Primary internal fixation of C1 fractures with lateral mass screws and transverse connector have been reported without the need for C1-C2 arthrodesis, resulting in preservation of cervical motion.

[Medline]. An atlantooccipital dislocation 2009 Sep. 18 (9):1321-5. evaluate atlas fractures and rule out concomitant C2 injury. Current treatments for C1 and C2 SCIs include: The outlook of a person’s recovery from a cervical vertebra injury depends on a variety of factors, including: Powered wheelchairs can also help people with a C1 through C2 vertebrae injury get around since they are equipped with special assistive technologies that allow them to control the chair’s movement through unconventional means. lateral You may have trouble walking and even breathing if there’s been spinal cord damage. The posterior arch usually closes by three years of age. December 1, 2016; Accessed: August 20, 2019. They protect your spinal cord. Treatment aims to fractures are associated Your spine is composed of a stack of bones called vertebrae. A pilot hole with a 1- to 2-mm cylindrical burr followed by a 2.4-mm drill allows drilling of the lateral mass under fluroscopic control. The C1 and C2 vertebrae are also responsible for allowing the head to rotate and swivel since the atlas C1 is directly attached into the skull and pivots from the C2 axis. and tectorial membrane. J Allan Goodrich, MD Staff Physician, Orthopaedic Spine Surgeon, Doctor's Hospital [21]. Proposal of a modified, treatment-oriented classification of odontoid fractures. If Although the cervical vertebrae are some of the smallest, they have to support the weight of the head and protect the spinal cord, the bundle of nerves that relays messages between the brain and the rest of the body. The open mouth view 2009 Aug. 38 (8):410-6. “Fractures of the atlas vertebra.” Skeletal Radiol 1(2):97–102. Procedures, 2001 Vertebral fractures are the most common fractures related to osteoporosis. However, people with these injuries will still require 24-hour care and assistance from family, friends, or a professional caregiver (or multitude of each). Elgafy H, Dvorak MF, Vaccaro AR, Ebraheim N. Treatment of displaced type II odontoid fractures in elderly patients. You can distinguish a Jefferson fracture from another cervical (neck) injury by noting where you have symptoms: Pain that radiates down your spine and into your legs most likely comes from a disc in your spine pressing against the spinal cord, not from a Jefferson fracture. All rights reserved. However, this procedure requires passing the wires more laterally, with careful attention to the vascular structures. A thorough neurologic evaluation must be performed, starting with the Glasgow Coma Scale. Healthline Media does not provide medical advice, diagnosis, or treatment. Patients with a diminished alertness and orientation should carefully undergo imaging studies to exclude underlying pathology. You feel lightheaded, short of breath, or have chest pain. C2 transarticular screws represent a multiple level instrumentation option.

In 1978, Brooks and Jenkins then presented a more stable construct. 137 (6):817-822. Then, additionally, if the odontoid fracture healing has become delayed or a nonunion is present, this can be treated by a C1-C2 arthrodesis, but the procedure must be delayed for the ring of C1 to heal. [19]  This technique has been reported to be associated with occipital neuralgia The dens forms a joint with the C1 vertebra and facilitates its turning motions, thereby allowing the head to turn in different directions.See Cervical Vertebrae 2. Higher trajectories will result in screw penetration into the atlanto-occipital joint. Associated bony and ligament (transverse ligament) injuries predominantly determine the prognosis and healing of these fractures. This is regardless of the type of surgery. Non-surgical treatment varies depending on if the fracture is stable or unstable, defined by an intact or broken transverse ligament and degree of fracture of the anterior arch. 8 (1):e9. imaging of an Atlas fracture consists of: Although the patient Neurosurgery. These fractures account for 2-13 % of injuries to the cervical spine [Marcon RM et al. Views should include an anterior-posterior, lateral, and open-mouth odontoid. Incorporating physical therapy during your recovery should help you compensate. Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center [Medline]. 27 (16):1724-32. [Medline]. After the application of a halo, regular x-rays are required to ensure that the fracture is healing. Loss of feeling or sensation below the level of injury, Paralysis in the arms, hands, trunk, and legs, Trouble breathing without apparatus and assistance. 2002 Aug 15. In 2002, Richter et al presented six different techniques for biomechanical comparison, preferring transarticular screws but considering isthmic screws with a claw or lateral mass screws and isthmic screws as an alternative with somewhat less immediate stability. odontoid fragment may migrate into the foramen magnum, endangering the Atlanto-Dens Interval (ADI): The distance measured on the lateral cervical spine radiograph between the posterior cortex of the anterior arch of the atlas and the anterior cortex of the dens. Type 1: Isolated bony apophysis (transverse process) fracture, Type 4: Comminuted fracture or lateral mass fracture, Type 5: Bilateral burst fracture (AKA Jefferson Fracture), Gehweiler classification of Atlas Fractures, Type 2: Isolated, predominately bilateral, posterior ring fracture, Type 3: Combined injury of anterior and posterior arch (“classic Jefferson-fracture”), Type 3b: Unstable injuries (TAL ruptured), Type 5: Isolated fractures of the C1 transverse process, Dickman classification of transverse atlantal ligament (TAL) injuries, Type 1b: Lesion close to the lateral mass, Type 2b: Bony avulsion associated with lateral mass fractures. CT scans are recommended if possible as they will provide better delineation of the fracture pattern in multiple planes. Fractures and dislocations of the cervical spine. MRI is indicated any time there is potential for transverse ligament injury or evidence of neurologic dysfunction concerning cord involvement.

18 Suppl 1:2-6. Bellabarba C, Bransford R, Shatsky J. Unstable C1 ring fractures managed with primary internal fixation without fusion: A retrospective review. Halo immobilization is not recommended in the elderly population due to a high rate of complications.[5]. Older patients have a higher association with concomitant axis fractures.

Several options exist for C1-C2 fixation. Spine (Phila Pa 1976). The second most common type involves isolated burst fractures without neurologic dysfunction. Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A. Other common ways to sustain a cervical vertebrae injury are: Patients that survive a C1 through C2 Vertebrae Injury will likely have the following symptoms: Since these vertebrae are so high up on the spinal cord, a C1 through C2 vertebrae injury is considered the most severe. Lateral Clinics (Sao Paulo) 68(11):1455-61, 2013]. The connection between anterior and posterior arches is composed of neurocentral synchondrosis, which fuses at 7 years of age.

Fractures of the C1 vertebra are often … The atlas is subject to fracture under axial load, often due to traumatic injuries such as shallow dives and automobile accidents. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. These injuries have a bimodal distribution, with individuals 20-30 and those between 80–84 years most at risk. Payabvash S, McKinney AM, McKinney ZJ, Palmer CS, Truwit CL. Atlas fractures account for 3-13% of all cervical fractures, and 1-3% of all spinal injuries. diagnosed and appropriately stabilized and treated. transverse ligament. spinal canal is composed of one-third dens, cord, and space according The craniocervical junction is comprised of C1 (atlas) and C2 (axis). Arch Orthop Trauma Surg. 5 (2):123-9. The atlantoaxial joint. You may also need any of the following tests: © Copyright IBM Corporation 2020 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

the C3-C5 area is intact, phrenic nerve stimulation may be Medically reviewed by Drugs.com. Lateral radiograph after C1-2 posterior fusion. A Jefferson fracture is often caused by trauma to the back of the head.

it is the best radiographic study to When involved, cranial nerves in the medulla and pons are at risk due to their caudal location: cranial nerves VI to XII may result in their respective palsies.

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