Di Francesco M E, Magunia H, Örgel A, Tatagiba M, Radwan M, Adib S D
Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
Department of Anesthesiology and Intensive Care Medicine, University of Tuebingen, Tuebingen, Germany.
Front Surg. 2023 May 16;10:1123947. doi: 10.3389/fsurg.2023.1123947. eCollection 2023.
Acute myocardial infarction (MI) frequently leads to consciousness disturbance following hemodynamic collapse. Therefore, MI can occur together with upper cervical spine trauma. Herein, we report the successful treatment of complex C1/C2 fractures in a patient with concomitant three-vessel coronary artery disease (CAD).
A 70-year-old patient presented in our emergency outpatient clinic after a hemodynamic collapse without neurological deficits or heart-related complaints. Computed tomography (CT) scan of the cervical spine revealed a dislocated odontoid fracture Anderson and D'Alonzo type II and an unstable Gehweiler type III injury (Jefferson's fracture). An intradiploic arachnoid cyst in the posterior wall of the posterior fossa was a coincident radiological finding. Furthermore, coronary angiography confirmed three-vessel CAD with high-grade coronary artery stenosis. Indication for upper cervical spine surgery and bypass surgery was given. An interdisciplinary team of neurosurgeons, cardiothoracic surgeons and anesthesiologists evaluated the patient's case to develop the most suitable therapy concept and alternative strategies. Finally, in first step, C1-C2 fusion was performed by Harms technique under general anesthesia with x-ray guidance, spinal neuronavigation, Doppler ultrasound and cardiopulmonary monitoring. Cardiothoracic surgeons were on standby. One month later bypass surgery was performed uneventfully. Follow-up CT scan of cervical spine revealed intraosseous screw positioning and beginning fusion of the fractures. The patient did not develop neurological deficits and recovered completely from both surgeries.
Treating complex C1/C2 fractures with concomitant severe CAD requiring treatment is challenging and carries a high risk of complications. To our knowledge, the literature does not provide any guidelines regarding therapy of this constellation. To receive upper cervical spine stability and to prevent both, spinal cord injury and cardiovascular complications, an individual approach is required. Interdisciplinary cooperation to determine optimal therapeutic algorithms is needed.
急性心肌梗死（MI）常导致血流动力学崩溃后意识障碍。因此，MI可能与上颈椎创伤同时发生。在此，我们报告1例伴有三支冠状动脉疾病（CAD）的患者复杂C1/C2骨折的成功治疗。
一名70岁患者在血流动力学崩溃后就诊于我们的急诊门诊，无神经功能缺损或心脏相关主诉。颈椎计算机断层扫描（CT）显示齿状突骨折脱位，Anderson和D’Alonzo II型，以及不稳定的Gehweiler III型损伤（Jefferson骨折）。后颅窝后壁板障内蛛网膜囊肿是偶然的影像学发现。此外，冠状动脉造影证实三支血管CAD伴严重冠状动脉狭窄。给予上颈椎手术和搭桥手术指征。神经外科医生、心胸外科医生和麻醉医生组成的跨学科团队评估了患者的病情，以制定最合适的治疗方案和替代策略。最后，第一步，在全身麻醉下，采用Harms技术，在X线引导、脊髓神经导航、多普勒超声和心肺监测下进行C1-C2融合。心胸外科医生随时待命。1个月后顺利进行搭桥手术。颈椎随访CT扫描显示骨内螺钉定位及骨折开始融合。患者未出现神经功能缺损，且从两次手术中完全康复。
治疗伴有严重CAD且需要治疗的复杂C1/C2骨折具有挑战性，且并发症风险高。据我们所知，文献中没有关于这种情况治疗的任何指南。为了获得上颈椎稳定性并预防脊髓损伤和心血管并发症，需要个体化方法。需要跨学科合作以确定最佳治疗算法。
