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Acute injuries of the axis vertebra

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Abstract

A retrospective analysis of 165 patients admitted to Hermann Hospital with acute injuries of the axis vertebra revealed 68 (41%) dens fractures, 62 (38%) cases of traumatic spondylolisthesis (“hangman's” fracture), 21 (13%) extension teardrop fractures, 10 (6%) hyperextension dislocations, and 2 (1.0%) fractures each of the laminae and spinous processes. Of the 68 dens fractures, none (0%) were of the Anderson and D'Alonzo Type I; 21 (31%) were Type II (“high”); and 47 (69%) were Type III (“low”). The 62 traumatic spondylolistheses included 13 (21%) Effendi type I, 35 (56%) type II and 3 (5%) type III. This review disclosed an additional 11 (18%) patients with an atypical variety of traumatic spondylolisthesis, not previously reported, in which one or both fractures involved the posterior cortex of the axis body. Of the axis injuries 31 (18%) were limited to the axis body alone. Of these, 21 (61%) were hyperextension teardrop fractures and 10 (32%) were hyperextension dislocations. Axis injuries were associated with acute injuries of other cervical vertebrae in 14 (8%) of the patients.

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References

  1. Alexander E Jr, Forsyth HF, Davis CH, Nashold BS Jr (1958) Dislocation of the atlas on the axis. The value of early fusion of C1, C2 and C3. J Neurosurg 15:353

    Google Scholar 

  2. Amyes EW, Anderson FM (1956) Fracture of the odontoid process. Arch Surg 72:377

    Google Scholar 

  3. Anderson LD, D'Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663

    Google Scholar 

  4. Apuzzo MLJ, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T (1978) Acute fractures of the odontoid process. J Neurosurg 48:85

    Google Scholar 

  5. Banna M, (1985) Clinical radiology of the spine and the spinal cord. Aspen System Corp, Rockville

    Google Scholar 

  6. Bohler J (1982) Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg [Am] 64:18

    Google Scholar 

  7. Bohlman HH (1979) Acute fractures and dislocations of the cervical spine. J Bone Joint Surg [Am] 61:1119

    Google Scholar 

  8. Borne GM, Bedou GL, Pinaudeau M (1984) Treatment of pedicular fractures: A clinical study and screw fixation technique. J Neurosurg 60:88

    Google Scholar 

  9. Brashear HR Jr, Venters GC, Preston ET (1975) Fractures of the neural arch of the axis. J Bone Joint Surg [Am] 57:879

    Google Scholar 

  10. Bucholz RW (1981) Unstable hangman's fractures. Clin Orthop 154:119

    Google Scholar 

  11. Cornish BL (1968) Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Br] 50:31

    Google Scholar 

  12. Dalinka MK, Kessler H, Weiss M (1985) The radiologic evaluation of spinal trauma. Em Med Cl N A 3:475

    Google Scholar 

  13. Davis D, Bohlman H, Walker AE, Fisher R, Robinson R (1971) The pathological findings in fatal craniospinal injuries. J Neurosurg 34:603

    Google Scholar 

  14. Dickson H, Engel S, Blum P, Jones RF (1984) Odontoid fractures, systemic disease and conservative care. Aust NZ J Surg 54:243

    Google Scholar 

  15. Reference deleted

  16. Dunn ME, Seljeskog EL (1986) Experience in the management of odontoid process injuries: An analysis of 128 cases. Neurosurgery 18:306

    Google Scholar 

  17. Edeiken-Monroe BE, Wagner LK, Harris JH Jr (1986) Hyperextension dislocation of the cervical spine. AJNR 7:135

    Google Scholar 

  18. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg [Br] 63:319

    Google Scholar 

  19. Elliott JM, Rogers LF, Wissinger JP, Lee JF (1972) The Hangman's fracture: Fractures of the neural arch of the axis. Radiology 104:303

    Google Scholar 

  20. Federle M, Brandt-Zawadski M (eds) (1982) Computed tomography in the evaluation of trauma. Williams and Wilkins. Baltimore

    Google Scholar 

  21. Francis WR, Fielding JW (1978) Traumatic spondylolisthesis of the axis. Orthop Clin North Am 9:1011

    Google Scholar 

  22. Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R (1981) Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Br] 63:313

    Google Scholar 

  23. Garber JN (1964) Abnormalities of the atlas and the axis vertebrae. J Bone Joint Surg [Am] 46:1782

    Google Scholar 

  24. Gehweiler JA Jr, Clark WM, Schaaf RE, Powers B, Miller MD (1979) Cervical spine trauma: The common combined conditions. Radiology 130:77

    Google Scholar 

  25. Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM (1976) Fractures of the atlas vertebra. Skeletal Radiol 1:97

    Google Scholar 

  26. Gehweiler JA Jr, Martinez S, Clark WM, Miller MD, Stewart GC Jr (1977) Spondylolisthesis of the axis vertebra. AJR 128:682

    Google Scholar 

  27. Gehweiler JA Jr, Osborne RI Jr, Becker RF (1980) The radiology of vertebral trauma. WB Saunders. Philadelphia

    Google Scholar 

  28. Gerlock AJ Jr, Mirfakhraee M (1983) Computed tomography and Hangman's fractures. South Med J 76:727

    Google Scholar 

  29. Gray's Anatomy (1973) 29th Edition. Lea and Febiger, Philadelphia

  30. Hadley MN, Browner CM, Liu SS, Sonntag VK (1988) New subtype of acute odontoid fractures (Type IIa). Neurosurgery 22:67

