Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Concomitant traumatic injuries in the upper cervical spine are often encoun tered and rarely reported. We examined the data concerning 784 patients wit h cervical spine injuries following trauma, including 116 patients with upp er cervical spine injuries. Twenty-six percent of patients with upper cervi cal spine injuries (31 cases) were found to have combined injuries involvin g either the upper or the upper and lower cervical spine. The frequent patt erns were combined type I bipedicular fracture of the axis and dens fractur e, and combined dens fracture and fracture of the posterior arch of C1. Oth er patterns posed specific problems, such as combined dens and Jefferson fr acture and combined dens and C2 articular pillar fracture. Seventy percent of atlas fractures, 30% of C2 traumatic spondylolistheses and 30% of dens f ractures were part of a combination. A total of 1.7% of patients with lower cervical spine injuries had a combined injury in the upper cervical spine. A comprehensive therapeutic schedule is outlined. Combined injuries in the upper cervical spine should be sought in any patient with a cervical spine injury.