Rafet ÖZAY, Ahmet GÜNAYDIN, Şahin HANALİOĞLU, Betül Yaman, Mehmet Erhan Türkoğlu, Cem Atabey

Üst servikal vertebra travmalarının cerrahi tedavi sonuçları

Amaç: Bu çalışmada üst servikal travmalı hastalarda yapmış olduğumuz cerrahi tedavi yöntemlerinin değerlendirilmesi amaçlanmıştır..Gereç ve Yöntem: Bu çalışmada, 2014-2016 tarihleri arasında üst servikal travma nedeniyle opere edilmiş 12 hastanın verileri retrospektif olarak değerlendirildi. Kitle, metastaz veya romatoid artrit gibi patolojik fraktür nedeniyle opere edilmiş olan hastalar çalışma dışı bırakıldı. Tüm hastalarda tanı; servikal direk grafi, bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) ile gerçekleştirildi. Bulgular: Üst servikal travma nedeniyle opere edilen hastalar’da (6K, 6E, ortalama yaş; 46) etiyolojik nedenler arsında en sık etken yüksekten düşme tespit edildi. Yine en sık izlenen patoloji tip-2 odontoid fraktürü idi. Bir hastada kuadriparezi, bir hastada monoparezi ve bir hastada 12. Kranial sinir defisiti saptandı. Sadece bir hasta dışında (anterior odontoid vidalama-AOV) tüm hastalarda üst servikal (C1-C2) posterior segmental stabilizasyon (PSS) uygulandı. Hastaların hiçbirinde ek nörolojik defisit gelişmedi, bir hastada yara yeri enfeksiyonu gelişti (%8.3) ve bir hasta sistemik komplikasyonlar nedeniyle kaybedildi (%8.3).Sonuç: Üst servikal travmalı hastalarda, servikal kolar veya halo yelek ile mobilizasyon kısıtlaması, AOV veya C1-C2 PSS gibi cerrahi yöntemler tercih edilebilecek tedavi seçenekleridir. Özellikle servikal BT ve MRG ile elde edilen görüntüler eşliğinde anatomik varyasyonların ve ligamentöz hasarın tespiti uygulanacak cerrahi teknik açısından oldukça önemlidir.

Anahtar Kelimeler:

Üst servikal omurga, travma

Outcome of surgical treatment in upper cervical spine traumas

Purpose: In this study, we aimed to evaluate surgical management strategies adopted in our clinic for the management of patients with upper cervical spine traumas. Materials and Methods: In this study, we retrospectively analysed clinical and radiological data of 12 patients with upper cervical spine traumas operated in our clinic between 2014 and 2016. The patients who underwent surgery for pathological fractures due to tumor, metastasis, or rheumatoid arthritis were excluded from the study. In all patients, diagnosis was made on the basis of cervical X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Results: The mean age of the patients (6 M, 6 F) was 46 years. High falls were the most common etiological cause in patients with upper cervical spine traumas. The most common pathology was type 2 odontoid fracture. Quadriparesis was observed in one patient, monoparesis in one patient and hypoglossal nerve palsy in one patient. All patients but one, who had anterior odontoid screw fixation, underwent upper cervical (C1-2) posterior segmental stabilization. No patient had additional neurological deficits postoperatively, one patient had surgical site infection (8.3%) and one patient was lost due to systemic complications (8.3%). Conclusion: In patients sustaining upper cervical spine trauma, immobilization with cervical collar or halo vest, anterior odontoid screw fixation and C1-2 posterior segmental stabilization are available management alternatives. Particularly, the awareness of anatomical variations and ligamentous injury with the aid of radiological images obtained via cervical spinal CT and MRI are critical to guide surgical technique.

