Treatment of vertebral fractures C1 - Causes, symptoms and treatment. MF.

The first cervical vertebra, atlant, is an annular bone formation between the occipital bone and the second cervical vertebra. It provides connections between the bones of the skull( occipital) and the spine, flexion-extensor and rotational movements and lateral inclinations in it. The first vertebra does not have a body and a spinous process. The lateral masses of the atlas are two wedge-shaped bones - they are joined into a ring by arcs, front and back. In front, the lateral masses are connected by a powerful transverse band, which provides additional stability of the ring and prevents the atlas from shifting anteriorly. The first vertebra is put on the tooth-shaped process of the second vertebra. Around the tooth, the atlas rotates with the skull.

The weak muscular corset of the neck, the small size of the vertebrae make it vulnerable to injury. Injury of the "diver" - vertical compression, "whiplash" injury in road traffic accidents lead to severe trauma to the cervical vertebrae and spinal cord until death.

Fractures of the C1 ring are more likely to occur with axial tension, more often they are combined with traumas of other cervical vertebrae, in 50% of cases with a fracture of the second cervical vertebra - axis. Damage to the atlanto-occipital junction can be caused by a sharp tilt of the head back, a fall on the back of the head. With a complete rupture of ligamentous - articular structures with damage to the spinal cord, the outcome is lethal.

Schematic representation of the atlant fracture by Jefferson.

The following fractures of the first cervical vertebra are possible:
1. fracture of the posterior arch,
2. fracture of the posterior arch at the junction with the lateral masses of the atlas,
3. fracture of the lateral masses of the vertebra on one side,
4. fracture of lateral masses of the vertebra on one sidewith a fracture of the posterior arch from the fracture of the lateral mass,
5. fracture of the lateral masses of the vertebra on one side with a fracture of the posterior arch on the opposite side.
6. An explosive fracture like the Jefferson fracture. Jefferson's fracture - is more often four fractures - two fractures of the posterior arch and two fractures of the anterior.

In the development of stability, the damage to the ligamentous-muscular apparatus plays a role. Fractures of the posterior arch are mostly stable, the anterior can be unstable and stable.

All those affected with neck trauma need hospitalization and X-ray, computer-aided examination, and, if necessary, magnetic resonance imaging, general clinical examination.

The treatment methods are different and depend on the diagnosis and the individual condition of the patient. With an atlanto-occipital dislocation, it is possible to use arthrodesis and internal fixation, strengthening the vertebrae with titanium structures, osteosynthesis, and sometimes skeletal traction. With an isolated fracture of C1 without breaking the transverse ligament, external fixation is possible, with ligament rupture - external or surgical fixation. With a fracture of Jefferson - fixation with a halo unit or an occipital cervical spondylodease. In case of damage to the spinal cord, decompression of the spinal cord and stabilization of the spine are necessary. Laminectomy is possible. During surgery, general anesthesia is used, sometimes local with premedication. The choice is made by the anesthesiologist depending on the general condition of the patient and the complexity of the surgical intervention, its duration. The possibility of using endoscopic surgery, the use of the rear or front access is also decided individually.

Basically, conservative treatment is used - stretching with Glisson loops, directing, immobilization. All of the above - serious methods of treatment and serious injuries, which can endanger human life - the choice of a method of treatment is the doctor's lot. The task of surgical treatment is decompression of the vascular-neural formations of the spine;complete restoration of the spine axis in three-dimensional space( 3D);reliable spondylodease with additional fixation of the vertebrae.

In the rehabilitation period, it is recommended to wear a Shantz collar from a month to six, depending on the severity of the damage to the atlant.

Shanza Collar

In the presence of neurological complications( possibly the development of vertebral artery syndrome, vertebro-basilar insufficiency) - rehabilitation in a neurologist.

Doctor neurologist Kobzeva S.V.