Combined Injury of the Atlas and Axis Vertebrae

Authors: J. Kočiš;  P. Wendsche;  V. Mužík;  R. Veselý;  I. Černohousová
Authors‘ workplace: Klinika traumatologie LF MU, Úrazová nemocnice v Brně
Published in: Cesk Slov Neurol N 2008; 71/104(5): 576-582
Category: Short Communication


Objective of study:
The article presents the authors’ retrospective assessment of a sample of patients with a finding of combined injury of the atlas and axis vertebrae and their experience in treating this type of combined injury.

In the years 1999–2006 we treated 35 patients in our clinic for combined injury of the atlas and axis vertebrae. Patients’ ages ranged from 13 to 94 years with an average of 49.4 years. The sample included 21 men and 14 women. The most frequent cause of injury was a car/motorcycle accident (16 cases in total), a fall while walking in 9 cases, a fall from a height in 6 cases and jumping into shallow water in 4 cases. Fractures were classified according to Aebi and Nazarian. The breakdown of types of injuries was as follows: type C1.2 20 cases, type C1.3 5 cases, type C1.1 4 cases, type C2.3 3 cases, type C3.1 2 cases and type C2.1 1 case. The neurological condition of 32 patients received was assessed as Frankel E, two patients were classified as Frankel A and one patient as Frankel B. The dominant therapeutic approach was conservative, in 28 cases. We operated on seven patients. We carried out compression osteosynthesis of the axis vertebra in two cases and in two cases we used the Gallie technique. Magerl’s rear transarticular stabilization technique was used in the treatment of three patients.

The monitoring period for patients is at least six months to four years. We ca­tegorised all patients’ wounds as healed six months after injury. X‑ray pictures, functional x-ray pictures and the scope of movement of the cervical spinal co­lumn were assessed. Two patients with a neurological deficit improved; one patient with a neurological Frankel A damage died without a direct causal relationship to the injury or its treatment. We did not observe any complications in relation to the treatment of patients.

Combined injury of the atlas and axis vertebrae is relatively frequent. It is always necessary to look for a simultaneous injury of the other vertebra when a fracture of one of these vertebrae is identified. In our sample, patients experienced neurological handicaps in the event of combined ligament and bone‑ligament injuries type C1–C2. Treatment is guided by an assessment of the instability of the injury. Treatment strategy is dominated by the aim of achieving stable osteosynthesis in unstable injuries if the patient’s health condition permits this.

Key words:
atlas – axis – combined injury of the atlas and axis


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Paediatric neurology Neurosurgery Neurology
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