Mosquera BG, Hernández GEH, Guevara OE, Sulca CX, Téllez IR, Ramírez RE

Language: Spanish
References: 13
Page: 536-545
PDF size: 581.56 Kb.

ABSTRACT

Background: combined lesions of atlas and axis are the most common cervical spine traumas in elderly people, with an incidence of about 70 %. The diagnosis demands the use of advance radiologic procedures and the treatment options runs through conservative to complex surgical interventions to restore the stability of the occipito-cervical region.
Objective: to present a combined lesion of the first and second cervical vertebra as a less frequent shape of odontoid fracture.
Clinical case: a 79-year-old patient who suffered a posterior cranial trauma followed by bilateral cervicobrachialgia and paresthesias after a horse fall. At physical exploration no signs of radicular or cordonal compression were demonstrated. Computarized axial tomography with tridimentional reconstructions showed a bilateral and symmetrical fracture of the posterior arch of the atlas, associated with longitudinal and oblique fracture of odontoid next to the isthmus. No dislocation was observed that is why the upper cervical spine stability was preserved. Conservative treatment was achieved by an external orthesis with a favourable evolution.
Conclusions: for atlantoaxial traumatic lesions diagnosis, the use of computerized axial tomography is important associated or not with nuclear magnetic resonance. The stability of this region in correspondence with neurological status are the most important factors to select the best treatment choice.

REFERENCES

1. Robinson Y, Robinson AL, Olerud C. Systemat-ic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly. Biomed Res Int [Internet]. 2014 Feb [citado 6 Feb 2016]:[aprox. 7 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934525/.

2. Molinari WJ, Molinari RW, Khera OA, Gruhn W. Functional outcomes, morbidity, mortality and fracture healing in 58 consecutive pa-tients with geriatric odontoid fracture treated with cervical collar or posterior fu-sion. Global Spine J. 2013;3: 21-32.

3. Tay BK, Eismont FJ. Injuries of the upper cer-vical spine. En: Rothman RH- Simeone FA, editors. The Spine. Philadelpia: Saunders Elsevier; 2011. p. 1307-32.

4. Heinzelmann M, Eld K, Boos N. Cervical spine injuries. En: Boos N, Aebi M,

5. editors. Spinal Disorders. Germany: Sping-er Verlag; 2008. p: 825 -71.

6. Scheyerer MJ, Zimmermann SM, Simmen HP, Wanner GA, Werner C. Treatment modality in type II odontoid fractures defines the outcome in elderly patients. BMC Surgery [Internet]. 2013 [citado 2016 Feb 6];13:[about 54 p.]. Available from. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833842/

7. Fehlings MG, Arun R, Vaccaro AR, Arnold PM, Chapman JR, Kopjar. Predictors of Treat-ment Outcomes in Geriatric Patients With Odontoid Fractures. Spine [Internet]. 2013 May [citado 2016 Feb 6];38(11):[about 5 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678886/.

8. Chapman J, Smith JS, Kapjar B, Vaccaro AR, Arnold P, Shaffrey CI, et al. The AOSPINE North America Geriatric Odontoid Fracture Mortality study. Spine. 2013;38(13):1098-1104.

9. Reinhold M, Bellabarba C, Bransford R, Chap-man J, Krengelw W, Lee M, et al. Radio-graphic analysis of type II odontoid frac-tures in geriatric patient population : de-scription and pathomechanism. Eur Spine J. 2011;20:1928-39.

10. Liu C, Kuang L, Wang L, Tian J. Management of combination fractures of the atlas and axis: a report of four cases and literature review. Int J Clin Exp Med [Internet]. 2014 Aug [citado 2016 Feb 6];7(8):[about 6 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161549/.

11. Wang L, Liu C, Zhao QH, Tian JW. Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent seg-ments. J Orthop Surg Res [Internet]. 2014 Aug [citado 2016 Feb 6];9(6):[about7 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237887/.

12. Joaquim AF, Ghizoni E, Tedeschi H, Law-rence B, Brodke DS, Vaccaro AR, et al. Up-per cervical injuries – A rational approach to guide surgical management. J Spinal Cord Med [Internet]. 2014 Mar [citado 2016 Feb 6];37(2):[about 12 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066422/.

13. Nizare EF, Abdelali B, Fahd DH, Yassad OM, Rachid G, Rachid EM, et al. Upper cervical spine injuries: a management of a series of 70 cases. Pan Afr Med J [Internet]. 2014 May [citado 2016 Feb 6];15(1):[about 6 p.]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801262/.