Tag: C2 fracture

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Stereotactic CT image guidance and biplanar fluoroscopy for transoral C2 vertebroplasty and direct anterolateral subaxial vertebroplasty

Acta Neurochirurgica (2020) 162:2533–2536

Metastatic cervical spine disease can cause compression fractures, cervical spine instability, and pain. Vertebroplasty can stabilize a fracture, reduce the pain associated with a compression fracture, prevent or stop the progression of a fracture, thus avoiding cervical spine fixation, and decreased mobility. Transoral C2 vertebroplasty is less invasive than open fusion surgery, but it poses its own risk of infection and cement leak in this highly sensitive area.

Methods The image guidance setup consisted of the Stryker NAV3i navigation system, Stryker CranialMask tracker, and the CranialMap 3.0 software combined with biplanar fluoroscopy.

Results The patient’s neck pain has completely resolved immediately after the surgery. There were no complications.

Conclusion Quality of life preservation is paramount in the management of metastatic spine disease. Vertebroplasty of osteolytic lesions can both relieve pain and restore stability, thus avoiding permanent stiff cervical collar, halo vest, or upfront occipitocervical fusion. With the increasing availability of surgical navigation systems, its use combined with biplanar fluoroscopy for performing transoral C2 vertebroplasty seems to be an adequate treatment in selected cases for pain relief, stabilization, and maintaining quality of life in the complex cancer population with C2 pathological fractures. The article describes as well vertebroplasty of the subaxial spine through a conventional anterior approach which again seems to be adequate in the treatment of spinal pathological fractures.

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Minimally invasive posterior percutaneous transarticular C1–C2 screws: how I do it

Acta Neurochirurgica (2020) 162:2047–2050

Transarticular C1–C2 screw fixation, first described by Magerl, is a widely accepted used technique for C1–C2 instability with a good biomechanical stability and fusion rate.

Method We present a 69-year-old woman, who was diagnosed with a C2 Odontoid fracture type III and primarily treated with conservative treatment and collar. During first 2 weeks of follow-up, the patient developed cervical pain associated with C1–C2 instability. A minimally invasive posterior C1–C2 transarticular screw instrumentation with a percutaneus approach was performed.

Results and conclusion Minimally invasive approach with tubular transmuscular approach for C1–C2 transarticular screws instrumentation is safe and effective for C1–C2 instability.

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Morbidity and Mortality of C2 Fractures in the Elderly- Surgery and Conservative Treatment

Neurosurgery 70:1055–1059, 2012 DOI: 10.1227/NEU.0b013e3182446742

Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients.

OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality.

METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival.

RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups.

CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

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