Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 1996 Jan;38(1):44-50
Date
01/01/1996Pubmed ID
8747950DOI
10.1097/00006123-199601000-00012Scopus ID
2-s2.0-0030070354 (requires institutional sign-in at Scopus site) 210 CitationsAbstract
Comprehensive anatomic and clinical analyses of 39 patients with injuries involving the transverse atlantal ligament or its osseous insertions were performed to assess the morphology of the injured ligaments and the patients' capacity to heal. Injuries of the upper cervical spine were screened with plain radiographs, thin-section computed tomography, and magnetic resonance imaging studies. The injuries were classified as disruptions of the substance of the ligament (Type I injuries, n = 16) or as fractures and avulsions involving the tubercle for insertion of the transverse ligament on the C1 lateral mass (Type II injuries, n = 23). These two types of injuries had distinctly different clinical characteristics that were useful for determining treatment. Type I injuries were incapable of healing satisfactorily without internal fixation; they should be treated with early surgery. Type II injuries, which rendered the transverse ligament physiologically incompetent even though the ligament substance was not torn, should be treated initially with a rigid cervical orthosis, because they had a 74% success rate nonoperatively. Surgery should be reserved for patients with Type II injuries that have nonunion with persistent instability after 3 to 4 months of immobilization. Type II injuries had a 26% rate of failure of immobilization; therefore, close monitoring is needed to detect patients who will require delayed operative intervention.
Author List
Dickman CA, Greene KA, Sonntag VKAuthor
Karl A. Greene MD Adjunct Assistant Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Cervical Atlas
Disability Evaluation
Female
Follow-Up Studies
Fracture Fixation, Internal
Fractures, Ununited
Humans
Immobilization
Ligaments
Magnetic Resonance Imaging
Male
Middle Aged
Neurologic Examination
Postoperative Complications
Spinal Fractures
Spinal Fusion
Tomography, X-Ray Computed
Treatment Outcome