Prognosis of neurological deficits associated with upper cervical spine injuries.

We investigated the type of injury and neurological prognosis in 82 patients with an upper cervical spine injury with neurological deficits, from a total of 247 such patients that we treated, from which 11 patients who were dead on arrival had been excluded. The incidence of neurological deficits in upper cervical spine injury was 33%. They were classified into three signs; cord, upper cervical nerve root, and cranial nerve signs. The types of injury accompanied by neurological deficits were burst fracture of the atlas, type II dens fracture, body fracture of the axis, type II traumatic spondylolisthesis of the axis, atlanto-occipital dislocation, and atlanto-axial dislocation. Most were unstable vertebral injuries. The four patients who died after arrival at hospital had complete tetraplegia with respiratory distress. The neurological deficit was one of paresis in the 78 patients who survived; in many, the paresis was mild with a resulting good neurological prognosis.