Surgery pp 545-562 | Cite as

Traumatic Injury of the Spine

  • Justin F. Fraser
  • John Boockvar
  • Roger Hartl


Acute injury to the spine is a major cause of morbidity in trauma patients. Of 39.15 million reported injury-related emergency department visits in 2002, 5.1% (1.997 million) were related to the spine.1 The incidence of traumatic spinal cord injury (SCI) alone is estimated to be 11,000 to 14,000 cases per year in the United States, with an estimated annual cost of medical and supportive care exceeding $9.7 billion.2, 3, 4, 5, 6, 7 SCI are particularly debilitating; more than 50% of patients with SCI are between 16 and 30 years old.2 In the acute trauma setting, SCI may be missed if appropriate clinical and radiographic tests are not performed. For example, in a 10-year retrospective study, Poonnoose et al. found that among 569 patients with SCI, 9.1% of the diagnoses were missed initially; in 50% of missed cases, mismanagement resulted in worsened neurological status.8,9 The medical and fiscal costs of caring for spine injuries are high, and spinal pathology, especially if undiagnosed, may complicate the prognosis and treatment of the trauma patient. Outcome depends highly on appropriate management, skilled surgical intervention, and management of comorbid conditions. As such, it is important to approach the patient with a potential traumatic injury of the spine with an accurate understanding of potential pathology and stability, to manage the patient appropriately.


Spinal Cord Injury Cervical Spine Cervical Spine Injury Burst Fracture Functional Independence Measure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Adv Data 2004;340:1–34.PubMedGoogle Scholar
  2. 2.
    Baker SP, O’Neill B, Ginsburg M, Li G. The Injury Fact Book. 2nd ed. New York. Oxford University Press, 1992.Google Scholar
  3. 3.
    Bracken MB, Freeman DH Jr, Hellenbrand K. Incidence of acute traumatic hospitalized spinal cord injury in the United States, 1970–1977. Am J Epidemiol 1981;113:615–622.PubMedGoogle Scholar
  4. 4.
    Fehlings MG, Tator CH. An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg Spine 1999;91:1–11.Google Scholar
  5. 5.
    Hadley MN, Walters BC, Grabb PA, et al. Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 2002;49:407–498.PubMedGoogle Scholar
  6. 6.
    Irwin ZN, Arthur M, Mullins RJ, et al. Variations in injury patterns, treatment, and outcome for spinal fracture and paralysis in adult versus geriatric patients. Spine 2004;29:796–802.PubMedGoogle Scholar
  7. 7.
    Julien TD, Frankel B, Traynelis VC, Ryken TC. Evidence-based analysis of odontoid fracture management. Neurosurg Focus 2000;8: article 1.Google Scholar
  8. 8.
    Gunnarsson T, Fehlings MG. Acute neurosurgical management of traumatic brain injury and spinal cord injury. Curr Opin Neurol 2003;16:717–723.PubMedGoogle Scholar
  9. 9.
    Poonnoose PM, Ravichandran G, McClelland MR. Missed and mismanaged injuries of the spinal cord. J Trauma 2002;53:314–320.PubMedGoogle Scholar
  10. 10.
    Harris MB, Kronlage SC, Carboni PA, et al. Evaluation of the cervical spine in the polytrauma patient. Spine 2000;25:2884–2891; discussion 2892.PubMedGoogle Scholar
  11. 11.
    Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663–1674.PubMedGoogle Scholar
  12. 12.
    Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. 1974. J Bone Joint Surg Am 2004;86A:2081.Google Scholar
  13. 13.
    Benzel EC, Hart BL, Ball PA, et al. Fractures of the C-2 vertebral body. J Neurosurg 1994;81:206–212.PubMedGoogle Scholar
  14. 14.
    Hadley MN, Dickman CA, Browner CM, et al. Acute axis fractures: a review of 229 cases. J Neurosurg 1989;71:642–647.PubMedGoogle Scholar
  15. 15.
