Operative Treatment For Cervical Spine Fractures

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Operative Treatment For Cervical Spine Fractures

• Dr. T. G. Hogan

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Occipito-cervical Dissociation
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Occipitocervical Instability
Basion-Dens-Interval lt12 mm. gt12 mm. Suggests
Vertical Instability Basion-Axial-Interval lt
12mm gt12mm. Suggests Anterior Instability lt0mm.
Suggests Posterior Instability
Basion
Basion Axis Int lt12
BDI lt 12
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Occipitocervical Dislocation

• Mechanism Unclear
• Rotation Distraction
• Neurological Deficits Confusing
• High Tetraplegia
• Cruciate Paralysis
• Wallenbergs Syndrome
• Ligamentous Injuries Unstable
• Avoid Traction

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Atlas Fractures Extension

• Anterior Arch
• Hyper-extension
• Avulsion of Longus Colli
• R/O Other Injuries
• 65 (Landells)
• Stewart G, Radiology 1977

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Atlas Fractures Extension

• Posterior Arch Fractures
• Occipital Pain Numbness
• Stable
• R/O Other Injuries
• (Odontoid )

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Jefferson Fractures

• Four Part Burst
• Axial Load
• 6.9 mm Overhang
• Spence KF, JBJS, 1970
• 8.1 mm Overhang
• Heller JG, J Spinal Disord, 1993

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Lateral Mass Fractures of C-1

• Free-Floating Lateral Mass of C-1
• Often Comminuted
• Segal Stauffer, JBJS, 1987

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Treatment Results C-1 s

• Good Results Reported with
• Halo Traction Vest
• Rigid or Simple Orthoses
• Late Pain
• Ant/Post Arch 50
• Jefferson 70
• Lateral Mass 33
• Landells, VanPeteghem, Spine 1987

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Anderson DAlonzo Classification (JBJS, 1974)

• Type I
• Type II
• Type III

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Odontoid fractures
Type 1 Type 2 Type 3
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Type II Odontoid

• Halo-Thoracic Brace
• Non-union Rate 14-32-75
• Risk Factors
• Failure to Treat
• 5mm Displacement
• gt10 deg. Angulation
• Posterior Displacement
• Elderly

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Type II Odontoid

• Direct Screw Fixation
• Preserves C1-2 Motion
• No Bone Graft Required
• Avoid Non-Unions
• Avoid Reverse Oblique
• Aebi, Spine 1989

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Type II Odontoid

• Posterior Fusion
• Primary
• for Non or Delayed Union
• Trans-articular Facet Screws
• 96 Fusion Rate
• Restricted Rotation

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C2 Magerl screw fixation

• Good stability
• Does not need
• odontoid
• C1 arch
• C2 arch
• Challenging

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Odontoid stabilisation
Osteosynthesis odontoid screw fixation

• Arthrodesis Magerl screw fixation - challenging
• Good stability
• Does not need odontoid, C1 arch or C2 arch

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Traumatic Spondylolisthesis C-2(Levine
Edwards, JBJS, 1985)
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Traumatic Spondylolisthesis C-2(Levine
Edwards, JBJS, 1985)
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Traumatic Spondylolisthesis C-2(Levine
Edwards, JBJS, 1985)
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Traumatic Spondylolisthesis C-2(Levine
Edwards, JBJS, 1985)
Dislocated
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Subaxial C-Spine
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Flexion-compression...
3
4
2
5
1
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Checklist Approach

• Applies to trauma and degenerative disease
• The more points the more unstable
• 5 points does not mean surgery occasionally lt5
  need Sx gt5 dont need Sx
• Currently investigated by CSRS
• Different considerations for different levels
• 2-column VS 3-column

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Sensitivity Settings
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C2-T1

• Usually for trauma, but applies to all
• Ant./post. Element failure
• Stretch test (1.7mm, gt7.5 degrees)
• X-Ray (gt3.5mm, 11 degrees)
• Flex/ext x-ray (gt3.5mm, 20 degrees)
• Pavlovs ratio (lt0.8) sagittal diameter lt13
• Narrow disc
• Cord damage
• Root damage
• Dangerous loading anticipated

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Cervical Measurements
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Mr. Roeth. C-4 Fracture
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Mr. Roeth. C-4 Fracture
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CSLP Ant. Post Instability
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Mr. R. Co. C5 6 Fractures
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Mr. R. Co. C5 6 Fractures
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Mr G H C4-5 Facet Dislocation
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Mr G H C4-5 Facet Dislocation
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Cervical trauma

• Case presentations

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Cervical trauma

• Case 1

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Patient JM, 16yrs

• Fell boarding 2/52 ago
• winded
• continued 2/7
• hemoptysis 4/7
• saw GP
• neck xrayed
• Full ROM
• Not tender

C6
C6
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Patient JM, 16yrs
C6
C7
Spot lateral
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Patient JM, 16yrs
C6
C6
C7
C7
Flexion
Extension
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Patient JM, 16yrs
C6
C7
CT reformats
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• New or old injury?
• Snowboarding 2wks ago?
• Dirtbike 2yrs ago?
• Observe only?
• Advice and precautions
• Risks
• Stabilise?
• Anterior or posterior
• Risks

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Patient EC, 72f
Initial Xray
C5
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Patient EC, 72f
C5
Right
Left
CT
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Patient EC, 72f
C5
Postreduction
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EC
C5
Postop
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Cervical trauma

• Case 3

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Patient M, 65yrs
Initial CT
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Patient M, 65yrs
Initial CT
Left
Right
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Patient M, 65yrs
Intraoperative
Postop
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Patient M, 65yrs
Initial CT
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Patient BB, 32yrs
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BB
10lbs
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BB
57
BB
3 months
6 months