Craniocervical Traumatic Injuries: Evaluation and Surgical Decision Making

摘要

We present a literature review of current approaches to craniocervical traumatic injuries. In an attempt to categorize the injuries that involve the upper cervical spine, we divide the injuries into two groups: (1) injuries affecting mainly bone structures and (2) predominantly ligamentous injury. This division is based on the principle that bone injuries have the potential to heal with conservative treatment whereas ligamentous injury would not heal properly, leading to an unstable spine. An accurate diagnosis and treatment are necessary to improve patient’s outcome and avoid complications. As a general rule, ligamentous injuries are unstable lesions, requiring surgical treatment. Bony injuries can be conservatively treated, with surgery reserved for more unstable patterns (unstable C1 ring, displaced odontoid or C2 pars fractures). Keywords: craniocervical traumatic injuries, atlas, axis, occipital condyle, upper spine injuries Craniocervical traumatic injuries represent a small number of cervical spine injuries, affecting the skull base, the atlas, and the axis. 1 2 They are generally associated with high-energy trauma; most of them are caused by motor vehicle accidents, but they also can be secondary to low-energy injuries, like a ground-level fall in older individuals with bone fragility. 2–4 The complex and unique anatomy and strong stability related to the ligamentous status of this region result in some peculiarities that distinguish this group of injuries from the subaxial cervical spine. 3 4 The craniocervical junction is also biomechanically responsible for the majority of axial rotation at the atlantoaxial complex and the greatest range of flexion and extension at the occiput–C1 joint. 5 In this article, we present a brief overview of the most common craniocervical traumatic injuries and their diagnosis and treatment.