Upper Cervical Spine Fractures - Orthopaedic Trauma Association

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1、Upper Cervical Spine FracturesDaniel Gelb, MDCreated January 2006Upper Cervical Spine Fractures Epidemiology Anatomy Radiology Common Injuries Management IssuesUpper Cervical Spine Fractures Epidemiology Cause MVC42% Fall20% GSW16% Gender Male81% Female19%Etiology of Spinal Cord Injury by AgeSource:

2、 National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2004 Annual Statistical Report, June, 2004 Upper Cervical Spine Fractures Epidemiology Level of Education To 8th Grade: 10% 9th to 11th: 26% High School: 48% College: 16%Source: National Spinal Cord Injury Statisti

3、cal Center, University of Alabama at Birmingham, 2004 Annual Statistical Report, June, 2004 Employment StatusSource: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2004 Annual Statistical Report, June, 2004 Percent EmployedUpper Cervical AnatomyUpper Cervical An

4、atomy Biomechanically Specialized Support of “large” Cranial mass Large range of motion Flexion/extension Axial rotation Unique osteological characteristicsC1 - Atlas No body 2 articular pillars Flat articular surface Vertebral artery foramen 2 arches Anterior Posterior Vertebral artery grooveAnatom

5、y The Atlas Transition zone between head and c-spine Important anatomical points Superior articular processes allow flex/ext Inferior articular processes are important for rotation Notch for vertebral artery is a common fracture siteC2 Anatomy Dens Embriological C1 body Base poorly vascularized Oste

6、oporotic Flat C1-2 joints Vertebral artery foramena Inferomedial to superolateralAnatomy The Axis Important transition point for forces within the c-spine Important anatomical points Superior and inferior articular processes are “offset” in the AP direction- due to different functions at each articu

7、lation Pars interarticularis- due to this transition is a frequent fracture site Odontoid process- the “pivot” for rotationAnatomy The Ligaments Allow for the wide ROM of upper C-spine while maintaining stability Classified according to location with respect to vertebral canal Internal: Tectorial me

8、mbrane Cruciate ligament including transverse ligament Alar and apical ligaments External Anterior and posterior atlanto-occipital membranes Anterior and posterior atlanto-axial membranes Articular capsules and ligamentum nuchaeAtlantoAxial AnatomyTectorial MembraneAtlantoAxial AnatomyocciputC1C2Tra

9、nverse LigamentC1-C2 jointAlar LigamentAtlantoAxial AnatomyTransverseLigamentFacet forOccipitalCondyleAtlantoAxial AnatomyVertebral ArteryRadiographic EvaluationLateral ViewPrevertebral SwellingSoft Tissue Shadow6mm at C2Concave/FlatPredental space 3mm Atlanto-Occipital Joint CongruenceRadiographic

10、Lines*Open Mouth APDistractionC1-2 SymmetryRadiographic Diagnosis Screening LinesPowerss RatioHarris et al, Am J Radiol, 1994 Basion-Dental Interval (BDI) Basion to Tip of Dens 12 mm ABNORMAL Basion-Axial Interval (BAI) Basion to Posterior Dens -4-12 mm in 98% 12 mm Anterior Subluxation 4 mm Posteri

11、or SubluxationHarris LinesRadiographic Lines BC/OA 1 considered abnormal Limited Usefulness Positive only in Anterior Translational injuries False Negative with pure distractionPowers et al, Neurosurg, 1979 Powers RatioCT Scan Same rules as with plain films Better visualization of craniocervical jun