Surgery of Fractures of the Upper Cervical Spine

M.A. Nekrasov, A.K. Nekrasov, V.V. Krylov, A.A. Grin

(Sklifosovsky Research Institute of Emergency care, Moscow
Regional Clinical Hospital, Ivanovo)

The goal of the study was to improve treatment of patients with fractures of the upper cervical spine.

Materials and Methods. There were 62 cases with fractures of the upper cervical spine, treated from 14.03.89 up to 30.01.2003. Standard and functional rentgenologic examination, CT-examination of C1-C2 vertebrae and MRI-examination of the cervical spine were carried out on admission. The distribution of fractures was as follows: fractures of the 2nd type – 15; fractures of the 3rd type – 26; associated injury of the epistropheus dens and posterior semi-ring of C1 – 4; a “hangman’s” fracture – 6; injury of the odontoid process, combined with Jefferson’s fracture - 3; fractures of the spinous process of C2 or its arch – 8. Interventions were made in 35 out of 62 cases. External rigid fixation with reposition by the Medbiotex halo-apparatus was performed in 19 patients. A rigid cervical head holder was used in 8 cases. Operations were made in acute (21), subacute (24) and remote (9) periods.

Results. Depending on a character of injury the patients were subject to posterior combined spondylodesis of C1-C2 (Halifax’s tightening device) with transpharyngeal resection of the odontoid process or without it; transdental spiral fixation; occipitospondylodesis with use of plates, cages; a combination of the above methods with preceding halo-reposition and fixation; combined halo-reposition and fixation.

The results of treatment were good in all cases. Reposition and stabilization were achieved. Pain syndrome and neurological deficit regressed almost completely.

Conclusion. 1. Active surgical tactics makes it possible to obtain optimum clinical and orthopedic results in injuries of the upper cervical spine. 2. It is necessary to use a differentiated approach while choosing a decompression method, which depends on a type of injury of upper cervical vertebrae.