    Huelke DF, O’Day J, Mendelsohn RA. Cervical injuries suffered in automobile crashes. J Neurosurg 1981;54:316–322.PubMedGoogle Scholar
  16. 16.
    Marino RJ, Ditunno JF Jr, Donovan WH, et al. Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehabil 1999;80:1391–1396.PubMedGoogle Scholar
  17. 17.
    Drainer EK, Graham CA, Munro PT. Blunt cervical spine injuries in Scotland 1995–2000. Injury 2003;34:330–333.PubMedGoogle Scholar
  18. 18.
    Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury? J Trauma 1993;34:549–553; discussion 553–554.PubMedGoogle Scholar
  19. 19.
    Chiu WC, Haan JM, Cushing BM, et al. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma 2001;50:457–463; discussion 464.PubMedGoogle Scholar
  20. 20.
    Davis JW, Phreaner DL, Hoyt DB, et al. The etiology of missed cervical spine injuries. J Trauma 1993;34:342–346.PubMedGoogle Scholar
  21. 21.
    Demetriades D, Charalambides K, Chahwan S, et al. Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls. J Trauma 2000;48:724–727.PubMedGoogle Scholar
  22. 22.
    Grossman MD, Reilly PM, Gillett T, et al. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma 1999;47:684–690.PubMedGoogle Scholar
  23. 23.
    MacDonald RL, Schwartz ML, Mirich D, et al. Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma 1990;30:392–397.PubMedGoogle Scholar
  24. 24.
    Morris CG, McCoy E. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Anaesthesia 2004;59:464–482.PubMedGoogle Scholar
  25. 25.
    Morris CG, Mullan B. Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit. Anaesthesia 2004;59:755–761.PubMedGoogle Scholar
  26. 26.
    Schenarts PJ, Diaz J, Kaiser C, et al. Prospective comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma 2001;51:663–668; discussion 668–669.PubMedGoogle Scholar
  27. 27.
    Akmal M, Trivedi R, Sutcliffe J. Functional outcome in trauma patients with spinal injury. Spine 2003;28:180–185.PubMedGoogle Scholar
  28. 28.
    Blood pressure management after acute spinal cord injury. Neurosurgery 2002;50:S58–S62.Google Scholar
  29. 29.
    Cervical spine immobilization before admission to the hospital. Neurosurgery 2002;50:S7–S17.Google Scholar
  30. 30.
    Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma 1987;27:445–447.PubMedGoogle Scholar
  31. 31.
    Burney RE, Waggoner R, Maynard FM. Stabilization of spinal injury for early transfer. J Trauma 1989;29:1497–1499.PubMedGoogle Scholar
  32. 32.
    Prasad VS, Schwartz A, Bhutani R, et al. Characteristics of injuries to the cervical spine and spinal cord in polytrauma patient population: experience from a regional trauma unit. Spinal Cord 1999;37:560–568.PubMedGoogle Scholar
  33. 33.
    Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969;7:179–192.PubMedGoogle Scholar
  34. 34.
    Clinical assessment after acute cervical spinal cord injury. Neurosurgery 2002;50:S21–S29.Google Scholar
  35. 35.
    Cohen ME, Ditunno JF Jr, Donovan WH, et al. A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 1998;36:554–560.PubMedGoogle Scholar
  36. 36.
    El Masry WS, Tsubo M, Katoh S, et al. Validation of the American Spinal Injury Association (ASIA) motor score and the National Acute Spinal Cord Injury Study (NASCIS) motor score. Spine 1996;21:614–619.PubMedGoogle Scholar
  37. 37.
    Hamilton BB, Laughlin JA, Fiedler RC, et al. Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med 1994;26:115–119.PubMedGoogle Scholar
  38. 38.
    Jonsson M, Tollback A, Gonzales H, et al. Inter-rater reliability of the 1992 international standards for neurological and functional classification of incomplete spinal cord injury. Spinal Cord 2000;38:675–679.PubMedGoogle Scholar
  39. 39.
    Maynard FM Jr, Bracken MB, Creasey G, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 1997;35:266–274.PubMedGoogle Scholar
  40. 40.
