Executive Editor: Luiz Vialle

Authors: Carlo Bellabarba, Marcelo Gruenberg, Cumhur Oner

Subaxial cervical trauma - A4

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Glossary

A4

Burst fracture or sagittal split involving both endplates

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative (collars) Stable undisplaced A4 fractures; unconscious patient Basic surgical experience, no specialized skills Basic equipment only
Nonoperative (halo vest) Only indicated in selected cases Some specialized surgical experience Simple surgical and imaging resources
Combined anterior and posterior (360) A4 fractures at the cervico thoracic junction; spinal cord compression Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterior plating All unstable or displaced A4 fractures; polytrauma; SCI Basic surgical experience, no specialized skills Full specialized surgical and imaging resources

Special considerations

Pediatric fractures
Ankylotic spine
Postoperative deformities
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources