– By Dr. Manish Kumar, Neurosurgeon (MBBS, DNB (Neurosurgery))
Off all the cases of cervical spine (neck) trauma, about one out of five involves the axis (C-2 – the second vertebra of spine in the neck). The commonest type of the axis injury is the fracture at the junction of the odontoid/ dens (the peg like structure from the superior aspect of the axis vertebra in to the first vertebra C – 1 also called as Atlas) and the body of the second vertebra/ axis also called as type II odontoid fracture. The importance of the part of bone called dens can be understood by the fact that this few millimetre-thick bone appears to be the only bony connection between the cervical spine and the head and its fracture is like separation of the head from rest of the body below!
The C1-2 complex allows far more motion than any other single level in the cervical spine. This motion is predominantly rotational, since translational motion at C1- C2 is limited by the strong transverse ligament. This restriction is lost after fracture of the odontoid and may be associated with abnormal movement of the C1-C2 complex in relation to the C2 body. This may result in spinal cord compression producing severe neurological problems. The injury is like decapitation. About 25-40% of dens fractures are fatal at the time of accident due to cessation of breathing and sudden loss of other vital functions or other associated injuries like Brain injuries. Many patients suffer with severe morbidity because of poor handling during transit or in the hospital sometimes even resulting in prolonged hospital stay and death.
In case of type 2 Odontoid fracture, surgical fixation with lag screw passed through the C-2 body up to the tip of the dens is of the first choice if there is no other fracture associated. In case this procedure fails or in case there are other associated injuries, posterior procedure of Occipito cervical stabilisation and fusion is done which results in significant restriction of the neck movements for rest of life.
At Park Hospital, Gurugram on 15th of June, we had a patient with anterior screw fixation of type 2 odontoid fracture who was operated successfully. The patient had come following an injury due to fall from electric pole. The patient is an electric technician, had developed severe neck pain and inability to move the head following the trauma. Luckily he did not develop any weakness of the hands or legs or any difficulty in breathing. Skull pin traction was applied immediately on arrival as the patient was waiting for definitive surgery. Post operatively patient is not having any weakness of hands or legs and is able to talk and eat immediately after the surgery. He could walk on the next day of the surgery. He will have normal range of neck movement.