SPECIFIC SPINAL INJURIES Upper cervical spine (skull–C2)

SPECIFIC SPINAL INJURIES Upper cervical spine (skull–C2)

Occipital condyle fracture This is a relatively stable injury often associated with head injuries and is best treated in a hard collar for 6–8 weeks. Occipitoatlantal dislocation This injury is usually caused by high-energy trauma and is often fatal. The dislocation may be anterior, posterior or to assess skull translation. Treatment is with a halo brace or occipitocervical fixation. Atlas fracture (Jefferson fracture) Fracture of the C1 ring is associated with axial loading of the cervical spine and may be stable or unstable ( Figure 30.25a,b Associated transverse ligament rupture may occur ( Figure 30.25c ). Most are treated non-operatively in a cervical collar or halo brace. Barry Powers , contemporary , Chief and Clinical Professor of Radiology , Duplin General Hospital, Kenansville, NC, USA, described his ratio in 1979. Sir Geo ff rey Je ff erson , 1886–1961, Professor of Neurosurgery , University of Manchester, UK, became the UK’s first Professor of Neurosurgery in 1939. In 1947 he was elected a Fellow of the Royal Society , a rare distinction for a practising surgeon. Although he became a neurosurgeon, he performed the first successful embolectomy in England in 1925 at Salford Royal Hospital. (a) (b) ).

Figure 30.23 Vertical occipitocervical dislocation. B O A C Figure 30.24 Powers’ ratio. BC/OA ≥ 1 indicates anterior translation; ≤ 0.75 indicates posterior translation. (c) Figure 30.25 Stable (a) versus unstable (b) Jefferson’s fracture of C1. (c) Open mouth view of C1/2 demonstrating C1 lateral mass deviation (arrows). Rupture of the transverse ligament is present when the combined lateral mass deviation exceeds 6.9 mm.