2Afyonkarahisar Devlet Hastanesi, Ortopedi ve Travmatoloji Kliniği, Afyonkarahisar, Türkiye AIM: Cervical spine trauma is an important cause of morbidity and mortality worldwide. The craniocervical junction (CCJ) is responsible for head and neck movement and is the most flexible part of the spine. Traumatic injuries are therefore mostly seen in this region. Diagnosis and treatment of CCJ trauma patients are difficult. In this article, we aimed to present a comprehensive study in which we investigated the demographic-epidemiological characteristics, diagnostic results and treatment outcomes of patients with CCJ trauma.
MATERIAL and METHODS: We included 79 of the 412 cervical trauma patients seen with CCJ trauma and monitored between the years 1995-2005 in our clinic in the study. This retrospective study had two stages. In the first stage, these 79 patients were investigated in terms of demographic, epidemiological and diagnostic characteristics. In the second stage, treatment outcomes and neurological recovery were investigated in the conservatively or surgically treated and regularly followed up patients. RESULTS: The incidence of CCJ trauma was identified as 19%. The majority of our patients were male (61%) and in the adult age group (51%). The most common etiological causes were reported as traffic accidents (41%). The lesions were detected at a rate of 68% with X-ray. Lesions in addition to plain radiography findings were identified with computerized tomography (CT) in 11 patients (14%). The rate of injuries detected by CT alone was 18%. These percentages were statistically significant (p <0.05; t-test). The most common CCJ injury was fracture of the axis (49.4%), most commonly in the form of a type 2 odontoid fracture (62%). The second most frequent injury was fracture of the atlas (34.4%) and the least common was occipital condyle fracture (15.2%). Some cases (24 cases) had multiple fractures and/or instability. 19 of the 32 patients who had fractures with neurological symptoms and/ or instability underwent Halovest treatment. Surgery was performed in 18 cases. There was a statistically significant difference between the initial assessment and Frankel stage in the last follow-up (p <0.05, chi-square test) after an average of 6.5 years of monitoring. We found a strong correlation between mortality and the presence of cranial lesions with low Glasgow Coma Score (r = 0.9 and r = 0.6; Pearson correlation test).
CONCLUSION: CCJ traumas are often seen in young males and after traffic accidents. CT must be used in the diagnosis. The most common CCJ injuries are axis fractures, most commonly in the form of type 2 odontoid fractures. Unstable injury may be associated with neurological deficits. Low GCS and the presence of cranial lesions especially increase the mortality risk. Stable injuries can be treated conservatively. Surgical treatment is a good option in unstable cases with neurological symptoms.
Anahtar Kelimeler : Craniocervical junction, Upper cervical spine, Trauma, Radiological diagnostic methods, Treatment outcome