Cases with Fractures of C1 and C2 Vertebrae: Treatment Tactics

Nekrasov M.*, Nekrasov À.**, Grin À.*, Nikolaev N.*

* Sklifosovsky Research Institute of Emergency Care, Moscow, Russia;
** Regional Clinical Hospital, Ivanovo, Russia


The research goal was to improve an approach to treatment of cases with fractures of the upper cervical spine.

Material and Methods. There were 97 cases with fractures of C1 and C2, treated since 14.02.89 up to 01.12.05. The patients underwent standard and functional X-ray examinations, CT of C1-C3 vertebrae and MRI of the cervical spine. Their findings were as follows: fractures of the odontoid process of type II and III - 26 and 25 respectively; combined injury of the odontoid process and posterior semiring of C1 vertebra - 4; a hangman’s fracture - 29; combined hangman’s and Jefferson’s fractures - 4; Jefferson’s fracture - 7; transligamentous dislocation of C1 vertebra - 2 cases. Operations were performed in 65 out of 97 patients. External rigid fixation and reposition with a Halo-apparatus (Medbiotex), were made in 30 patients. External fixation was used in 2 cases.

Results. Interventions were dependent on an injury character. We used the following methods: combined posterior spondylodesis of C1-C2 vertebrae (Halifax tightening devices) with transpharyngeal resection of the odontoid process or without it; transdental screw fixation; transarticular screw fixation; occipitospondylodesis; anterior spondylodesis with plates and cages; a combination of the above methods with preceding Halo-reposition and fixation; isolated Halo-reposition and fixation. Good and satisfactory results were observed in 90 (97%) and 2 (2%) cases respectively. The mortality rate was 5% (5 cases died).

Conclusions. 1. Active surgical tactics allows 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 method of decompression and stabilization; it should be dependent on a type of injury of upper cervical vertebrae.