Tooth formation of vertebra: location, photo, displacement, fracture

Few know where the tooth-shaped process is.

Most vertebrae have seven processes: awned, four articular and two transverse. But in the cervical spine is a vertebra with a special structure. He has one more appendage than the rest. This is the second cervical vertebra. Its eighth process is directed upwards. dentate process

Anatomical location of the

The dentition is articulated with the first cervical vertebra, called the "atlas", because it holds the skull base on itself. Between these vertebrae there is a movable articulation. Its medical name is atlanto-axial. Figuratively speaking, the ring of the first cervical vertebra is worn on the tooth-shaped process of its lower neighbor. That's why the person's neck is so mobile. Almost 70 percent of the volume of all head turns occurs in this junction. A tooth-shaped process is the point of rotation of our neck.

What is the cause of the occurrence?

The emergence of the dentate process is due to evolutionary causes, because a person( as well as a number of oth

er vertebrates) needed a quick and complete overview of the space around him for survival. However, the atlas-axial junction is very vulnerable. Where there is a large degree of mobility - there is a risk of pathological dislocations, fractures, hypermobility. This joint is surrounded by a strong ligamentous apparatus, which provides strengthening of the tooth-like process of the vertebra during the performance of physiologically normal movements. But prolonged or abrupt pressure, exceeding normal, can lead to violation of its integrity.

What are the problems with the second cervical vertebra?

In cases of fractures of the second cervical vertebra, if the process has not shifted, the symptoms of this pathology are not obvious, and sometimes completely absent. Approximately half of these fractures go unnoticed in the acute period, and almost a third is diagnosed only after two to three months, and sometimes years pass before this fracture in the patient is established. Doctors say that even the X-ray of the upper cervical spine is very problematic, as images of other bone structures are layered on the first and second vertebrae. dentate process of vertebra

However, this is a very significant injury, in which the tooth-like process and the atlas are often displaced along with the skull towards the vertebral canal. And this leads to increasing problems with motor activity, to the formation of a craniospinal syndrome in the patient, sometimes with a fatal outcome.

With the asymmetry of the tooth-like process of C2 very often the patients have headaches that can last a long time.

statistics About 20 percent of tooth fractures are complicated by damage to the integrity of the spinal cord, and approximately seven percent lead to the worst outcome - the death of the patient. At the same time, about 8-15 percent of all cervical fractures are of this type. Groups of risk are children under eight years old and older people over seventy.

Damage to the tooth-shaped process is so serious in its consequences that doctors treat all patients with suspicion of these as those with a fracture already established. That is, they are immobilized in the cervical department and are delivered to the vertebrological ambulance center( or another medical institution where there is a neurosurgical or trauma department) in a neutral position. dentiform process photo

Types of

fractures Due to computed tomography today, physicians have an opportunity to determine exactly which of the following types of fracture is a fracture of the dentate process of the vertebra:

  1. The first type is in this case an oblique fracture of the apex of the dentition in the place where the pterygoid ligament is attached to it. It is considered very rare.
  2. The second type - with it, the fracture line crosses the narrowest part of the tooth, i.e., the junction of the dentition and vertebra. At the same time, the stability of the axial and atlas joint is lost. A fractured fractures of this type significantly complicate the process of treatment.
  3. The third type. Here, the fracture line runs along the vertebra itself, starting from the base of the dental process. The stability of the joint is also broken here.

Clinical picture of fractures of the second cervical vertebra

With these fractures, the clinical picture is very wide: from minor pain when turning the head and to a momentary lethal outcome. If a fracture occurs without or with a slight bias, the patient may experience minor pain in the upper part of the neck, which increases slightly when the head turns. This is also the case with the asymmetry of the tooth-shaped process. subluxation of the tooth-like process

There may also be rapid loss of pain during swallowing, neck mobility may be somewhat limited. Pain can also occur when the jaws are wide open. In addition, all these sensations can quickly pass, and the patient begins to behave as usual. But doctors warn that apparent welfare at this fracture is dangerous for life. Enough inadvertent step, sudden shock, etc. - and there will be a secondary displacement of the broken tooth process, displacement of the upper cervical vertebra and squeezing of the spinal cord. And then the symptomatology will be sharply expressed, down to loss of consciousness.

If there is a significant displacement of the dental spine according to the second type, then the symptoms of a compressed spinal or medulla oblongata, transmitted vertebral arteries, are possible. This can be tetraparesis, weakness or numbness of the limbs, a sensitivity disorder, a violation of the pelvic or respiratory organs. Symptoms such as broken speech, frustration of swallowing movements, difficulty opening the mouth and breaking taste sensations can join them. The severe symptoms characteristic of spinal cord injury include breathing disorders or the development of cruciate paralysis.

What is characteristic?

