Management of Cervical Spinal Fractures in Ankylosing Spondylitis
Barend J. van Royen, Ben A. C. Dijkmans in Ankylosing Spondylitis Diagnosis and Management, 2006
The anterior portion of the axis is comprised of a vertebral body with a cephalad-projecting extension named the odontoid process or dens. A transverse groove lies across the dorsal aspect of the dens. The transverse ligament passes over this groove. The laminae of the posterior arch of C2 are thick and stout. The atlas has a relatively large and long pars interarticularis. This structure serves to transition the facet articulation from the relatively anterior position of the occipital condyle and C1 to the more dorsal location of the lateral masses of the subaxial cervical spine. Fractures of the pars interarticularis of the atlas are termed hangman’s fractures because of their constant appearance following judicial hangings. The large, bifid spinous process provides an anchor point for many strong tendons and ligaments.
Cervical spine injury
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Strong ligaments and cervical paraspinous muscles stabilize the C-spine, creating a physiologic lordosis (an arch in the spine). The anterior and posterior longitudinal ligaments originate at the occiput and run along the anterior and posterior aspects of the vertebral bodies. Posteriorly, the ligamentum flavum, interspinous, and supraspinous ligaments connect the laminae and stabilize the posterior elements of the vertebrae. A complex array of ligaments also join the C1 and C2 vertebrae to each other and to the occiput. The cruciate ligament attaches the dens to the occiput and the atlas. The transverse ligament of the atlas is the main stabilizer of the dens posteriorly inside the atlas. The right and left alar ligaments project from the dens superiorly to the occipital condyles (Figure 11.2).3
Cervical spine trauma
Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou in Orthopaedic Trauma, 2014
Undisplaced type 2 fractures generally require a halo vest or, in elderly patients, a hard collar. Displaced fractures can undergo either reduction with traction and immobilization in a halo vest (significant risk of non-union) or internal fixation with anterior screws or posterior C1–2 fusion (limits rotation). Indications for screw fixation are: Anterosuperior to posteroinferior fracture line.Absence of significant comminution.Intact transverse ligament.Acceptable bone stock.
Surgical treatment of neglected C2 odontoid process fracture with anterior atlantoaxial dislocation
Published in British Journal of Neurosurgery, 2021
Vladimir Klimov, Murodzhon Kosimshoev, Aleksey Evsyukov, Vitaly Stepanenko, Jamil Rzaev
The patient kept his head bent slightly forward. No neurological deficit was found. A radiograph of the cervical spine (Figure 1(B)) revealed an old fracture through the base of the odontoid. In the lateral projection (Figure 1(A)), the ventral and angular displacement of the dens was observed to be 14 mm anterior with an angular deformation of approximately 60°. CT (Figure 1(C,D)), demonstrated a fracture of the odontoid base with anterior displacement. According to the Anderson-D'Alonzo classification, this injury was identified as a displaced type II fracture. Under Steel’s rule,9 the spinal cord occupied less than 1/3 of the axial canal area. According to MRI (Figure 2(A,B)), a rupture of the atlas transverse ligament was felt to be present. CT angiography was performed for screw placement planning and it identified an aberrant vertebral artery at the level of C2 classified as type III, according to R. Shane Tubbs10 (Figure 1(E,F)).
Integrity of the tectorial membrane is a favorable prognostic factor in atlanto-occipital dislocation
Published in British Journal of Neurosurgery, 2020
Gil Kimchi, Gahl Greenberg, Vincent C. Traynelis, Christopher D. Witiw, Nachshon Knoller, Ran Harel
The underlying instability in AOD is often attributed to rupture of the tectorial membrane and alar ligaments.2 The craniocervical junction is supported anteriorly by a ligamentous complex that comprises two distinct groups;12 the first includes the atlanto-condylar articulation, the cruciate ligament and the anterior atlanto-occipital ligament. This group provides stability chiefly to the atlanto-cranial and the atlanto-dental complexes. The second group of ligaments provides stability to the cranium-odontoid complex. It consists of the tectorial membrane, the apical ligament and the alar ligaments. Of special importance within that group is the tectorial membrane; this strong collagenous continuum of the posterior longitudinal ligament lies posteriorly to the transverse ligament and connects the dorsum of the dens to the clivus. Its primary role is to resist hyperextension, although it may also serve to limit hyperflexion as well.13 The prominent role of the tectorial membrane in craniocervical stabilization is well elucidated in a cadaver study,14 in which the authors removed the alar and transverse ligaments and applied various manipulations on the CCJ. They revealed that the tectorial membrane acts as the ‘second line of defense’ by preventing the odontoid process from translating posteriorly and consequently compressing the spinal canal.
Cervical myelopathy causing numbness and paresthesias in lower extremities: A case report identifying the cause of a false positive Sharp–Purser test
Published in Physiotherapy Theory and Practice, 2019
The SPT is performed with the patient sitting on the plinth table (Reiman, 2015). The neck is then semiflexed to 20–30°. During the neck flexion phase of the SPT, the patient in this case report experienced numbness into anterior thighs bilaterally. The physical therapist then placed one hand in a pincer grip to the spinous process of C2, and applied a posterior force through the patient’s forehead with the opposite hand (Reiman, 2015). For this patient, the maneuver alleviated anterior numbness in both thighs. A positive SPT is the reproduction of myelopathic symptoms with cervical flexion and resolution of symptoms with posterior force directed through forehead (Meadows, 1998; Reiman, 2015; Uitvlugt and Indenbaum, 1988). Biomechanically, if the transverse ligament is compromised the dens will compress the spinal cord with active cervical flexion, and the SPT maneuver will decompress the dens from the spinal cord (Meadows, 1998; Reiman, 2015; Uitvlugt and Indenbaum, 1988).
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