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Operative Treatment For Cervical Spine Fractures Dr. T. G. Hogan.

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Presentation on theme: "Operative Treatment For Cervical Spine Fractures Dr. T. G. Hogan."— Presentation transcript:

1 Operative Treatment For Cervical Spine Fractures Dr. T. G. Hogan

2 Occipito-cervical Dissociation

3 Occipitocervical Instability Basion BDI < 12 Basion Axis Int <12 Basion-Dens-Interval <12 mm. >12 mm. Suggests Vertical Instability Basion-Axial-Interval < 12mm >12mm. Suggests Anterior Instability <0mm. Suggests Posterior Instability

4 Occipitocervical Dislocation Mechanism Unclear –Rotation & Distraction Neurological Deficits Confusing –High Tetraplegia –Cruciate Paralysis –Wallenberg’s Syndrome Ligamentous Injuries = Unstable Avoid Traction

5 Atlas Fractures: Extension Anterior Arch –Hyper-extension –Avulsion of Longus Colli –R/O Other Injuries –65% (Landells) Stewart G, Radiology 1977

6 Atlas Fractures: Extension Posterior Arch Fractures Occipital Pain & Numbness Stable R/O Other Injuries (Odontoid #)

7 Jefferson Fractures Four Part Burst Axial Load 6.9 mm Overhang –Spence KF, JBJS, mm Overhang –Heller JG, J Spinal Disord, 1993

8 Lateral Mass Fractures of C-1 Free-Floating Lateral Mass of C-1 Often Comminuted –Segal & Stauffer, JBJS, 1987

9 Treatment & Results C-1 #’s Good Results Reported with –Halo Traction + Vest –Rigid or Simple Orthoses Late Pain: –Ant/Post Arch50% –Jefferson 70% –Lateral Mass33% Landells, VanPeteghem, Spine 1987

10 Anderson & D’Alonzo Classification (JBJS, 1974) Type I Type II Type III

11 Odontoid fractures Type 1 Type 2 Type 3

12 Type II Odontoid Halo-Thoracic Brace Non-union Rate % Risk Factors: –Failure to Treat –5mm Displacement –>10 deg. Angulation –Posterior Displacement –Elderly

13 Type II Odontoid Direct Screw Fixation Preserves C1-2 Motion No Bone Graft Required Avoid Non-Unions Avoid Reverse Oblique # –Aebi, Spine 1989

14 Type II Odontoid Posterior Fusion –Primary –for Non or Delayed Union Trans-articular Facet Screws 96% Fusion Rate Restricted Rotation

15 C2 Magerl screw fixation Good stability Does not need – odontoid – C1 arch – C2 arch Challenging

16 Odontoid stabilisation Arthrodesis: Magerl screw fixation - challenging –Good stability –Does not need odontoid, C1 arch or C2 arch Osteosynthesis: odontoid screw fixation

17 Traumatic Spondylolisthesis C-2 (Levine & Edwards, JBJS, 1985)

18

19

20 Dislocated

21 Subaxial C-Spine

22 Flexion-compression

23 Checklist Approach Applies to trauma and degenerative disease The more points the more unstable 5 points does not mean surgery occasionally 5 don’t need Sx Currently investigated by CSRS Different considerations for different levels 2-column VS 3-column

24 Sensitivity Settings

25 C2-T1 Usually for trauma, but applies to all Ant./post. Element failure Stretch test (1.7mm, >7.5 degrees) X-Ray (>3.5mm, 11 degrees) Flex/ext x-ray (>3.5mm, 20 degrees) Pavlov’s ratio (<0.8) sagittal diameter <13 Narrow disc Cord damage Root damage Dangerous loading anticipated

26 Cervical Measurements

27 Mr. Roeth. C-4 Fracture

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29 CSLP Ant. & Post Instability

30 Mr. R. Co. C5 & 6 Fractures

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32 Mr G H C4-5 Facet Dislocation

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38 Cervical trauma Case presentations

39 Cervical trauma Case 1

40 Patient JM, 16yrs C6C6 C6C6 Fell boarding 2/52 ago –“winded” –continued 2/7 –hemoptysis 4/7 –saw GP –neck xrayed Full ROM Not tender

41 Patient JM, 16yrs C6C6 C7C7 Spot lateral

42 Patient JM, 16yrs C6C6 C7C7C7C7 Extension C6C6 C7C7C7C7 Flexion

43 Patient JM, 16yrs C7C7C7C7 C6C6C6C6 CT reformats

44 New or old injury? –Snowboarding 2wks ago? –Dirtbike 2yrs ago? Observe only? –Advice and precautions –Risks Stabilise? –Anterior or posterior –Risks

45 Patient EC, 72f Initial Xray C5C5

46 Patient EC, 72f CT Left Right C5C5C5C5

47 Postreduction C5C5C5C5 T2 MRI C5C5C5C5

48 EC Postop C5C5C5C5

49 Cervical trauma Case 3

50 Patient M, 65yrs Initial CT

51 Patient M, 65yrs Initial CT Left Right

52 Patient M, 65yrs Intraoperative Postop

53 Initial CT

54 Patient BB, 32yrs

55 25lbs + 1 day 25lbs20lbs 15lbs BB 10lbs

56 BB

57 6 months 3 months


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