Differential treatment in acute upper cervical spine injuries: A critical review of a single-institution series

BACKGROUND A single-institution series of injuries of the upper cervical spine are ana lyzed retrospectively and the literature relevant to the topic is reviewed. METHODS Seventy patients (34 female, 36 male, mean age 47 years) were admitted duri ng a 5-year period for injuries of the upper cervical spine. Sixty-five wer e followed for a mean time of 18 months. Three isolated ligamentous instabi lities, 6 isolated C1 fractures, 3 complex C2 fractures, 10 combined C1/C2, and 48 C2 fractures (17 hangman's, 31 odontoid) were diagnosed. Twenty-nin e patients were treated conservatively and for 41 patients surgery was the primary treatment. Twenty-three ventral odontoid screw fixations, 8 ventral platings and 10 dorsal stabilizations were performed. Stability was evalua ted using flexion-extension radiography. Pain levels and neurological outco me were assessed. RESULTS Operative mortality and neurological morbidity were 0%. Two wound infection s and 3 instabilities (17%) in odontoid Type II fractures primarily treated with ventral odontoid screw fixation needed dorsal restabilization. During follow-up examinations the neurological status of three patients was impro ved. In 62 patients preoperative status was attained. Six patients evaluate d their pain as severe, two as disabling. CONCLUSIONS Candidates for surgery as the primary treatment include those with isolated ligamentous instabilities, Type III hangman's fractures and Type II odonto id fractures with dislocation more than 5 mm. In combined C1/C2 fractures t he axis fracture dictates the treatment strategy. Patients who undergo dors al procedures and have involvement of C1 have a greater chance of developin g persistent pain. (C) 2000 by Elsevier Science Inc.