Zeitschrift für Wirbelsäulen- und Neurochirurgie

Cranio-Cervical Trauma Eidemiology, Classification, Diagnosis And Management

Amar Saxena

Objective: To provide an overview of current knowledge of the management of Cranio-Cervical (Occipito-cervical) injuries.

Method: Literature search for new trends in the management of Cranio-cervical injuries. The article is divided into subheadings of Introduction, Epidemiology, pre-disposing factors and Anatomy of the Cranio-cervical junction including relevant surgical anatomy. NICE guidelines for management of cervical spine injuries and its recommendations are mentioned. This is followed by description of individual fractures, including their classification, clinical presentation and management. Recent advances in the management of individual fractures are mentioned with reference. The fractures covered are Occipital Condylar fractures (including Traumatic Atlanto-Occipital Dislocation), C1 Fractures (including Jefferson Fracture) and Odontoid fractures (including Hangman’s fracture) with brief description of surgical techniques to stabilize these fractures. Results: Cranio-cervical junction is a very tough construct and it requires very strong forces to result in occipito-cervical bony or ligamentous injuries. Cranio-cervical injuries must be suspected in high velocity injuries like RTAs and also in the elderly with neck pain and stiffness following a fall. Since Conventional cervical spine plain films can miss injuries in this region, there is need for a high index of suspicion as elaborated by NICE guidelines. There are new trends in the surgical management of Jefferson’s fractures (Posterior osteosynthesis) and Hangman’s fractures of C2 (Anterior approach better)

Conclusion: Cranio-cervical injuries constitute a significant proportion of high velocity trauma and can be missed. There is a need for high index of suspicion in such patients. Recent trends seem to favour surgical management of these injuries even in the elderly. Aim should be early surgical fixation wherever possible even in elderly patients, if there is no significant co-morbidity or contraindication for surgery.