Conservative treatment of neural arch fractures of the axis

Computed tomography scan and X-ray study on consolidation time

Alessandro Ramieri, Maurizio Domenicucci, Alessandro Landi, Emanuela Rastelli, Antonino Raco

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined. Methods: A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface. Results: Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46%). Conclusions: CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients.

Original languageEnglish
Pages (from-to)314-319
Number of pages6
JournalWorld Neurosurgery
Volume75
Issue number2
DOIs
Publication statusPublished - Feb 2011

Fingerprint

X Ray Computed Tomography
Tomography
Bone Nails
Bone and Bones
Orthotic Devices
Three-Dimensional Imaging
Neck Pain
Paresthesia
Skull
Immobilization
Quality of Life
X-Rays
Conservative Treatment
Prospective Studies
Wounds and Injuries
Brain

Keywords

  • Axis fracture
  • Conservative management
  • CT scan
  • Halo vest

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Conservative treatment of neural arch fractures of the axis : Computed tomography scan and X-ray study on consolidation time. / Ramieri, Alessandro; Domenicucci, Maurizio; Landi, Alessandro; Rastelli, Emanuela; Raco, Antonino.

In: World Neurosurgery, Vol. 75, No. 2, 02.2011, p. 314-319.

Research output: Contribution to journalArticle

Ramieri, Alessandro ; Domenicucci, Maurizio ; Landi, Alessandro ; Rastelli, Emanuela ; Raco, Antonino. / Conservative treatment of neural arch fractures of the axis : Computed tomography scan and X-ray study on consolidation time. In: World Neurosurgery. 2011 ; Vol. 75, No. 2. pp. 314-319.
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abstract = "Background: Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined. Methods: A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface. Results: Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46{\%}). Conclusions: CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients.",
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