Keywords:

Upper cervical spine, trauma,

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1. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80:1411-9.
2. Damadi AA, Saxe AW, Fath JJ, Apelgren KN. Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center. J Trauma. 2008;64:745-8.
3. Malik SA, Murphy M, Connolly P, O'Byrne J. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J. 2008;17:585-91.
4. Fredø HL, Bakken IJ, Lied B, Rønning P, Helseth E. Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study. Scand J Trauma Resusc Emerg Med. 2014;22:78.
5. Longo UG, Denaro L, Campi S, Maffulli N, Denaro V. Upper cervical spine injuries: indications and limits of the conservative management in Halo vest. a systematic review of efficacy and safety. Injury. 2010;41:1127-35.
6. Kobylarz K, Kwiatkowski S, Inglot B, Mróz A. [Comprehensive management of a child with a post-traumatic brain stem and spinal cord injury. A case study and presentation of current therapeutic modalities]. Przegl Lek. 2008;65:102-6.
7. Ryba L, Cienciala J, Chaloupka R, Repko M, Vyskočil R. Injury of upper cervical spine. Soud Lek. 2016;61:20-5.
8. Chittiboina P, Banerjee AD, Nanda A. Do concomitant cranium and axis injuries predict worse outcome? a trauma database quantitative analysis. Skull Base. 2011;21:249-54.
9. Wang H, Ou L, Zhou Y, Li C, Liu J, Chen Y et al. Traumatic upper cervical spinal fractures in teaching hospitals of China over 13 years: a retrospective observational study. Medicine (Baltimore). 2016;95:e5205.
10. Clayton JL, Harris MB, Weintraub SL, Marr AB, Timmer J, Stuke LE et al. Risk factors for cervical spine injury. Injury. 2012;43:431-5.
11. Graber MA, Kathol M. Cervical spine radiographs in the trauma patient. Am Fam Physician. 1999;59:331-42.
12. Blacksin MF, Lee HJ. Frequency and significance of fractures of the upper cervical spine detected by CT in patients with severe neck trauma. AJR Am J Roentgenol 1995;165:1201-4.
13. Corr P, Govender S. The role of magnetic resonance imaging on spinal trauma. Clin Radiol. 1999;54:629-35.
14. Gleizes V, Jacquot FP, Signoret F, Feron JM. Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period. Eur Spine J. 2000;9:386-92.
15. Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine (Phila Pa 1976). 1997;22:1843-52.
16. Daneyemez M, Kahraman S, Gezen F, Sirin S. Cervical spine injuries and management: experience with 235 patients in 10 years. Minim Invasive Neurosurg. 1999;42:6-9.
17. Chiba K, Fujimura Y, Toyama Y, Fujii E, Nakanishi T, Hirabayashi K. Treatment protocol for fractures of the odontoid process. J Spinal Disord. 1996;9:267-76.
18. Polin RS, Szabo T, Bogaev CA, Replogle RE, Jane JA. Nonoperative management of Types II and III odontoid fractures: the Philadelphia collar versus the halo vest. Neurosurgery. 1996;38:450-7.
19. Anderson PA, Budorick TE, Easton KB, Henley MB, Salciccioli GG. Failure of halo vest to prevent in vivo motion in patients with injured cervical spines. Spine (Phila Pa 1976). 1991;16: 501-5.
20. Manthey DE. Halo traction device. Emerg Med Clin North Am. 1994;12:771-8.
21. Lee D, Adeoye AL, Dahdaleh NS. Indications and complications of crown halo vest placement: A review. J Clin Neurosci. 2017 Feb 10. pii: S0967-5868(16)30796-2. doi: 10.1016/j.jocn.2017.01.002. [Epub ahead of print]
22. White AP, Hashimoto R, Norvell DC, Vaccaro AR. Morbidity and mortality related to odontoid fracture surgery in the elderly population. Spine. 2010;35:146-57.
23. Marwan Y, Kombar OR, Al-Saeed O, Aleidan A, Samir A, Esmaeel A. The feasibility of two screws anterior fixation for type II odontoid fracture among Arabs. Spine (Phila Pa 1976). 2016;41:643-6.
24. Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine (Phila Pa 1976). 2002;27:1494-8.
25. Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976). 2002;27:2435-40.
26. Lee SC, Chen JF, Lee ST. Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci. 2006;13:193-8.
27. Baaj AA, Vrionis FD. Atlantoaxial stabilization utilizing atlas translaminar fixation. J Clin Neurosci. 2010;17:1578-80.
28. Zhang HL, Zhou DS, Jiang ZS. Analysis of accuracy of computer-assisted navigation in cervical pedicle screw installation. Orthop Surg. 2011;3:52-6.
29. Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 2000;25:962-9.
30. Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R et al. The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J. 2015;24:2967-76.