title: Upper cervical spine injuries: a management of a series of 70 cases.
abstract: Traumatic injuries of the upper cervical spine are often encountered, and may be associated to severe neurological outcome. This is a retrospective study of 70 patients, admitted over a 14 years period (1996 to 2010), for management of upper cervical spine injuries. Data concerning epidemiology, radiopathology and treatment was reviewed, and clinical and radiological evaluation was conducted. Men are more affected than women, with traffic accidents being the major traumatic cause. A cervical spine syndrome of varied intensity was found in about 90% of patients; neurological deficit was noted in 10 patients (21%). Radiological analysis discovered varied and many combined lesions: C1-C2 dislocation (7 cases), C2-C3 dislocation (9 cases), C1 fracture (10 cases) and C2 fracture (44 cases) including 28 odontoid fractures. Orthopedic treatment was carried out exclusively for 31 patients, and surgical treatment for 38 patients. One patient died before surgery because of a polytraumatisme. Posterior approach was performed in 29 cases including hooks and rods in 18 patients, wiring in 9 cases, and 2 transarticular screw fixations. In 9 cases anterior approach was performed: 5 odontoid screwing and 4 cases of C2-C3 discectomy with bone graft. Nearly all patients were improved in post-operative. Elsewhere, the operating results were marked by a persistent neurological deficit in 2 cases, and infection in 2 cases controlled by medical treatment. Mean follow-up was 23 months and showed good clinical and radiological improvement. Early management of cervical spine injuries can optimize outcome. Treatment modalities are well codified; however controversy remains especially with type II odontoid fractures.
authors.affiliation: Service de Neurochirugie, Hôpital Ibn Sina, CHU Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V - Souissi, Maroc.
authors.forename: El Fatemi
authors.initials: el F
authors.lastname: Nizare
authors.forename: Bouchaouch
authors.initials: B
authors.lastname: Abdelali
authors.forename: Derkaoui Hassani
authors.initials: DH
authors.lastname: Fahd
authors.forename: Oudrhiri Mohammed
authors.initials: OM
authors.lastname: Yassad
authors.forename: Gana
authors.initials: G
authors.lastname: Rachid
authors.forename: El Maaqili
authors.initials: el M
authors.lastname: Rachid
authors.forename: Bellakhdar
authors.initials: B
authors.lastname: Fouad
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D017678:Sex Distribution; D013124:Spinal Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Upper cervical spine; injury; prognosis; surgical management