    Stineman MG, Marino RJ, Deutsch A, et al. A functional strategy for classifying patients after traumatic spinal cord injury. Spinal Cord 1999;37:717–725.PubMedGoogle Scholar
  41. 41.
    Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA 1984;251:45–52.PubMedGoogle Scholar
  42. 42.
    Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990;322:1405–1411.PubMedGoogle Scholar
  43. 43.
    Bracken MB, Holford TR. Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS. J Neurosurg 1993;79:500–507.PubMedGoogle Scholar
  44. 44.
    Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997;277:1597–1604.PubMedGoogle Scholar
  45. 45.
    Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery 2002;50:S63–S72.Google Scholar
  46. 46.
    Matsumoto T, Tamaki T, Kawakami M, et al. Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury. Spine 2001;26:426–430.PubMedGoogle Scholar
  47. 47.
    McCutcheon EP, Selassie AW, Gu JK, et al. Acute traumatic spinal cord injury, 1993–2000. A population-based assessment of methylprednisolone administration and hospitalization. J Trauma 2004;56:1076–1083.PubMedGoogle Scholar
  48. 48.
    Peter Vellman W, Hawkes AP, Lammertse DP. Administration of corticosteroids for acute spinal cord injury: the current practice of trauma medical directors and emergency medical system physician advisors. Spine 2003;28:941–947; discussion 947.PubMedGoogle Scholar
  49. 49.
    Hugenholtz H. Methylprednisolone for acute spinal cord injury: not a standard of care. C Med Assoc J 2003;168:1145–1146.Google Scholar
  50. 50.
    Hugenholtz H, Cass DE, Dvorak MF, et al. High-dose methylprednisolone for acute closed spinal cord injury: only a treatment option. Can J Neurol Sci 2002;29:227–35.PubMedGoogle Scholar
  51. 51.
    Geisler FH, Coleman WP, Grieco G, et al. The Sygen multicenter acute spinal cord injury study. Spine 2001;26:S87–S98.PubMedGoogle Scholar
  52. 52.
    Initial closed reduction of cervical spine fracture-dislocation injuries. Neurosurgery 2002;50:S44–S50.Google Scholar
  53. 53.
    Grant GA, Mirza SK, Chapman JR, et al. Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg 1999;90:13–18.PubMedGoogle Scholar
  54. 54.
    Hadley MN, Fitzpatrick BC, Sonntag VK, et al. Facet fracture-dislocation injuries of the cervical spine. Neurosurgery 1992;30:661–666.PubMedGoogle Scholar
  55. 55.
    Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000;343:94–99.PubMedGoogle Scholar
  56. 56.
    Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery 2002;50:S30–S35.Google Scholar
  57. 57.
    Roth BJ, Martin RR, Foley K, et al. Roentgenographic evaluation of the cervical spine. A selective approach. Arch Surg 1994;129:643–645.PubMedGoogle Scholar
  58. 58.
    Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery 2002;50:S36–S43.Google Scholar
  59. 59.
    Berne JD, Velmahos GC, El-Tawil Q, et al. Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. J Trauma 1999;47:896–902; discussion 903.PubMedGoogle Scholar
  60. 60.
    Borock EC, Gabram SG, Jacobs LM, et al. A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma 1991;31:1001–1005; discussion 1005–1006.PubMedGoogle Scholar
  61. 61.
    Mace SE. Emergency evaluation of cervical spine injuries: CT versus plain radiographs. Ann Emerg Med 1985;14:973–975.PubMedGoogle Scholar
  62. 62.
    Tan E, Schweitzer ME, Vaccaro L, et al. Is computed tomography of nonvisualized C7-T1 cost-effective? J Spinal Disord 1999;12:472–476.PubMedGoogle Scholar
  63. 63.
    Lewis LM, Docherty M, Ruoff BE, et al. Flexion-extension views in the evaluation of cervical-spine injuries. Ann Emerg Med 1991;20:117–121.PubMedGoogle Scholar
  64. 64.
