Fractures of the condyles (C0)
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
The connection between the head and the spine is the atlanto-occipital joint. It consists of the condyles of the occipital bone and the upper joint surfaces of the 1st cervical vertebra. The 1st cervical vertebra is called the atlas. The atlas is connected to the 2nd cervical vertebra (axis) below as well.
It is most common in a high impact blunt trauma. Isolated fractures of the condyls are rare. In most cases it is accompanied by a fracture of the 1st cervical vertebra. Fractures of the condyles are classified by
Mazeratti or Anderson and Montesano (PMID: 3194779
- Type I fractures result from axial loading, and the fractured condyle is comminuted with minimal or no displacement
- Тype II fractures result from direct trauma to the skull, and occur in conjunction with basilar skull fractures
- Type III fractures are avulsion fractures that occur from lateral flexion or rotatory forces with resultant pulling by the alar ligament
CAUSE OF SYMPTOMS
Acute compression of the cervical spinal cord
Cervical vertebral fracture
Lower cranial nerve (IX, X, and XI) injury
SYMPTOMS AND SIGNS
Total or partial paralysis of the hands and feet
Insensitivity from the neck down
Pain and stiffness in the neck
Paralysis of tongue and soft palate
THE DIAGNOSIS IS BASED ON Medical history Computer tomography
additionally you may have to do: Radiographs Magnetic resonance imaging (MRI) Digital subtraction angiography
Most often, treatment is conservative (non-surgical). Patients with an occipital condyle fracture not accompanied by craniocervical misalignment or neurological symptoms, should be treated with a rigid collar or halo orthosis fixing the neck for about 6-8 weeks.
Non-surgical treatment may include Nonsteroidal anti-inflammatory drugs
Immobilization with collar
WHEN SHOULD AN OPERATION BE PERFORMED?
Patients with craniocervical misalignment or neurological symptoms should undergo surgical stabilization using occipitocervical fusion, except when contraindicated by the severity of the patient's polytraumatic injuries.
WHAT IS THE GOAL OF SURGERY?
To restore the protective function of the spine
HOW IS SURGERY PERFORMED?
Posterior occipitocervical fusion and if necessary decompression
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Other fractures of the spine