Executive Editor: Luiz Vialle

Subaxial cervical trauma - A3

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Glossary

General considerations

Type A3 fractures involve one endplate and the posterior wall. Depending on the posterior wall displacement, a neurological injury may have occurred, indicating a surgical treatment.

Posterior fixation is normally not indicated for A4 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
Stable undisplaced A3 fractures; unconscious patient Basic surgical experience, no specialized skills Basic equipment only

Indications:

  • All stable and undisplaced A3 fractures
  • Unconscious patients

Contraindications:

  • Burns or other skin lesions
  • Grossly displaced A3 fractures
  • Spinal cord injury
Nonoperative (halo vest)
Main indication Skill Equipment
Only indicated in selected cases Basic surgical experience, no specialized skills Basic equipment only

The use of a halo vest should be avoided for A3 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
A3 fractures at the cervico thoracic junction; spinal cord compression Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications:

  • All A3 fractures at the cervico thoracic junction
  • spinal cord compression

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
All unstable or displaced A3 fractures; polytrauma; SCI Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications:

  • All unstable or displaced A3 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