    Brady WJ, Moghtader J, Cutcher D, et al. ED use of flexion-extension cervical spine radiography in the evaluation of blunt trauma. Am J Emerg Med 1999;17:504–508.PubMedGoogle Scholar
  65. 65.
    Stanislas MJ, Latham JM, Porter KM, et al. A high risk group for thoracolumbar fractures. Injury 1998;29:15–18.PubMedGoogle Scholar
  66. 66.
    Samuels LE, Kerstein MD. ‘Routine’ radiologic evaluation of the thoracolumbar spine in blunt trauma patients: a reappraisal. J Trauma 1993;34:85–89.PubMedGoogle Scholar
  67. 67.
    Benzel EC, Hart BL, Ball PA, et al. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 1996;85:824–829.PubMedGoogle Scholar
  68. 68.
    Karnaze MG, Gado MH, Sartor KJ, et al. Comparison of MR and CT myelography in imaging the cervical and thoracic spine. AJR Am J Roentgenol 1988;150:397–403.PubMedGoogle Scholar
  69. 69.
    Jelsma RK, Rice JF, Jelsma LF, et al. The demonstration and significance of neural compression after spinal injury. Surg Neurol 1982;18:79–92.PubMedGoogle Scholar
  70. 70.
    Pasquale M, Fabian TC. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma 1998;44:941–956; discussion 956–957.PubMedGoogle Scholar
  71. 71.
    Davis JW, Parks SN, Detlefs CL, et al. Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy. J Trauma 1995;39:435–438.PubMedGoogle Scholar
  72. 72.
    Sandler AJ, Dvorak J, Humke T, et al. The effectiveness of various cervical orthoses. An in vivo comparison of the mechanical stability provided by several widely used models. Spine 1996;21:1624–1629.PubMedGoogle Scholar
  73. 73.
    Sees DW, Rodriguez Cruz LR, Flaherty SF, et al. The use of bedside fluoroscopy to evaluate the cervical spine in obtunded trauma patients. J Trauma 1998;45:768–771.PubMedGoogle Scholar
  74. 74.
    Widder S, Doig C, Burrowes P, et al. Prospective evaluation of computed tomographic scanning for the spinal clearance of obtunded trauma patients: preliminary results. J Trauma 2004;56:1179–1184.PubMedGoogle Scholar
  75. 75.
    Diaz JJ Jr, Gillman C, Morris JA Jr, et al. Are five-view plain films of the cervical spine unreliable? A prospective evaluation in blunt trauma patients with altered mental status. J Trauma 2003;55:658–663; discussion 663–664.PubMedGoogle Scholar
  76. 76.
    Bolinger B, Shartz M, Marion D. Bedside fluoroscopic flexion and extension cervical spine radiographs for clearance of the cervical spine in comatose trauma patients. J Trauma 2004;56:132–136.PubMedGoogle Scholar
  77. 77.
    Adams VI. Neck injuries: I. Occipitoatlantal dislocation: a pathologic study of twelve traffic fatalities. J Forensic Sci 1992;37:556–564.PubMedGoogle Scholar
  78. 78.
    Alker GJ Jr, Oh YS, Leslie EV. High cervical spine and craniocervical junction injuries in fatal traffic accidents: a radiological study. Orthop Clin N Am 1978;9:1003–1010.Google Scholar
  79. 79.
    Bucholz RW, Burkhead WZ. The pathological anatomy of fatal atlanto-occipital dislocations. J Bone Joint Surg Am 1979;61:248–250.PubMedGoogle Scholar
  80. 80.
    Saeheng S, Phuenpathom N. Traumatic occipitoatlantal dislocation. Surg Neurol 2001;55:35–40.PubMedGoogle Scholar
  81. 81.
    Vaccaro AR, Cook CM, McCullen G, et al. Cervical trauma: rationale for selecting the appropriate fusion technique. Orthop Clin N Am 1998;29:745–754.Google Scholar
  82. 82.
    Traynelis VC, Marano GD, Dunker RO, et al. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 1986;65:863–870.PubMedGoogle Scholar
  83. 83.
