Recent Trends in Management of Upper Cervical Spine Injuries (Atlas & Axis)

Abstract

Theuppercervicalspineconsistsoftheatlas(C1)andtheaxis(C2).Thesefirst2vertebraearequitedifferentfromtherestofthecervicalspine.Theatlasarticulatessuperiorlywiththeocciput(theatlanto-occipitaljoint)andinferiorlywiththeaxis(theatlantoaxialjoint). Ithasbeenreportedthatthecervicalspineisinjuredin2.4%ofblunttraumavictimsallpatientswhosustainsignificantpolytraumaand/orheadtraumashouldbeassumedtohaveacervicalspineinjury. ThelateralcervicalspineradiographishighlysensitivetodiagnosebonylesionswhileCTscanhasanimportantroletodiagnoseandclassifyoccultorqueryfractures,MRIhasimportantroleinsofttissueinjury,eitherligamentousorcordinjury. Cervicalspineinjuriesarebestclassifiedaccordingtothemechanismsofinjury,whichincludeflexion,flexion-rotation,extension,extension-rotation,verticalcompression,lateralflexion. Managementincludesnonsurgicalandsurgicaltreatmentoffractures.Immobilizationisimperativetominimizeorpreventfurtherspinalcordinjury.Theonlyexceptionsarewhenthereisimminentdangerfromanexternalcause,suchasbecomingtrappedinaburningbuilding. Inthelongterm,physicaltherapywillbegiventobuildstrengthinthemusclesofthenecktoincreasestabilityandbetterprotectthecervicalspine. Collars,tractionandsurgerycanbeusedtoimmobilizeandstabilizetheneckafteracervicalfracture. VarioussurgicalproceduresareavailableforfixationofAtlasandAxisfracturesthroughplates,screwsandwires.Themostimportantistoobtainrigidfixationandabsolutestability Image-guidedsurgeryandthetoolsassociatedwithspinalnavigationaddasignificantvaluetothearmamentariumofthespinesurgeon.Im