Vacuum phenomenon as a sign of an ununited, unstable dens fracture.
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Stable injuries of the cervical spine can be treated with a cervical collar. Unstable injuries that do not require repositioning can be immobilized with a Minerva plaster cast. Crutchfield's extension is used for extension of short duration during repositioning before setting a cast or performing surgery and for long-term extension in cases of transverse lesions of the spinal cord. The Halo apparatus is especially suitable for treatment requiring extension of long duration when there are no symptoms of transverse lesions of the spinal cord.
In the period from 1981 to 1985, 32 odontoid fractures were treated in the National Institute of Traumatology. In 4 cases anterior stabilization was made with compression-screws from the ventral approach. Two cases of odontoid fractures are shown, one accompanied by ventral, the other by dorsal dislocation. A brief review of the results with different methods of treatment is given on the basis of the international literature.
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The treatment of fractures of the cervical spine, like that of fractures of the extremities, has been considerably improved in the last decade. The aim of these changes has been to prevent and correct deformities and to achieve such a high degree of primary stability with the use of different internal fixation techniques that traditional external fixation can be avoided. Non-stable internal fixation and laminectomies, which invariably result in further loss of stability, have thus been completely eliminated from the therapeutic arsenal. The new system implies a considerably milder course of treatment for the patient. Confinement to bed is limited to a few days, even for tetraplegic patients. The duration of stay in the hospital is short and any necessary rehabilitation can be started at an extremely early stage. This article describes some of the new techniques and provides examples of indications for and methods of performing stable internal fixation.
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An odontoid bone was detected in an adult patient after injury to neck, with secondary appearance of disorders related to C1-C2 instability that disappeared after posterior C1-C2 arthrodesis. The odontoid bone is a rare anomaly of debatable origin. Current pathogenicity theories are discussed.
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The trend in the treatment of odontoid bone fractures is characterized by progressive application of operative methods. Special instruments for the fixation of odontoid bone was developed. Due to the ventral extraoral approach odontoid bone is possible to fix temporary with two rigid Kirschner wires by these hollow screws drilled from the ventral lower edge of the second vertebral body through the fracture in the odontoid bone. By using this method the operative procedure is much more safety as well as the x-ray exposure of the patient and of the operating team is reduced.
Surgery is the treatment of choice in injuries of the cervical spine. In the upper cervical spine, fractures of the dens are stabilized by anterior screw fixation. In the lower cervical spine, injuries are stabilized with short fusions.
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Cervical spine involvement with psoriatic arthritis has been reported to occur in about 35% of patients and to be primarily ankylosing in nature. This previously described pattern is characterized by syndesmophytes, ankylosis and ligamentous ossification. Our study defines the incidence and clinical characteristics of a rheumatoid-like form of inflammatory cervical spine involvement. This pattern is characterized by apophyseal and odontoid erosions, and axial and subaxial subluxations. Clinical histories were obtained from 28 patients with both psoriasis and inflammatory arthritis between the years of 1971 and 1984. Cervical spine involvement was found in 75% of the group, 13/21 had ankylosing and 8/21 inflammatory characteristics. Three of our patients developed cervical myelopathy, one in the ankylosing and 2 in the inflammatory subgroup.
We present operative procedures for the stabilization of fractures of C1 and C2. As is the case for fractures of the extremities, a direct approach to the injury should be attempted in order to avoid the inclusion of intact segments in the spondylodesis. The aim of the three presented techniques - direct screw fixation of fracture of the dens axis and traumatic lysis of C2 - is to active anatomical reconstruction by optimal stabilization. The new technique of transarticular screw fixation of C1-2 developed by Magerl allows unisegmental three-dimensional stabilization in cases in which at least a three-level fusion would have previously been considered necessary.
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