    Dublin AB, Marks WM, Weinstock D, et al. Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival. With a radiographic method of measuring the AOA. J Neurosurg 1980;52:541–546.PubMedGoogle Scholar
  84. 84.
    Powers B, Miller MD, Kramer RS, et al. Traumatic anterior atlanto-occipital dislocation. Neurosurgery 1979;4:12–17.PubMedGoogle Scholar
  85. 85.
    Wholey MH, Bruwer AJ, Baker HL Jr. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 1958;71:350–356.PubMedGoogle Scholar
  86. 86.
    Harris JH Jr, Carson GC, Wagner LK, et al. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994;162:887–892.PubMedGoogle Scholar
  87. 87.
    Lee C, Woodring JH, Goldstein SJ, et al. Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 1987;8:19–26.PubMedGoogle Scholar
  88. 88.
    Diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 2002;50:S105–S113.Google Scholar
  89. 89.
    Harris JH, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994;162:881–886.PubMedGoogle Scholar
  90. 90.
    Bulas DI, Fitz CR, Johnson DL. Traumatic atlanto-occipital dislocation in children. Radiology 1993;188:155–158.PubMedGoogle Scholar
  91. 91.
    Przybylski GJ, Clyde BL, Fitz CR. Craniocervical junction subarachnoid hemorrhage associated with atlanto-occipital dislocation. Spine 1996;21:1761–1768.PubMedGoogle Scholar
  92. 92.
    Greenberg MS. Handbook of Neurosurgery. New York: Thieme, 2001.Google Scholar
  93. 93.
    Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. Fixed rotatory subluxation of the atlanto-axial joint. J Bone Joint Surg Am 1977;59:37–44.PubMedGoogle Scholar
  94. 94.
    Jefferson G. Fractures of the atlas vertebra: report of four cases and review of those previously reported. Br J Surg 1920;7:407–422.Google Scholar
  95. 95.
    Segal LS, Grimm JO, Stauffer ES. Non-union of fractures of the atlas. J Bone Joint Surg Am 1987;69:1423–1434.PubMedGoogle Scholar
  96. 96.
    Hein C, Richter HP, Rath SA. Atlantoaxial screw fixation for the treatment of isolated and combined unstable Jefferson fractures: experiences with 8 patients. Acta Neurochir (Wien) 2002;144:1187–1192.Google Scholar
  97. 97.
    Isolated fractures of the atlas in adults. Neurosurgery 2002;50:S120–S124.Google Scholar
  98. 98.
    Hadley MN, Dickman CA, Browner CM, et al. Acute traumatic atlas fractures: management and long-term outcome. Neurosurgery 1988;23:31–35.PubMedGoogle Scholar
  99. 99.
    Levine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg Am 1991;73:680–691.PubMedGoogle Scholar
  100. 100.
    Ruf M, Melcher R, Harms J. Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures. Spine 2004;29:823–827.PubMedGoogle Scholar
  101. 101.
    Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg Am 1970;52:1017–1024.PubMedGoogle Scholar
  102. 102.
    Spence KF Jr, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am 1970;52:543–549.PubMedGoogle Scholar
  103. 103.
    Fielding JW, Cochran GB, Lawsing JF III, et al. Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am 1974;56:1683–1691.PubMedGoogle Scholar
  104. 104.
    Heller JG, Viroslav S, Hudson T. Jefferson fractures: the role of magnification artifact in assessing transverse ligament integrity. J Spinal Disord 1993;6:392–396.PubMedGoogle Scholar
  105. 105.
    Apuzzo ML, Heiden JS, Weiss MH, et al. Acute fractures of the odontoid process. An analysis of 45 cases. J Neurosurg 1978;48:85–91.PubMedGoogle Scholar
  106. 106.
    Hadley MN, Browner C, Sonntag VK. Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 1985;17:281–290.PubMedGoogle Scholar
  107. 107.
    Marchesi DG. Management of odontoid fractures. Orthopedics 1997;20:911–916.PubMedGoogle Scholar
  108. 108.
    Sasso RC. C2 dens fractures: treatment options. J Spinal Disord 2001;14:455–463.PubMedGoogle Scholar
  109. 109.
