Unstable cervical spine x rays3/28/2024 ![]() The integrity of anterior longitudinal ligament, disc, and facet joint attributes to the stability of axis fractures. The transverse ligament serves as the most crucial element in determining the stability of occipital condyle fractures and atlas fractures as well as atlanto-axial injury. The ligamentous integrity is the key element of impacting the stability of the upper cervical spine injuries. Only a few classification systems support decision-making concerning instability leading to early operative treatment. ![]() CT scan is more sensitive and reliable than X-ray in detecting misalignment of the upper cervical spine. The status of crucial ligaments plays a key role in determining instability of upper cervical spine injuries. The determinants involve translation, vertical distraction, angulation, rotation, obliquity of fracture line, comminution, and ligamentous disruption. Various instability criteria were established as well. The recent classifications pay more attention to the investigation of ligamentous status. The early classifications are based primarily on injury morphology and mechanism. Numerous separate classification systems for each specific injury of the upper cervical spine were obtained. An English literature search was conducted using various combinations of keyword terms. MethodsĪ systematic review of literature concerning upper cervical spine injuries was performed on the PubMed database from inception to December 2019. Since identifying unstable injuries of the upper cervical spine is essential for immediate stabilizing therapy, this article reviews the current classification systems of upper cervical spine injuries and their statements towards instability. 2015 24:195–202.The diagnosis of instability of the injured upper cervical spine remains controversial, due to its complicated anatomical configuration and biomechanical property. Hyperextension injury of the cervical spine with central cord syndrome. Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India. Incidence and demographics of cervical spine fractures over a 10 year period at level I trauma center. Spine (Phila Pa 1976) 1982 7:1–27.īlizzard DJ, Miller CP, Blizzard ST, Grauer JN. ![]() A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. 2016 25:74–9.Īllen BL, Jr, Ferguson RL, Lehmann TR, O’Brien RP. Limitation of previous Allen classification and subaxial cervical spine injury classification (SLIC) system in distractive-extension injury of cervical spine: proposal of modified classification system. Song KJ, Lee SK, Ham DH, Kim YJ, Choi BW. This method of immediate reduction and circumferential stabilization is rapid, safe, and effective and has a low rate of complications.Ĭervical injuries Circumferential stabilization Posterior tension band column. In unstable cervical injuries, stabilization of disrupted posterior tension band increases the stability of anterior plating and fusion. Data were analyzed using paired t-test.Īll patients had solid fusion at the desired level with considerable neurological improvement at the 1-year follow-up. Data of all patients were analyzed with respect to pre- and postoperative neurological status based on American Spinal Injury Association grading, Visual Analog Scale score, the observation of bony fusion, and implant failure at 1, 3, 6, and 12 months. All patients were managed by immediate reduction, posterior and anterior stabilization, and fusion in a single session of anesthesia. We retrospectively evaluated 24 patients with post-traumatic unstable subaxial cervical spine injuries with their preoperative clinical details, X-ray, computed tomography, and magnetic resonance imaging of the cervical spine for fracture classification based on the mechanism of injury with status of disc herniation and posterior tension band disruption. Controversy still exists regarding stabilization of unstable cervical fractures by anterior or posterior approach alone or combined approaches. Different methods of reduction and surgical approaches have been published in the literature, with lack of consensus on a uniform or standardized method. Such injuries need immediate surgical intervention. Unstable subaxial cervical spine injuries often involve disruption of the anterior column and posterior tension band osteoligamentous complex. To evaluate clinical and radiological outcomes of unstable subaxial cervical spine injuries managed by both posterior tension band column stabilization and anterior decompression, stabilization, and fusion.
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