    Google Scholar 

  31. Hanssen AD, Cabanela ME, Cass JR (1987) Fractures of the dens (odontoid process). In: Advances in orthopaedic surgery. Williams and Wilkins, Baltimore

    Google Scholar 

  32. Harris JH Jr, Edeiken-Monroe BE (1987) Radiology of acute cervical spine trauma (2nd edn). Williams and Wilkins, Baltimore

    Google Scholar 

  33. Harris JH Jr, Burke JT, Ray RD, Nichols-Hostetter S, Lester RG (1984) Low (type III) odontoid fracture: A new radiographic sign. Radiology 153:353

    Google Scholar 

  34. Holdsworth FW, (1963) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg [Br] 45:6

    Google Scholar 

  35. Holdsworth FW (1970) Fractures, dislocations and fracture-dislocations of the cervical spine. J Bone Joint Surg [Am] 52:1534

    Google Scholar 

  36. Kazarian L (1981) Injuries to the human spinal column. Exerc Sport Sci Rev 9:297

    Google Scholar 

  37. Lee C, Kim KS, Rogers LF (1982) Triangular cervical vertebral body fractures. AJR 138:1123

    Google Scholar 

  38. Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg [Am] 67:217

    Google Scholar 

  39. Lind B, Nordwall A, Sihlbom H (1987) Odontoid fractures treated with halo-vest. Spine 12:173

    Google Scholar 

  40. Maiman DJ, Larson SJ (1982) Management of odontoid fractures. Neurosurgery 11:471

    Google Scholar 

  41. Miller MD, Gehweiler JA, Martinez S, Charlton OP, Daffner RH (1978) Significant new observations on cervical spine trauma. AJR 130:659

    Google Scholar 

  42. Mirvis SE, Young JWR, Lim C, Greenberg J (1987) Hangman's fracture: Radiologic assessment in 27 cases. Radiology 163:713

    Google Scholar 

  43. Mouradian WH, Fietti VG, Cochran GVB, Fielding JW, Young J (1978) Fractures of the odontoid: A laboratory and clinical study of the mechanisms. Orthop Clin North Am 9:985

    Google Scholar 

  44. Paradis GR, Janes JM (1973) Posttraumatic atlantoaxial instability: The fate of the odontoid process fracture in 46 cases. J Trauma 13:359

    Google Scholar 

  45. Pepin JW, Bourne RB, Hawkins RJ (1985) Odontoid fractures, with special reference to the elderly patient. Clin Orthop 193:178

    Google Scholar 

  46. Rogers LF (1982) The radiology of skeletal trauma. Churchill Livingston, New York

    Google Scholar 

  47. Rothman RR, Simeone FA (1975) The spine. W.B. Saunders, Philadelphia

    Google Scholar 

  48. Ryan MD, Taylor TKK (1982) Odontoid fractures: A rational approach to treatment. J Bone Joint Surg [Br] 64:416

    Google Scholar 

  49. Schatzer J, Rorabeck CH, Waddell JP (1971) Fractures of the dens (odontoid process). J Bone Joint Surg [Br] 53: 392

    Google Scholar 

  50. Scher AT (1980) Diversity of radiological features in hyperextension injury of the cervical spine. S Afr Med J 58:27

    Google Scholar 

  51. Schneider RC, Livingston KE, Cave AJE, Hamilton G (1965) “Hangman's fracture” of the cervical spine. J Neurosurg 22:141

    Google Scholar 

  52. Selecki BR, Williams HBL (1970) Injuries to the cervical spine and cord in man. Australian Medical Association. Mervyn Archdall Medical Monograph Number 7, Australasian Medical Publishing Co., New South Wales

    Google Scholar 

  53. Shapiro R, Youngberg AS, Rothman SL (1973) The differential diagnosis of traumatic lesions of the occipito-atlantoaxial segment. Radiol Clin North Am 11:505

    Google Scholar 

  54. Sherk HH, Howard T (1983) Clinical and pathologic correlations in traumatic spondylolisthesis of the axis. Clin Orthop 174:122

    Google Scholar 

  55. Sherk HH, Nicholson JT, Chung SMK (1978) Fractures of the odontoid process in young children. J Bone Joint Surg [Am] 60:921

    Google Scholar 

  56. Southwick WO (1980) Management of fractures of the dens (odontoid process). J Bone Joint Surg [Am] 62:482

    Google Scholar 

  57. Wackenheim A (1974) Roentgen diagnosis of the craniovertebral region. Springer, Berlin Heidelberg New York

    Google Scholar 

  58. Waddell JP, Reardon GP, (1983) Atlantoaxial arthrodesis to treat odontoid fractures. Can J Surg 26:255

    Google Scholar 

  59. Wang GJ, Mabie KN, Whitehill R, Stamp WG (1984) The nonsurgical management of odontoid fractures in adults. Spine 9:229

    Google Scholar 

  60. Weir DC (1975) Roentgenographic signs of cervical injury. Clin Orthop 109:9

    Google Scholar 

Download references

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This work was supported, in part, by a grant from the John S. Dunn Foundation

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Burke, J.T., Harris, J.H. Acute injuries of the axis vertebra. Skeletal Radiol 18, 335–346 (1989). https://doi.org/10.1007/BF00361422

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