The epidemiology of fractures and fracture-dislocations of the cervical spine

doi:10.1016/0020-1383(92)90123-A

Injury

Volume 23, Issue 1, 1992, Pages 38-40

https://doi.org/10.1016/0020-1383(92)90123-A Get rights and content

Abstract

A total of 717 fractures and fracture-dislocations of the cervical spine occurred in 657 patients in a 13-year period. Injury was commonest in the third decade of life. The levels most frequently injured were the second, fifth, and sixth. Injuries of the first and second cervical vertebrae commonly occurred together, and injuries involving the upper and lower cervical spine in the same individual occurred in 9 per cent of patients with fractures of C1 and C2. Odontoid fractures were the most frequent fractures in patients over 70 years of age, and formed the majority of fractures in patients over 80 years of age. It is recommended that if a fracture of the upper cervical spine is seen on radiographs, another fracture in the upper or lower cervical spine should be excluded. Patients aged 70 years and above who complain of neck pain after trauma should be suspected of having an odontoid fracture, until proven otherwise.

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Upper cervical spine fractures are commonplace in the elderly following low energy trauma. These injuries carry high mortality rates, similar to patients sustaining hip fractures. A key aspect affecting clinical outcome is effective management in the first 12 weeks following injury. This study aims to assess the understanding of healthcare staff that may be required to care for such patients.
A survey was carried out over a single day at the UK's largest Spine Specialist referral centre (Salford Royal Foundation Trust, SRFT) assessing the understanding of healthcare staff of the term, ‘Collar with occipital extension’, by asking staff to identify the safe position of the neck when looking at clinical images of a model in a collar in various different neck positions. The participants demographics were then taken, including profession, grade, spinal/post graduate experience, if English is their first language and their understanding of the term ‘Collar with occipital extension’.
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Biomechanical comparison of two different compression screws for the treatment of odontoid fractures in human dens axis specimen.
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Lag screw osteosynthesis for odontoid fractures has a high rate of pseudoarthrosis, especially in elderly patients. Besides biomechanical properties of the different screw types, insufficient fragment compression or unnoticed screw stripping may be the main causing factors for this adverse event. The aim of the study was to compare two screws in clinical use with different design principles in terms of compression force and stability against screw stripping.
Twelve human cadaveric C2 vertebral bodies were considered. Bone density was determined. The specimens were matched according to bone density and randomly assigned to two experimental groups. An odontoid fracture was induced, which were fixed either with a 3.5 mm standard compression screw or with a 5 mm sleeve nut screw. Both screws are certified for the treatment of odontoid fractures. The bone samples were fixed in a measuring device. The screwdriver was driven mechanically. The tests were analyzed for peak interfragmentary compression and screw-in torque with a frequency of 20 Hz.
The maximum fragment compression was significantly higher with screw with sleeve nut at 346.13(SD ±72.35) N compared with classic compression screw at 162.68(SD ±114.13) N (p = 0.025). Screw stripping occurred significantly earlier in classic compression screw at 255.5(SD ±192.0)° rotation after reaching maximum compression than in screw with sleeve nut at 1005.2(SD ±341.1)° (p = 0.0039).
Screw with sleeve nut achieves greater fragment compression and is more robust to screw stripping compared to classic compression screw. Whether the better biomechanical properties lead to a reduction of pseudoarthrosis has to be proven in clinical studies.
Development of a Predictive Model for Persistent Instability Following Conservative Management of Type II Odontoid Fractures
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Odontoid fractures are common cervical spine fractures; however, significant controversy exists regarding their treatment. Risk factors for failure of conservative therapy have been identified, although no predictive risk score has been developed to aid in decision-making.
A retrospective review was conducted of all patients evaluated at a level 1 trauma center. Patients identified with type II odontoid fractures as classified by the D'Alonzo Classification system who were treated with external orthosis were included in analysis. Patients were considered to have failed conservative therapy if they were offered surgical intervention. A machine learning method (Risk-SLIM) was then utilized to create a risk stratification score based on risk factors to identify patients at high risk for requiring surgical intervention due to persistent instability.
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Worsening ambulation in elderly patients with cervical odontoid fractures: A nationwide multicenter study in Japan
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Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months.
This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients’ background.
Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D’Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation.
Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.
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PaperThe epidemiology of fractures and fracture-dislocations of the cervical spine

Abstract

Injury

Injury

Fractures of the odontoid process. A clinical and radiographic study

Acta Orthop. Scand.

Fractures of the odontoid process of the axis

J. Bone Joint Surg.

Acute fractures and dislocations of the cervical spine

J. Bone Joint Surg.

Fractures of the dens, a multicentre study

J. Bone Joint Surg.

Fracture-dislocations of the cervical spine

J. Bone Joint Surg.

Paper
The epidemiology of fractures and fracture-dislocations of the cervical spine