Upper Cervical Spine Injuries

Abstract

anterior; type II, longitudinal; and type III, posterior.6 Diagnosis of occipitocervical dislocation can be made on a plain radiograph of the lateral cervical spine using the Powers ratio7 and Harris rule of 12 (Table 1).8,9 Although other measurements have been proposed,10-14 these remain the most commonly used clinical tools for diagnosis. In their study, Harris et al9 noted that a Powers ratio was not measurable in 17 of 37 cases, and that even when evaluated, it failed to detect 40% of injuries. Other authors5,15 have endorsed the use of the Harris measurements for diagnosis of atlanto-occipital dislocation injury. In a recent literature review, Theodore et al4 analyzed 105 atlanto-occipital dislocations to assess the various methods of diagnosing these injuries. They concluded that using lateral radiographs, the Harris method described above provides the most sensitive method for diagnosis. However, because this method only had a sensitivity of 50.5% on plain radiographs, the authors suggested that additional images with CT or MRI be obtained when atlanto-occipital dislocation is suspected. Although atlanto-occipital dissociation injuries result from high-energy mechanisms, other injuries are often present, including skull fracture; spinal cord transection; occipital condyle fracture; atlas fracture; atlantoaxial dislocation; lower cervical spine fracture; vertebral artery injury; subarachnoid F ractures involving the upper cervical spine can be caused by traumatic incidents such as a motor vehicle accident or fall from a height. These fractures can be associated with other injuries and lead to significant disability if there is delayed recognition or inadequate treatment. Although protocols and treatment algorithms are becoming more prevalent, there is still debate as to the best methods for diagnosis and treatment of injuries in this area. We review the most current evidence in the literature to help develop and standardize approaches to fractures in the upper cervical spine that will decrease morbidity and mortality.