Davos Courses

Executive Editor: Luiz Vialle

Subaxial cervical trauma - A2

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Glossary

General considerations

Type A2 fractures involve both endplates. Depending on their severity they may lead to secondary kyphosis or pseudo-arthrosis. They may be treated with a collar or a halo vest depending on the severity.

Posterior fixation is normally not indicated for A2 fractures, however, in the cervicothoracic junction, it may be necessary to complement anterior fixation. The principle of the posterior fixation will be the same as for C fractures.

Nonoperative (collars)
Main indication Skill Equipment
All undisplaced A2 fractures; unconscious patient Basic surgical experience, no specialized skills Basic equipment only

Indications:

  • Less severe and undisplaced A2 fractures
  • Unconscious patients

Contraindications:

  • Burns or other skin lesions
  • Grossly displaced A2 fractures
Nonoperative (halo vest)
Main indication Skill Equipment
Only indicated in selected cases Some specialized surgical experience Simple surgical and imaging resources

The use of a halo vest should be avoided for simple A2 fractures. It is only indicated in rare cases.

Indications

  • Need of stabilization but anterior fixation is not possible

Contraindications

  • Obese patients
  • Spinal cord injury
  • Polytrauma
  • Fractures or soft tissue injuries of the skull
  • Serious osteoporosis

Disadvantages

  • Patient compliance needed
  • Greatly uncomfortable
  • Frequent follow up
  • Difficult to maintain personal hygiene
Combined anterior and posterior (360)
Main indication Skill Equipment
Grossly displaced A2 fractures at the cervico thoracic junction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications:

  • Grossly displaced A2 fractures at the cervico thoracic junction

The cervicothoracic junction is biomechanically different from the subaxial cervical spine. In this region the mechanical stress on any implant will be significantly greater than in the subaxial cervical spine. To ensure adequate stabilization, the lesion should be instrumented both anterior and posterior (360° procedure).

Anterior plating
Main indication Skill Equipment
Grossly displaced A2 fractures; polytrauma; SCI Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications:

  • Grossly displaced A2 fractures
  • Polytrauma
  • Spinal cord injury

Contraindications

  • General surgical contraindications

Anterior fixation of the cervicothoracic junction should be supplemented by a posterior fixation.

*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