For such fractures of the tooth-like process( the photo is presented below), the so-called late spinal cord disorders that develop as a result of compression of the spinal cord by the posterior part of the superior cervical vertebra with the continuing displacement of the tooth-like process as a result of its secondary shifts are characteristic.

In the case of fracture of the tooth-like process without its displacement, the delayed clinical picture( when it did not follow the established diagnosis due to the fact that the patient did not consult a doctor) may consist of aching pain in the occiput or the upper part of the neck. These pain develop during movement and calm down at rest. Difficulty of movement of the neck, dizziness, numbness of the face. The patient turns around the whole body to look around.

But this can also be manifested as a subluxation of the tooth-shaped process. asymmetry of the dentate process c2

Diagnosis of

fracture Diagnosis of all lesions localized in the upper cervical region is carried out according to a strict scheme. If there is no possibility to conduct an immediate computed tomography of the cervical spine, the patient is sent to the roentgenogram of this area in the lateral projection through the open mouth. This study can also be carried out in the position of flexion or extension of the neck. Since neck movements in case of suspected fracture are potentially dangerous for the patient, these studies should be performed under the supervision of the doctor and not exceed the limits in which the patient has the ability to bend or straighten the neck.

Actually carrying out the roentgenogram in a bent and straightened position especially for chronic fractures, since in the direct position of the neck the ratio of vertebrae in the pictures is most likely to be normal.

If, despite these manipulations, diagnosis is difficult, physicians resort to frontal and sagittal zonography or axial computed tomography. These are special studies that help to improve the accuracy of the images needed to diagnose spine sites.

Treatment of

fracture In the acute period of the dentition of the dentate process in the upper part of the cervical spine, immobilization, i.e., immobilization of the patient's neck, is often included. The pattern of treatment depends on the type of injury. In general, it must be remembered that manipulation is very dangerous here, implying the patient's head tilt forward, as this can lead to traumatization of the spinal cord. In general, treatment involves the removal of the displacement of the vertebrae and stabilization of the articulation. dentition

So, with a trauma that occurs as a result of diving head downwards or falling on the head of a heavy object, a plaster bandage is applied, which the patient wears for about six months. The fusion is slow. The patient is also prescribed therapy with the Galo apparatus for three to four months.

Also, for fractures of the dentate process without displacement, traction on the Glisson loop is used for one or one and a half months, after which a thoracocranial gypsum corset is applied, which must be worn for 4 to 6 months.

In the case of traumatic spondylolisthesis of the second cervical vertebra, which is called the fracture of the executioner, skeletal traction is used in the extensional position( i.e., spinal traction) for three weeks, after which the patient is given a thoracovanial gypsum corset for three months. The Galo apparatus is also used here for up to four months.

Prevention of neck injuries

To avoid fractures of the upper cervical vertebrae will help general recommendations that are suitable in general to prevent neck injuries. First of all, this is the fulfillment of requirements and safety rules. Also, resting in nature, in no case can not head down to dive into water, and also swim in a state of intoxication.

Often fractures of the two upper vertebrae occur in an accident, so the prevention in this case will be strict observance of traffic rules, checking the car for technical condition, the presence of airbags, etc.

First aid for suspected fracture of the second cervical vertebra

Unfortunately, this type of injury always occurs suddenly. As we have already mentioned, such a fracture may go unnoticed, and may immediately manifest itself in the most serious form. This can be an accident, an accident when resting in nature, bruised his head with the fall of an elderly person. Often the victim needs first aid to be in a safe position and wait for the ambulance to arrive. dentition

Kinds of accidents

In general, all accidents with neck injuries can be divided into injuries, trauma of intervertebral disks, fractures, dislocations, sprains and bruises. But the main point is that all neck injuries are extremely dangerous, therefore, before the doctor's arrival, neck movements should not be allowed, as in the presence of vertebral fractures the spinal cord can be injured.

Naturally, others can not establish the nature of the injury of the victim. Therefore, it is necessary to act according to the strict rules of pre-hospital care for these cases. It is urgent to call an ambulance - the patient should be urgently taken to the hospital for diagnosis and treatment.

In any trauma of the cervical spine, the first thing to do is to provide peace by using the cervical stasis. If there is no danger for the victim and he is in a horizontal position, it is better not to move him and even to stop his attempts to rise. If there are open wounds in the cervical region, they should be washed and an aseptic dressing applied, if possible( for example, a first aid kit in the car).

What else is considered a pre-hospital care?

Also for pre-hospital care for injuries of the tooth-shaped process is the urgent prevention of tetanus and the introduction of drugs that reduce the symptoms of the shock state of the victim. After the ambulance arrives, the medical team examines and transports the patient in a lying position on a level shield. A special tire will be placed on the cervical section or ambulance staff will conduct splinting from the area of ​​the crown to each of the patient's shoulders. Any movements of the injured person's body in this case are performed with the utmost care, in order to prevent possible traumatization of the spinal cord. Such patient will be hospitalized and examined in the most urgent order.