Article

Fractures and Dislocations of the Cervicothoracic Junction

Department of Orthopaedics, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK.
Journal of Spinal Disorders & Techniques (Impact Factor: 2.2). 01/2006; 18(6):499-505. DOI: 10.1097/01.bsd.0000156831.76055.f0
Source: PubMed

ABSTRACT

Presented is a retrospective review of case notes and all available imaging studies in seven patients with acute fractures-dislocations of the cervicothoracic junction. Imaging studies included radiographs (five cases), computed tomography (six cases), and magnetic resonance imaging (seven cases). The study group consisted of five men and two women with mean age at presentation of 43.6 years (range 25-69 years). Four patients had been in road traffic accidents, whereas three patients had had falls. Three patients sustained complete neurologic deficits with no recovery, whereas the remaining four had no abnormal neurology or mild deficit at presentation and were normal at final follow-up. The injury was missed initially in three cases. The commonest injury pattern was traumatic spondylolisthesis of C7 on T1 with multilevel neural arch fractures, resulting in increased anteroposterior canal dimensions (four cases). Bilateral pars fractures of C7 and pure facet dislocation were seen in one case each. Neurologic deficit was related to the degree of anterior displacement of C7 on T1. Fracture-dislocation at the cervicothoracic junction is a rare injury with a variation of injury patterns and neurologic outcome.

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    • "However, the CTJ is often inadequately visualized on lateral cervical X-rays due to anatomic variations and technical factors. Body mass index (BMI) and the length of the neck and shoulders are the major anatomic factors leading to insufficient view of the CTJ [5, 6]. Traditionally, the swimmer’s view or arm traction is used in these cases [1]. "
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    ABSTRACT: The cervicothoracic junction (CTJ) is often inadequately visualized on lateral cervical X-rays due to anatomic variations and technical factors. The aim of this study was to investigate whether the swimmer's view and arm traction could enhance the image field on the standard lateral cervical (SLC) X-ray. The study was conducted in a university hospital in October 2007 with 40 volunteers. SLC X-ray, lateral cervical X-ray in the swimming position, and lateral cervical X-ray with arm traction were performed in the supine position. The enhancements in the image fields were analyzed. There was a statistically significant difference for the increases in the view of cervical spines between SLC X-ray (12.60 +/- 7.48) and either lateral cervical X-ray with arm traction (21.73 +/- 9.78; p = 0.000) or in the swimming position (21.20 +/- 14.19; p = 0.001). Both arm traction and swimming position increased the field of view by approximately 9 mm. Increased visualization of the cervical spine occurred for 24 of the 40 participants using the arm traction view (60.0%) and 23 participants (57.5%) using the swimming position view-results found to be statistically similar according to the >/= 1/3 caudal vertebral height visualized (p = 0.902). Using the lateral cervical X-ray view, the number of cervical vertebrae visualized differed according to body mass index (BMI)-seven cervical vertebrae were visualized in participants with a BMI < 25 and six vertebrae were visualized in participants with a BMI >/= 25 (p = 0.007). Lateral cervical X-rays with arm traction and swimming position enhance the view of SLC X-rays. An initial SLC X-ray including the lower third of the cervical spine (with C7), arm traction, and swimming position may be beneficial in visualizing the CTJ. However, patients with an increased BMI are unlikely to benefit from all three methods.
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    ABSTRACT: Background context Several authors have reported cervical dislocations and fracture-dislocations above, below or through the fused cervical segment after cervical fusion. No previous reports have described fracture/dislocations at the cervicothoracic junction (CTJ) after multilevel anterior cervical spine fusion. Purpose To report CTJ fracture/subluxation after multilevel anterior cervical spine fusion surgery, a technique for surgical management and strategies to prevent this avoidable complication. Study design A case report and review of the literature. Methods A 61-year-old women underwent anterior cervical decompression and fusion (ACDF) from C3 to C7. The patient did well postoperatively until she suffered a CTJ fracture/subluxation 4 months later sustained during a fall. Results The patient underwent posterior and anterior fusion surgery C7–T2. Radiographs 2 years after her reconstruction surgery showed solid fusion from C3 to T2. Conclusions The CTJ area is susceptible to injury because it represents the transition between mobile and relatively immobile portions of the spine, especially when a long lever arm is created by a low cervical fusion. It is difficult to image with plain radiographs, and therefore, injury may be easily overlooked. If overlooked, severe neurological injury can result. Anterior and posterior fusion is often necessary to appropriately stabilize the CTJ after fracture/dislocation.
    No preview · Article · Oct 2011 · European Journal of Orthopaedic Surgery & Traumatology
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    [Show abstract] [Hide abstract]
    ABSTRACT: Presented is a retrospective review of case notes and all available imaging studies in seven patients with acute fractures-dislocations of the cervicothoracic junction. Imaging studies included radiographs (five cases), computed tomography (six cases), and magnetic resonance imaging (seven cases). The study group consisted of five men and two women with mean age at presentation of 43.6 years (range 25-69 years). Four patients had been in road traffic accidents, whereas three patients had had falls. Three patients sustained complete neurologic deficits with no recovery, whereas the remaining four had no abnormal neurology or mild deficit at presentation and were normal at final follow-up. The injury was missed initially in three cases. The commonest injury pattern was traumatic spondylolisthesis of C7 on T1 with multilevel neural arch fractures, resulting in increased anteroposterior canal dimensions (four cases). Bilateral pars fractures of C7 and pure facet dislocation were seen in one case each. Neurologic deficit was related to the degree of anterior displacement of C7 on T1. Fracture-dislocation at the cervicothoracic junction is a rare injury with a variation of injury patterns and neurologic outcome.
    Preview · Article · Jan 2006 · Journal of Spinal Disorders & Techniques
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