Overview of Subaxial Cervical Spine Fractures and Dislocations

Injuries of the subaxial cervical spine are among the most common and potentially most devastating injuries involving the axial skeleton. The lower cervical spine can suffer minor bony or ligamentous injury that nevertheless results in severe neurologic injury. Plain radiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are all part of the standard imaging regimen. The delayed timing of dislocation reduction and cost-effectiveness are two issues with routine use of MRI in the diagnosis of cervical facet dislocations. Serval treatment options and approaches can be used. However Orthopedic treatment can be used to reduce the fracture or dislocation returns the vertebral canal to its normal shape and dimensions and decompresses the spinal cord. Immediate treatment should be started if there are signs of spinal cord injury or any factor that could lead to such injuries. In this review we will be looking at epidemiology, causes, evaluation and treatment of such cases.

Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System

OBJECTIVE Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty. METHODS A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine. RESULTS In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p < 0.001). CONCLUSIONS The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.

Accessory articulation of the cervical vertebrae transverse processes simulating a fracture: Incidental findings of an uncommon anatomical variant

Accessory articulation of the transverse processes of the cervical vertebrae is an extremely rare congenital anomaly. We present two cases of accessory articulation of the transverse processes of the left C5/C6 and C6/C7 cervical vertebrae. The articulation at C5/C6 was found in a 34-year-old male following a mob assault, the C6/C7 accessory articulation occurred in a 28-year-old female involved in a high velocity motor-vehicle accident. Cervical spine fractures were suspected in both cases. Recognition of this variant anatomy and differentiation from a fracture is important especially in an acute trauma setting to prevent unnecessary immobilization and inappropriate specialist referral of these patients. Our search revealed only five previously reported cases in the literature mostly occurring at the C5/C6 level. This is only the second case ever described at the C6/C7 level.

Cervical spine fractures in multiple injured patients in Kurdistan Region, Iraq

Objectives: The aim of study to describe the main types of cervical spine fractures presented to the emergency department and to illustrate the main aspects of management and outcome. Methods: This is a prospective study of 72 patients with cervical injury out of 932 male patients with history of multiple injuries. All patients with cervical spine injury were admitted within 1 week of injury and follow up thereafter by regular outpatient visit. Cervical spine injuries were diagnosed by full radiological assessment according to NEXUS criteria (plain x-ray with lateral, anteroposterior, odontoid views in addition to cervical spine C.T for indicated patients) and evaluated neurologically. Results: Mean age of patients at time of accident was 25 years ranging from 7-73years, 50% of them were in the third decade of life. Road traffic accidents constitute 58.3% of causes of cervical injury followed by fall from height (19.5%). Results has shown that mid and lower cervical spine injuries constitute 87.5% of all types of vertebra involved while upper cervical spine injuries constitute only 12.5% of them. Associated injuries were found in 42 patients (58.3%) and the most common associated injury was cerebral concussion. 50% of patients had no history of neural deficit at time of admission, while the others had neurological abnormalities (27.7%) of them with complete deficit at time of admission. The most common type of skeletal injury was wedge fracture (28 patients, 38.8%), followed by spinous process fracture and burst fracture (18 patients, 25% and 12 patients, 16.6%) respectively. Respiratory complications were the most common in our series (12 patients of 72, 16.6%) followed by an equal share of urinary tract infection and neck pain (7 patients, 9.7%). Conclusion: Traffic accident constitutes the main reason for cervical spine fractures followed by falls. Cervical spine fractures affect the younger age group with mean age of 25 year. A collar is sufficient treatment for more un displaced fractures. Seat belt is one of the restrains that shares in reduction of fatality and severity of cervical spine injuries.