Treatment of traumatic lesions of the upper cervical spine

Shulyov Yu.A., Bikmullin V.N., Rudenko V.V., Khilko V.A., Vorobyev A.V., Rychkov V.L., Sheikho A.

(Municipal Neurosurgical Center of the City Multi-Field Hospital N 2, Chair of Neurosurgery of the Saint Petersburg Academy of Postgraduate Education, Saint Petersburg, Russia)

Different forms of traumatic lesions of the spine at the level of the first and second cervical vertebrae account for 1-15% of all trauma of the cervical spine (Powers B., Miller M.D., 1979; Hadley M.N., Dickman C.A., 1988; Husby J., Sorensen K.H., 1974). Injuries of the upper cervical spine are watched in 19 % of postmortem examinations of casualties, who died in road accidents (Alker G.J., Leslie E.V., 1978).

A choice of an optimum method of treatment, i.e. external rigid immobilization or direct surgical intervention with application of fixing metal systems, is a vexed question.

The experience of treatment of 7 patients with different types of injuries of the first and/or second vertebrae in the Neurosurgical Center of the City Multi-Field Hospital N 2 is analyzed. Three patients were operated earlier in other hospitals without achieving any orthopedic and clinical effect. Four patients were subject to surgical treatment in our Neurosurgical Center. Occipitocervical fixation with the SSD-cervical system (Sofamor-Danek company) was performed in three of them. Rigid external immobilization was used in three cases.

Our experience shows, that active surgical tactics in relation to patients with unstable traumas of the first and second vertebrae and use of modern fixing systems allows to get the most favorable clinical, orthopedic and rehabilitation effect during the shortest possible period.