title: Retrospective analysis of a case series of patients with traumatic injuries to the craniocervical junction.
abstract: OBJECTIVE
  To evaluate the correlation between the treatment, the characteristics of the lesions and the clinical outcome of patients with traumatic injuries to the craniocervical junction.
  
  
  METHODS
  This was a retrospective study of patients treated conservatively or surgically between 2010 and 2013 with complete data sets.
  
  
  RESULTS
  We analyzed 37 patients, 73% were men with mean age of 41.7 years. Of these, 32% were submitted to initial surgical treatment and 68% received conservative treatment. Seven (29%) underwent surgery subsequently. In the surgical group, there were seven cases of odontoid type II fractures, two cases of fracture of posterior elements of the axis, one case of C1-C2 dislocation with associated fractured C2, one case of occipitocervical dislocation, and one case of combined C1 and C2 fractures, and facet dislocation. Only one patient had neurological déficit that improved after treatment. Two surgical complications were seen: a liquoric fistula and one surgical wound infection (reaproached). In the group treated conservatively, odontoid fractures (eight cases) and fractures of the posterior elements of C2 (five cases) were more frequent. In two cases, in addition to the injuries of the craniocervical junction, there were fractures in other segments of the spine. None of the patients who underwent conservative treatment presented neurological deterioration.
  
  
  CONCLUSIONS
  Although injuries of craniocervical junction are relatively rare, they usually involve fractures of the odontoid and the posterior elements of the axis. Our results recommend early surgical treatment for type II odontoid fractures and ligament injuries, the conservative treatment for other injuries.
  
  
  OBJECTIVE
  Avaliar a correlação entre o tratamento, as características das lesões e o resultado clínico em pacientes com lesões traumáticas na junção craniocervical.
  Estudo retrospectivo de pacientes maiores de 18 anos tratados de forma conservadora ou cirúrgica, entre 2010 e 2013.
  
  
  RESULTS
  Foram analisados 37 pacientes, 73% eram do sexo masculino e a média de idade foi de 41,7 anos. Inicialmente 32% dos pacientes foram submetidos a tratamento cirúrgico, e 68% foram submetidos a tratamento conservador. Sete pacientes (29%) do grupo conservador foram submetidos posteriormente à cirurgia. No grupo cirúrgico, houve sete casos de fratura de odontóide tipo II, dois casos de fratura de elementos posteriores do áxis, um caso de luxação C1-C2, um caso de deslocamento occipito-cervical e um caso de fraturas de C1 e C2 e luxação facetária. Um paciente apresentava déficit neurológico, melhorando após o tratamento. Houve duas complicações pós-cirúrgicas, uma fístula liquórica e uma infecção de ferida operatória (reabordada). No grupo conservador, predominaram as fraturas do odontóide (oito) e dos elementos posteriores de C2 (cinco). Em dois casos, havia também fraturas em outros segmentos da coluna. Nenhum dos pacientes deste grupo apresentou deterioração neurológica.
  As lesões da junção craniocervical são raras, sendo mais frequentes as fraturas do odontóide e dos elementos posteriores do áxis. Nossos resultados recomendam o tratamento cirúrgico precoce para os pacientes com fraturas do odontóide tipo II e lesões ligamentares, e tratamento conservador para os demais pacientes.
authors.affiliation: Universidade Estadual de Campinas, Campinas, SP, Brazil.|Núcleo do Hospital de Força Aérea de São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Adriano
authors.initials: LA
authors.lastname: Esteves
authors.affiliation: Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Andrei Fernandes
authors.initials: AF
authors.lastname: Joaquim
authors.affiliation: Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Helder
authors.initials: H
authors.lastname: Tedeschi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D000072700:Conservative Treatment; D006259:Craniocerebral Trauma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000293:injuries; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D020196:Trauma, Nervous System / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult