Traumatic Lesions of Cranio-Cervical Junction

  • R. P. Vigouroux
  • Y. Reynier
  • M. Baldini


The occipito-vertebral region consists of an osseous complex, the inferior part of the occipital bone, the atlas and the axis, joined together by ligaments and articulations. It protects the medulla and the upper part of the spinal cord. It partly allows the mobility of the head, especially its rotation. It sustains the vertebral arteries which give blood supply to a part of the brain and to the medulla; because of their tortuous course, they are well adapted for the movements of the head over the neck. It allows the passage of the cervical roots (Hohl and Baker, 1964). Injuries of this area may involve each of the osseous or ligamentous elements or several together and be responsible for simple or more complex fractures, with or without displacement, for luxations and for dislocations with or without instability. These lesions may cause neurological or vascular disorders.


Cervical Spine Vertebral Artery Lateral Mass Occipital Bone Odontoid Process 
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  1. Alker GJ, Young SO, Leslie EV, Lehotay J, Panaro EG (1975) Postmortem radiology of head and neck injuries in fatal traffic accident. Radiology 114: 611–617.PubMedGoogle Scholar
  2. Alexander E Jr, Davis CH, Field CH (1958) Hyperextension injuries of the cervical spine. Arch Neurol 79: 146.Google Scholar
  3. Alexander E, Forsyth HF, Davis CH, Nashold BS (1958) Dislocation of the atlas on the axis. The value of early tension of C1, C2 and C3. Neurosurg 15: 353.CrossRefGoogle Scholar
  4. Alexander E, Davis CH (1969) Reduction and fusion of fracture of the odontoid process. J Neurosurg 31: 582.Google Scholar
  5. Amyes EW, Anderson FM (1956) Fracture of the odontoid process. Report of sixty-three cases. Arch Surg 72: 377–393.CrossRefGoogle Scholar
  6. Apuzzo MLT, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T (1978) Acute fractures of the odontoid process. J Neurosurg 48: 85–91.PubMedCrossRefGoogle Scholar
  7. Aronson NI (1961) Traumatic arterio-venous fistula of the vertebral vessels. Neurology (Min-neap) 11: 817.Google Scholar
  8. Barker EG Jr, Krampe J, Long JM (1976) Isolated fracture of the medial portion of the lateral mass of the atlas: a previously underrecognized entity. Am J Roentgenol 126: 1053–1058.Google Scholar
  9. Bedbrook GM (1963) Some pertinent observations on the pathology of traumatic spinal paralysis. Paraplegia 1: 215.PubMedCrossRefGoogle Scholar
  10. Benassy J (1970) Metamerical topography of the cord and its roots. Paraplegia 83: 75.CrossRefGoogle Scholar
  11. Blockey NJ, Purser DW (1956) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 38B: 794–817.Google Scholar
  12. Bohler J (1965) Fractures of the odontoid process. J Trauma 5: 386–390.CrossRefGoogle Scholar
  13. Braakman R, Penning L (1976) Injuries of the cervical spine. Handbook of Clinical Neurology. In: Vinken PJ, Debruyn GW (eds) Vol 25, pp 227–389.Google Scholar
  14. Brasher HR Jr, Venters GC, Preston ET (1975) Fractures of the neural arch of the axis. A report of twenty-nine cases. J Bone Joint Surg [Am] 57A: 879–887.Google Scholar
  15. Bricolo A, Dalle Ore G, Da Pian R, Faccioli F (1976) Local cooling in spinal cord injury. Surg Neurol 6: 101–106.PubMedGoogle Scholar
  16. Brookes TP (1935) Dislocations of the cervical spine, some predisposing causes. J Am 104: 902–906.Google Scholar
  17. Bürkle de la Camp H (1959) Zur Behandlung der Halswirbelluxationen. Langenbecks Arch Chir 292: 514.CrossRefGoogle Scholar
  18. Castaing J, Gouaze A, Plisson JL (1963) Technique de l’arthrodèse cervico-occipitale par greffon iliaque dans l’occipital. Rev Chir Orthop 49: 223–227.Google Scholar
  19. Chabannes J, Floucaud D, Terver S, Paquet F, Mondie JM (1977) Les luxations articulaires pures du rachis cervical (à propos de 19 observations). Rev Méd (Clermont-Ferrand) 5: 339–345.Google Scholar
  20. Charbonnel M, Sicard A (1938) Traitement des fractures fermées et récentes du rachis. Cong franc Chir 47/3: 126.Google Scholar
  21. Cooper PR, Mareville KR, Skar FH, Moody SF, Clark WK (1979) Halo immobilization of cervical spine fractures. J Neurosurg 50: 603–610.PubMedCrossRefGoogle Scholar
  22. Cornish BL (1968) Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Am] 50B/1: 31.Google Scholar
  23. Crutchfield WG (1954) Skeletal traction in treatment of injuries of the cervical spine. J Am Med Assoc 155: 29.PubMedCrossRefGoogle Scholar
  24. Delorme TL (1967) Fractures of cervical 2. Proceedings Amr. Orth. Ass. J. Bone Joint Surgery [Am] 49A: 1472.Google Scholar
  25. Estridge MN, Smith RA (1967) Transoral fusion of odontoid fracture. J Neurosurg 27: 462.PubMedCrossRefGoogle Scholar
  26. Evans DK (1961) Reduction of cervical dislocations. J Bone Joint Surg [Am] 43B: 552.Google Scholar
  27. Fang HSY, Ong GB (1962) Direct anterior approach to the upper cervical spine. J Bone Joint Surg [Am] 44A: 1588.Google Scholar
  28. Forsyth HF, Alexander E Jr, Davis C Jr, Underdal R (1959) The advantage of early spine fusion in the treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg [Am] 41A: 17.Google Scholar
  29. Frankel HL, Hancock DD, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JDS, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 73: 179.CrossRefGoogle Scholar
  30. Gallie WE (1939) Fractures and dislocations of the cervical spine. Ann Surg 46: 495.CrossRefGoogle Scholar
  31. Garber JN (1964) Abnormalities of the atlas and axis vertebrate congenital traumatic. J Bone Joint Surg [Am] 46A: 1782.Google Scholar
  32. Greeley PW (1930) Bilateral (90 degrees) rotatory dislocation of the atlas upon the axis. J Bone Joint Surg [Am] 12: 958.Google Scholar
  33. Grogono BJS (1954) Injuries of the atlas and the axis. J Bone Joint Surg [Am] 397.Google Scholar
  34. Gros C, Vlahovitch B, Mohasseb G (1960) Une forme peu connue de tétraplegie traumatique. Presse Med 68: 829.PubMedGoogle Scholar
  35. Guillaume MJ, Lubin P (1941) Traitement des luxations de l’atlas par Osteosynthèse métallique. Presse Med 49: 667.Google Scholar
  36. Guttmann L (1953) Medical history of the second world War. London, N.M.S.O., p 422.Google Scholar
  37. Guttmann L (1963) The paraplegic patient in pregnancy and labour. Proc Soc Med 56: 383.Google Scholar
  38. Guttmann L (1966) Initial treatment of traumatic paraplegia and tetraplegia. Spinal injuries. The Royal College of Surgeons, Edinburgh, p 80.Google Scholar
  39. Han SY, Witten DM, Mussleman JP (1976) Jefferson fracture of the atlas. J Neurosurg 44: 368–371.PubMedCrossRefGoogle Scholar
  40. Haralson RH, Boyd HB (1969) Posterior dislocation of the atlas on the axis without fracture. J Bone Joint Surg [Am] 51A: 561.Google Scholar
  41. Harris P (1966) Some neurosurgical aspects of traumatic paraplegia. In: Spinal injuries. Edinburgh. The Royal College of Surgeons, p 101.Google Scholar
  42. Heiden JS, Weiss MH, Rosenberg AW, Apuzzo MLJ, Kurze T (1975) Management of cervical spine cord trauma in Southern California. J Neurosurg 43: 732–736.PubMedCrossRefGoogle Scholar
  43. Hentzer L, Schalimizek M (1971) Fractures and subluxations of the atlas and axis. Acta Orthop Scand 42: 251–258.PubMedCrossRefGoogle Scholar
  44. Hohl M, Baker HR (1964) The atlanto-axial joint, roentgenographic and anatomical study of normal and abnormal motion. J Bone Joint Surg [Am] 46A: 1739. Citing Brav. (1936).Google Scholar
  45. Holdsworth FW (1963) Fractures, dislocations and fracture-dislocations of the spine. J. Bone Joint Surg [Am] 45B: 6.Google Scholar
  46. Hossack DW (1972) The pattern of injuries received by 500 drivers and passengers killed in road accidents. Med J Aust 2: 193–195.PubMedGoogle Scholar
  47. Howorth MB, Pétrie JG (1964) Injuries of the spine. Med., Williams and Wilkins Co., Baltimore.Google Scholar
  48. Jackson RH (1927) Simple uncomplicated rotary dislocation of the atlas. Surg Gynecol Obstet 45: 156.Google Scholar
  49. Jahan H (1961) Behandlung und Behandlungsergebnisse von 36 Brüchen des Dens epistropheus. Davon 18 mit Verschiebung des Atlas. Unfallheilkunde 68: 99.Google Scholar
  50. Jefferson G (1945) Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. — Br. J. Surg. 121: 826–832.Google Scholar
  51. Kahn EAZ, Yglesias L (1935) Progressive atlanto-axial dislocation. J Am Med Assoc 105: 348.CrossRefGoogle Scholar
  52. Kelly DL, Alexander E Jr, Davis CH Jr, Smith J (1972) Acrylic fixation of atlanto-axial dislocation. J Neurosurg 36: 366–371.PubMedCrossRefGoogle Scholar
  53. Kennedy F, Denker PG, Osborne R (1943) Early laminectomy for spinal cord injury not due to Subluxation. Am J Surg 60: 13–21.CrossRefGoogle Scholar
  54. Kissinger P (1899) Totale Luxation des Kopfes nach vorn. Zentralbl Chir 26: 424.Google Scholar
  55. McLaurin RL, Vernaland R, Salmon JH (1972) Treatment of fractures of the atlas and axis by wiring without fusion. J Neurosurg 36: 773–780.PubMedCrossRefGoogle Scholar
  56. Makhloaf (1958) L’arthrodèse mixte dans un cas de fracture ancienne de l’apophyse odontoide avec luxation de l’atlas. Mem Acad Chir 84: 289.Google Scholar
  57. Malgaigne JF (1847/1855) Traité des fractures et des luxations Vol. I: Des fractures. — Vol. II: Des luxations. Paris.Google Scholar
  58. Meinecke FW (1968) Frequency and distribution of associated injuries in traumatic paraplegia and tetraplegia. Paraplegia 5: 196.PubMedCrossRefGoogle Scholar
  59. Merle D’Aubigne RJ, Benassy J, Ramadier J (1956) Chirurgie orthopédique des paralysies, Masson & Cie, Paris.Google Scholar
  60. Nachemson A (1960) Fracture of the odontoid process of the axis. Acta Orthop Scand 29: 185.Google Scholar
  61. Nicol M, Javalet A (1957) Le verrouillage précoce des fractures de l’apophyse odontoide de l’axis. J Chir (Paris) 74: 362.Google Scholar
  62. Norrel H (1978) The treatment of unstable spinal fractures and dislocations. Clin Neurosurg 25: 193–208.Google Scholar
  63. Osterholm JL (1974) The pathophysiological response to spinal cord injury. The current status of related research. J Neurosurg 40: 5–33.PubMedGoogle Scholar
  64. Paradis GR, Janes M (1973) Posttraumatic atlanto-axial instability: the fate of the odontoid process fracture in 46 cases. J Trauma 13: 359–367.PubMedCrossRefGoogle Scholar
  65. Pedersen HE, Roy LJ, Salciccioli GG (1967) Axis-pedicle fractures Proc Am Orthop Ass J Bone Joint Surg [Am] 49A, 1472.Google Scholar
  66. Plaut HF (1958) Injuries of the upper cervical spine and their X-ray findings. Ohio State Med J 34: 760.Google Scholar
