Article
What about the joints? Peculiarities of atlanto-axial stability in upper cervical spine trauma with special focus on facet joint fractures C1/C2
Wie steht es um die Facettglenke? Besonderheiten der atlanto-axialen Stabilität bei Verletzungen der oberen Halswirbelsäule unter Berücksichtigung von Facettgelenkfrakturen C1/C2
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Authors
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Klaus-Peter Stein
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
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Amirshayan Erzi
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
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Karl Hartmann
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
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Belal Neyazi
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
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I. Erol Sandalcioglu
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Fractures of the facet joints C1/C2 are frequently found in cervical spine trauma. The purpose of this study was to clarify the significance of fractured facet joints for the assessment of segmental stability.
Methods: Spinal CT images of 342 patients between 2004 and 2020 with proven injury to the upper cervical spine were retrospectively analyzed. The focus was on specific injury pattern of the segment-forming bony structures C1 and C2 and on signs of segmental instability (enlarged atlanto-dental distance, dislocated odontoid fragment) of patients with and without facet joint fractures C1/C2.
Results: 122 patients presented with fractures of the facet joints C1/C2. Facet C2 was mainly affected (n=102; C1 n=18, combined n=2; unilateral n=73, bilateral n=49). The frequency of concomitant fractures (C1 arch and C2 odontoid) did not differ between patients with and without facet joint fractures C1/C2 (C1 22 vs. 35%, C2 odontoid 68 vs. 72%). In contrast, the ratio of type II and type III fractures (according to Anderson D'Alonzo) within both subgroups significantly differed (type III fracture 60 vs. 10%, chi-square test p = 0.00001). In the same context, the distribution of a dislocated odontoid fragment was significantly different (42 vs. 71%, chi-square test p = 0.00002). However, the frequency of an enlarged atlanto-dental distance in both groups was comparable (according to la Caffiniere; 14 vs. 13%).
Conclusion: Upper cervical spine trauma pattern with and without facet joint fractures of the key segment C1/C2 clearly differ and fractured facet joints are not necessarily associated with (increased) segmental instability. Whether a different trauma mechanism underlies this phenomenon remains unclear and needs further investigation.
