Surgically Treated C1 Fractures: A Population-Based Study
| Autor: | Jukka Huttunen, Olli-Pekka Kämäräinen, Nils Danner, Henna-Kaisa Jyrkkänen, Ville Leinonen, Henri Ylönen |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Bone Screws Population Neurosurgical Procedures Fracture Fixation Internal Cervical spine fracture Postoperative Complications medicine Medical imaging Humans Cervical Atlas Range of Motion Articular education Aged Retrospective Studies Aged 80 and over Neck pain education.field_of_study medicine.diagnostic_test business.industry Magnetic resonance imaging Middle Aged Magnetic Resonance Imaging Vertebra Surgery Treatment Outcome medicine.anatomical_structure Concomitant Cervical Vertebrae Spinal Fractures Female Neurology (clinical) Neurosurgery medicine.symptom business Follow-Up Studies |
| Zdroj: | World Neurosurgery. 154:e333-e342 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2021.07.046 |
| Popis: | Objective To characterize surgical treatment and outcomes of C1 fractures in a population-based setup. Methods Patients with C1 fracture treated at Kuopio University Hospital Neurosurgery were retrospectively identified from January 1996 to June 2017. C1 fractures were classified according to the AO Spine Upper Cervical and Gehweiler classification systems. Patients were divided into 4 groups based on their treatment: group 1 (underwent C1 surgery as a primary option), group 2 (underwent C1 surgery as a secondary option after initial nonoperative treatment), group 3 (underwent surgery involving the C1 level with main indication being a concomitant cervical spine fracture), and group 4 (C1 fracture treatment was nonoperative). Results We identified 47 patients with C1 fracture (mean age, 60.3 ± 18.2 years; 83.0% men; American Society of Anesthesiologists score, 2.3 ± 0.8). Concomitant cervical spine fractures were present in 89.4% of cases, most commonly in the C2 vertebra (75.4%). In group 2, 3 of 5 fractures changed from AO Spine type A to B in control imaging after nonoperative treatment, indicating fracture instability and requiring secondary surgery. Good C1 fracture alignment was achieved for 10 of 10 followed-up patients in groups 1 and 2, and for 10 of 11 followed-up patients in group 3. Residual neck pain and stiffness were present in all groups. Neurologic symptoms were rare and mild. Conclusions For unstable C1 fractures, surgery is safe treatment with good outcomes. Fractures initially determined as stable may require surgery if alignment is worsened in follow-up imaging. Magnetic resonance imaging is recommended to better detect unstable C1 fractures in diagnostic imaging. |
| Databáze: | OpenAIRE |
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