加重量,难以复位者行小关节突切除,复位后行前路植骨融合,钢板内固定术.结果 8例患者均获较好的复位,其中 6例获完全复位;复位牵引重量 10～ 18kg,平均 13.5kg; 6例获得随访,平均随访 14.5个月,按 Frankel分级,除 1例 A级患者无恢复外,其余 5例均有恢复,分别改善 1或 2级;所有患者均获骨性融合. 结论采用大重量颅骨牵引,难以复位者辅以小关节突切除,复位后行前路植骨融合,钢板内固定术治疗陈旧性下颈椎脱位,疗效满意.

Anterior/posterior operative reduction of cervical spine dislocation: techniques and literature review

Anterior/posterior operative reduction of cervical spine dislocation: techniques and literature review

Contribution to the surgical treatment of patients with cervical spine cord injury using simple procedures.

Thirty-nine patients with acute cervical spine fractures and/or dislocations between C3 and C7 were submitted to an anterior approach using bone graft fixation without screw and plate systems and three required a preliminary posterior approach to reduce a dislocation. Graft dislodgement due to technical problems occurred at a rate of 7.7% postoperatively and 2.8% 1 month later. No redislodgement occurred. All fusions became solid after 3 months. Their progress was based on the Frankel scale, before surgery, at the moment of the discharge, and at 6 months follow-up. This experience shows how patients with an acute cervical injury can improve even when admitted late after trauma.

Treatment of old dislocations of the lower cervical spine.

We treated surgically 12 patients with an old dislocation of the lower cervical spine. The time from injury to presentation averaged 3.5 (range 1.5-12) months, and the majority of the dislocations were between C4-5. Treatment started with 1 week of skull traction. If this resulted in reduction the area was stabilised by anterior fusion with plate fixation. If reduction by traction did not succeed a posterior partial facetectomy was performed. If this allowed reduction it was followed by a posterior fusion with plate fixation. If reduction was not achieved the traction was continued for a further week and then followed by anterior discectomy and fusion with plate fixation. The average follow-up was 34 (range 12-54) months, and all patients developed bone fusion and showed neurological improvement.

Posterior approach for low cervical fractures with unilateral or bilateral facet dislocation

We evaluated treatment by posterior approach and its results for unilateral and bilateral facet dislocation of the lower cervical spine. Fracture reduction and ultimate stabilization of low cervical fractures located between C3 and C7 depend on the mechanism of the lesion and the resulting affectation of the osteoligamentary structures. The varied surgical approaches to fractures with unilateral or bilateral luxation include anterior, posterior, and combined. No surgery is performed if a conservative approach is used. Of the 71 low cervical fractures treated in our service in 10 years, 42 were facetary luxations (unilateral in 24 patients and bilateral in 18). Radiological studies included X-ray, CT and, in some cases, MRI. Once cervical fracture was diagnosed, halo traction was initiated and the decision to operate (34 cases) or continue conservative treatment (eight cases) was made a week after admittance. Surgery consisted of the posterior approach (27 bilateral clamps with bone graft, 5 wires with bone graft, and two posterior plates). Average patient follow-up was 7 (range 2-12) years. The patients' neurological status improved in 30 cases (71.42%) and was unchanged in 12 (28.57%). Three of eight patients initially treated conservatively developed radicular pain and instability and underwent surgery. Clamps were placed via a posterior approach in one case and the other two cases required a combined posterior and anterior approach. No instrumentation has required removal, although one patient developed a wall abscess. We found a posterior approach provides good stability for placing an arthrodesis in patients with a unilateral or bilateral cervical dislocation. In most of our cases we used clamps, and there was no worsening of any patient's neurological condition.

Injuries to the cervical spine in American football players.

A national registry has documented data on more than 1300 cervical spine injuries resulting from tackle football. Axial loading of the cervical spine is the primary injury mechanism, an observation with profound implications regarding implementation of preventative measures. Characteristic injury patterns involving the middle (third and fourth) cervical segment and the more favorable response to prompt reduction of these injuries are emphasized. The marked instability and grave prognosis of axial load teardrop fractures are attributed to the associated sagittal vertebral body and posterior arch fractures. Spear tackler’s spine is described and is classified as an absolute contraindication to participation in collision sports. Cervical cord neurapraxia, with or without transient quadriplegia, is neither associated with nor presages permanent neurologic sequelae. However, there is a considerable risk of recurrence, which can be predicted on the basis of canal diameter data. The concept of spinal cord resuscitation is proposed as a means of obtaining maximum neurologic recovery by reversing the secondary injury phenomenon that occurs in acute spinal cord trauma. Athletic trauma to the cervical spine resulting in injury to the spinal cord is an infrequent but potentially catastrophic event. Recognition of the problems presented by injury to the cervical spine and spinal cord led to a series of field, clinical, and basic research studies conducted over the past twenty-five years. As a result of these efforts, basic questions have been answered regarding the epidemiology, prevention, pathomechanics, pathophysiology, and histochemical responses of reversible and irreversible cervical cord injuries. Allen et al.1 studied 165 closed indirect fractures and dislocations of the lower cervical spine, demonstrating various “spectra of injuries,” and developed a classification based on the mechanism of injury as determined by the presumed attitude of the cervical spine at the time of failure and the initial dominant mode of failure. The common …

Interruption of the spinolaminar line at C6 and C7: a normal variant

Objective: To describe a normal variant of the lower cervical spine manifested as interruption of the spinolaminar line. Although disruption of this line is a useful sign of significant cervical spine injury, it is important to note that this finding may represent a normal variation. Conclusion: Interruption of the spinolaminar line at C6 and C7 does not necessarily represent cervical spine dislocation and/or fracture and may be a normal anatomic variant. Knowledge of this fact may prevent false diagnosis and avoid unnecessary investigation. We propose that an alteration in facet joint orientation at C6 and C7 may represent the etiology of this normal variant.

Neural foraminal enlargement on axial images: A radiologic sign indicative of bilateral interfacetal dislocation or subluxation of the cervical spine

We describe neural foraminal enlargement as a radiologic sign indicating bilateral interfacetal dislocation or subluxation injuries (BID/S) of the lower cervical spine on axial images. Axial neural formainal width was measured by computed tomography or magnetic resonance imaging in 10 patients with BID/S and compared with measurements in 20 control patients. In both the BID/S patients and controls, the size of the foramina at the injured level was compared with the foramina at levels immediately above and below the injury. These measurements were compared for statistical significance using Student's t-test. The width of the injured foramina averaged 10.4 mm in BID/S and 5.3 mm in controls (P<0.001). The enlargement in the BID/S cases relative to foramina above and below the injured level was statistically significant. The sign was also assessed qualitatively for detection of BID/S by three reviewers blindly analyzing 19 cases (9 BID/S and 10 controls) for signs of widened neural foramina. The pooled blinded review yielded a sensitivity of 81% and a specificity of 83% for neural foraminal enlargement as a sign indicative of BID/S. We describe enlargement, of neural foramina as a radiologic sign corroborative of BID/S on axial images.