    Vaccaro AR, Cotler JM. Traumatic injuries of the upper cervical spine. In: An HS, Simpson JM, eds. Surgery of the Cervical Spine. London: Martin Dunitz, 1994:227–265.Google Scholar
  110. 110.
    Scott EW, Haid RW Jr, Peace D. Type I fractures of the odontoid process: implications for atlanto-occipital instability. Case report. J Neurosurg 1990;72:488–492.PubMedGoogle Scholar
  111. 111.
    Hadley MN, Browner CM, Liu SS, et al. New subtype of acute odontoid fractures (type IIA). Neurosurgery 1988;22:67–71.PubMedGoogle Scholar
  112. 112.
    Chutkan NB, King AG, Harris MB. Odontoid fractures: evaluation and management. J Am Acad Orthop Surg 1997;5:199–204.PubMedGoogle Scholar
  113. 113.
    Clark CR, White AA III. Fractures of the dens. A multicenter study. J Bone Joint Surg Am 1985;67:1340–1348.PubMedGoogle Scholar
  114. 114.
    Greene KA, Dickman CA, Marciano FF, et al. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 1997;22:1843–1852.PubMedGoogle Scholar
  115. 115.
    Bucholz RD, Cheung KC. Halo vest versus spinal fusion for cervical injury: evidence from an outcome study. J Neurosurg 1989;70:884–892.PubMedGoogle Scholar
  116. 116.
    Wang GJ, Mabie KN, Whitehill R, et al. The nonsurgical management of odontoid fractures in adults. Spine 1984;9:229–230.PubMedGoogle Scholar
  117. 117.
    Isolated fractures of the axis in adults. Neurosurgery 2002;50:S125–S139.Google Scholar
  118. 118.
    Seybold EA, Bayley JC. Functional outcome of surgically and conservatively managed dens fractures. Spine 1998;23:1837–1845; discussion 1845–1846.PubMedGoogle Scholar
  119. 119.
    Lennarson PJ, Mostafavi H, Traynelis VC, et al. Management of type II dens fractures: a case-control study. Spine 2000;25:1234–1237.PubMedGoogle Scholar
  120. 120.
    Bonn W, Kast E, Richter HP, et al. Anterior screw fixation in type II odontoid fractures: is there a difference in outcome between age groups? Neurosurgery 2003;52:1089–1092; discussion 1092–1094.Google Scholar
  121. 121.
    ElSaghir H, Bohm H. Anderson type II fracture of the odontoid process: results of anterior screw fixation. J Spinal Disord 2000;13:527–530; discussion 531.PubMedGoogle Scholar
  122. 122.
    Graziano G, Jaggers C, Lee M, et al. A comparative study of fixation techniques for type II fractures of the odontoid process. Spine 1993;18:2383–2387.PubMedGoogle Scholar
  123. 123.
    Harrop JS, Przybylski GJ, Vaccaro AR, et al. Efficacy of anterior odontoid screw fixation in elderly patients with type II odontoid fractures. Neurosurg Focus 2000;6:article 6.Google Scholar
  124. 124.
    Greene KA, Dickman CA, Marciano FF, et al. Transverse atlantal ligament disruption associated with odontoid fractures. Spine 1994;19:2307–2314.PubMedGoogle Scholar
  125. 125.
    Arand M, Neller S, Kinzl L, et al. The traumatic spondylolisthesis of the axis. A biomechanical in vitro evaluation of an instability model and clinical relevant constructs for stabilization. Clin Biomech (Bristol, Avon) 2002;17:432–438.Google Scholar
  126. 126.
    Cornish BL. Traumatic spondylolisthesis of the axis. J Bone Joint Surg Br 1968;50:31–43.PubMedGoogle Scholar
  127. 127.
    Schneider RC, Livingston KE, Cave AJ, et al. “Hangman’s fracture” of the cervical spine. J Neurosurg 1965;22:141–154.PubMedGoogle Scholar
  128. 128.
