gms | German Medical Science

Objective: The unique ligamentous and bone anatomy of the occipitocervical junction (OCJ) and the typical mechanisms of trauma yield a predictable variety of injury patterns. It is advantageous to classify injury of the OCJ as isolated ligamentous injuries, isolated bone fractures, or mixed ligamentous and bony injuries. This study was conducted to emphasize the importance of anatomy, diagnosis and appropriate treatment of trauma OCJ.

Method: Fortyfive patients (31 male, 14 female, mean age 44 years) were admitted during a 5-year-period for injuries of the upper cervical spine. Patients were followed for a mean time of 18 months. Two occipital condyle fractures, 13 isolated C1 fractures, 5 combined C1/C2 fractures, 4 rotatory C1/C2 dislocations and 21 C2 fractures (15 odontoid, 3 hangman’s, 3 miscellaneous fractures) were diagnosed. Stability was evaluated using flexion-extension radiography. In addition to clinical cases five cadavers were used to study the microsurgical anatomy and to demonstrate OCJ in a step-wise manner.

Results: Isolated fractures of atlas (nondisplaced or minimally displaced) heal satisfactorily with an orthosis. Odontoid Type II fractures (less than 6 mm dens displacement) primarily treated with halothoracic vest. Unstable odontoid type II fractures primarily treated with C1-C2 wire/graft (two patients). Unstable subtype of hangman’s fracture primarily treated with anterior cervical plating. Operative mortality and neurological morbidity were found in 0%.

Conclusions: Ligamentous structures must be evaluated on MRI carefully for treatment modality. Isolated ligamentous instabilities, odontoid Type II fractures with dislocation more than 6 mm and unstable subtype of hangman’s fractures require surgical treatment. When fractures extend into the foramen transversarium or a subluxation is found on radiological investigation, vertebral artery injuries must be kept in mind.