  67. Ramadier JO, Bombart M (1963) Fractures et luxations du rachis cervical sans lésions médullaires. Lésions des 5 dernières vertèbres cervicales. Rev Chir Orthop 50: 3.Google Scholar
  68. Rogers WA (1942) Treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg [Am] 24A: 245.Google Scholar
  69. Schatzker J, Rorabeck CH, Waddell JP (1971) Fractures of the dens (odontoid process). An analysis of thirty-seven cases. J Bone Joint Surg [Am] 538: 392–405.Google Scholar
  70. Schiff DCM, Parke WW (1973) The arterial supply of the odontoid process. J Bone Joint Surg [Am] 55A: 1450–1456.Google Scholar
  71. Schneider RC (1962) Surgical indications and contra-indications in spine and spinal cord trauma. Clin Neurosurg 8: 157.PubMedGoogle Scholar
  72. Schneider RC, Livingstone ICA, Cave AJF, Hamilton G (1965) Hangman’s fracture of the cervical spine. J Neurosurg 22: 141.PubMedCrossRefGoogle Scholar
  73. Schneider RC (1969) Concomitant craniocerebral and spinal trauma, with special reference to the cervico-medullary region. Clin Neurosurg 17: 266–309.Google Scholar
  74. Schneider RC, Crosby EV, Russo RH, Gosch HH (1973) Traumatic spinal cord syndromes and their managements. Clin Neurosurg 20: 424–491.PubMedGoogle Scholar
  75. Seljeskog EL, Chou SN (1976) Spectrum Hangman’s fracture. J Neurosurg 45: 3–8.PubMedCrossRefGoogle Scholar
  76. Sevitt S (1973) Fatal road accidents in Birmingham: times to death and their causes. Injury 4: 281–293.PubMedCrossRefGoogle Scholar
  77. Sherk HH, Nicholson JT (1970) Fractures of the atlas. J Bone Joint Surg [Am] 52A: 1017.Google Scholar
  78. Southwick WO, Robinson RA (1957) Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg [Am] 39A: 631.Google Scholar
  79. Spence KF, Decker S, Sell KW (1970) Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surgery [Am] 52A: 543.Google Scholar
  80. Tonge JL, O’Reilly MJJ, Davison A (1972) Traffic crash fatalities. Injury patterns and other factors. Med J Aust 2: 5–17.PubMedGoogle Scholar
  81. Verbiest H (1972) Antero-lateral operations for fractures and dislocations of the cervical spine due to injuries or previous surgical interventions. Clin Neurosurg 20: 334–365.Google Scholar
  82. Vlahovitch B, Fuentes JM, Guitar J, Perez-Dominguez E (1971) Plaidoyer pour une technique d’arthrodèse mixte rapide occipitocervicale dans les fractures de l’odontoid. Montpellier Chirurgical, T. XVII.Google Scholar
  83. Vlahovitch B, Bertrand A, Fuentes JM, Brahin B, Nègre G, Orst G, Mme Caussel (1974) Plaque d’ostéosynthèse occipito-vertébrale pour localisation métastatique haute du rachis cervical. Montpellier-Chirurgical, T. XX, Vol 6.Google Scholar
  84. White RJ, Yashon D, Albin MS (1972) The acute management of cervical cord trauma with quadriplegia. 40th Ann. Meet Am Assoc Neurol Surg, Boston.Google Scholar
  85. Wood JF (1913) The ideal lesion produced by judicial hanging. Lancet 1: 53.CrossRefGoogle Scholar
  86. Wortzman G, Dewar FP (1968) Rotary fixation of the atlanto-axial joint: rotational atlanto-axial subluxation. Radiology 90: 479.PubMedGoogle Scholar
  87. Young JS, Dexter WR (1978) Neurological recovery distal to the zone of injury in 173 cases of closed, traumatic spinal cord injury. Paraplegia 16: 39–49.PubMedCrossRefGoogle Scholar
  88. Zülch KJ (1962) Die spinale Mangeldurchblutung und ihre Folgen. Verh Dtsch Ges Inn Med 72: 1007.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1983

Authors and Affiliations

  • R. P. Vigouroux
    • 1
  • Y. Reynier
    • 1
  • M. Baldini
    • 1
  1. 1.MarseilleFrance

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