    Effendi B, Roy D, Cornish B, et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 1981;63B:319–327.Google Scholar
  129. 129.
    Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 1985;67:217–226.PubMedGoogle Scholar
  130. 130.
    Vaccaro AR, Madigan L, Bauerle WB, et al. Early halo immobilization of displaced traumatic spondylolisthesis of the axis. Spine 2002;27:2229–2233.PubMedGoogle Scholar
  131. 131.
    Management of combination fractures of the atlas and axis in adults. Neurosurgery 2002;50:S140–S147.Google Scholar
  132. 132.
    Dickman CA, Hadley MN, Browner C, et al. Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases. J Neurosurg 1989;70:45–49.PubMedGoogle Scholar
  133. 133.
    Allen BL Jr, Ferguson RL, Lehmann TR, et al. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 1982;7:1–27.PubMedGoogle Scholar
  134. 134.
    White AA, Panjabi MM. The Problem of Clinical Instability in the Human Spine: A Systematic Approach. Clinical Biomechanics of the Spine, 2nd ed. Philadelphia: Lippincott, 1990:277–378.Google Scholar
  135. 135.
    Kahn EA, Schneider RC. Chronic neurological sequelae of acute trauma to the spine and spinal cord. I. The significance of the acute-flexion or tear-drop fracture-dislocation of the cervical spine. J Bone Joint Surg Am 1956;38A:985–997.Google Scholar
  136. 136.
    Harris JH Jr, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin N Am 1986;17:15–30.Google Scholar
  137. 137.
    Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop 1984:65–76.Google Scholar
  138. 138.
    Chedid MK, Green C. A review of the management of lumbar fractures with focus on surgical decision-making and techniques. Contemp Neurosurg 1999;21:1–5.Google Scholar
  139. 139.
    McAfee PC, Levine AM, Anderson PA. Surgical management of thoracolumbar fractures. Instr Course Lect 1995;44:47–55.PubMedGoogle Scholar
  140. 140.
    Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 2005;30:2325–2333.PubMedGoogle Scholar
  141. 141.
    Vaccaro AR, Zeiller SC, Hulbert RJ, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 2005;18:209–215.PubMedGoogle Scholar
  142. 142.
    McAfee PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine 1982;7:365–373.PubMedGoogle Scholar
  143. 143.
    Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect 2004;53:359–373.PubMedGoogle Scholar
  144. 144.
    Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 2003;85A:773–781.Google Scholar
  145. 145.
    Verlaan JJ, Oner FC. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. J Bone Joint Surg Am 2004;86A:649–650; author reply 650–651.Google Scholar
  146. 146.
    Wettstein M, Mouhsine E. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. J Bone Joint Surg Am 2004;86A:651–652; author reply 652.Google Scholar
  147. 147.
    Anderson PA, Rivara FP, Maier RV, et al. The epidemiology of seatbelt-associated injuries. J Trauma 1991;31:60–67.PubMedGoogle Scholar
  148. 148.
    Biller J, Hingtgen WL, Adams HP Jr, et al. Cervicocephalic arterial dissections. A ten-year experience. Arch Neurol 1986;43:1234–1238.PubMedGoogle Scholar
  149. 149.
    Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine 1999;24:785–794.PubMedGoogle Scholar
  150. 150.
    Willis BK, Greiner F, Orrison WW, et al. The incidence of vertebral artery injury after midcervical spine fracture or subluxation. Neurosurgery 1994;34:435–441; discussion 441–442.PubMedGoogle Scholar
  151. 151.
    Management of vertebral artery injuries after nonpenetrating cervical trauma. Neurosurgery 2002;50:S173–S178.Google Scholar
  152. 152.
    Miller PR, Fabian TC, Croce MA, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 2002;236:386–393.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Justin F. Fraser
    • 1
  • John Boockvar
    • 2
  • Roger Hartl
    • 3
  1. 1.Department of Neurological SurgeryNew York-Presbyterian HospitalNew YorkUSA
  2. 2.Departments of Neurological Surgery, and SurgeryWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Neurological SurgeryWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations