Universität zu Köln

Meyer, Carolin, Bredow, Jan, Heising, Elisa, Eysel, Peer, Mueller, Lars and Stein, Gregor (2017). Influence of Osseous and Ligamentous Injuries on the Stability of the Atlantoaxial Complex. Z. Orthop. Unfallchir., 155 (3). S. 318 - 324. NEW YORK: THIEME MEDICAL PUBL INC. ISSN 1864-6743

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Abstract

Background The odontoid process and the transverse ligament are the most important structures stabilising the atlantoaxial complex. It has not been fully elucidated how injuries of these structures contribute towards instability and a potential narrowing of the spinal canal. Therefore, our investigation aimed to perform a biomechanical analysis of spinal width and dislocation of the odontoid process depending on injuries of the aforementioned structures. Methods In 10 fresh human cadaveric specimens, physiologic flexion and extension were simulated under fluoroscopy in intact specimens and after application of an odontoid process fracture and transverse ligament rupture in a crossover design. The width of the spinal canal and the dislocation of fragments were measured. Results In the intact condition, values of 19.8/19.5/19.8mm (neutral/flexion/extension) were observed regarding spinal width. After an isolated fracture, values were 18.5/18.9/17.9mm. With additional ligamentous injury, values changed to 20.3/19.4/22.6mm. In the second group, values after initial ligament injury were 18.6/16.2/17.3mm and 16.6/14.1/18.7mm after fracture. Dislocation of fragments after an isolated fracture averaged 2.2/2.5/2.5mm; an additional ligamentous injury led to 2.6/2.2/2.2mm. In the second group, where a ligamentous injury preceded the fracture, a dislocation of 1.5/1.9/3.5mm was detected after the fracture. Conclusion Neurological disorders have been observed starting at a spinal canal constriction of 2.0mm. Our results demonstrate that a relevant constriction of the spinal canal may be due to isolated or combined injuries of the bone and the transverse ligament. Furthermore, our results show the importance of posttraumatic immobilisation of the spine with a view to the role of the transverse ligament for stabilisation of the atlantoaxial complex.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meyer, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Bredow, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Heising, Elisa UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, Peer UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Stein, Gregor UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-228520
DOI:	10.1055/s-0043-100219
Journal or Publication Title:	Z. Orthop. Unfallchir.
Volume:	155
Number:	3
Page Range:	S. 318 - 324
Date:	2017
Publisher:	THIEME MEDICAL PUBL INC
Place of Publication:	NEW YORK
ISSN:	1864-6743
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language UPPER CERVICAL-SPINE; FATAL TRAFFIC ACCIDENTS; II ODONTOID FRACTURES; AXIS FRACTURES; DISLOCATIONS; EPIDEMIOLOGY; MANAGEMENT; RESTRAINTS; SIZE Multiple languages Orthopedics Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22852