[Temporary percutaneous spondylodesis C1/2 and halo vest immobilisation. An alternative treatment of complex injuries of the upper cervical spine].

Dislocated combined injuries of the upper cervical spine such as C 1/2 fractures require occipitocervical fusion, especially if the dislocation can not be redressed using halo vest immobilisition. We report on the clinical course and outcome of a young woman who sustained complex cervical spine injuries. Closed reduction and a percutaneous transfixation of C 1/2 with k-wires (Magerl) and an additional halo vest immobilisition was performed to avoid permanent fusion. The 25 year old patient was involved in a motor vehicle accident that resulted in a dislocated Jefferson's fracture, an odontoid fracture type II (Anderson and d'Alonso) with protrusion into the foramen magnum, and a dislocated C 6/7 fracture. A ventral spondylodesis C6/7 was followed by temporary dorsal spondylodesis C1/2 with k-wires (Magerl) and additional halo vest immobilisition after closed reduction. The temporary percutaneous fixation C1/2 was removed after 11 weeks, as was the halo vest immobilisition. After removing the temporary percutaneous fixation (k-wires) and the halo system, the patient showed very good functional results in terms of range of motion with only minor discomfort. Complex injuries of the upper cervical spine that cannot be retained by external fixation often require an occipitocervical fusion or fixation of C1/2. In the case presented, the temporary percutaneous fixation (Magerl) with k-wires was terminated after 3 months to avoid significant functional impairment. Younger patients benefit most from temporary fusion of the upper cervical spine, which results in better functional outcome and only minor pain.