The Natural History of Vertical C2 Body Fractures

Introduction: Vertical fractures of the C2 body have recently been classified into two types: a coronally oriented type I and a sagittally oriented type II. At present, the natural history of these fractures has not been described in the literature.

Methods: A retrospective review of all trauma patients presenting to the University of New Mexico Hospital between 1/90 and 12/98 was undertaken. >From this search 238 patients were identified as having upper cervical spine fractures of which 21 vertical C2 body fractures were identified who had their follow–up performed at UNMH.

Results: Of the 21 vertical C2 body fractures there were 16 type I and 5 type II fractures. The average age (47.1 yrs and 40.0 yrs), mode of injury (MVA in 1 3/16 (81 %) and 4/5 (80%)), male sex prevalence (1O/16 (63%) and 4/5 (80%)), presenting symptoms (neck pain in 15/16 (94%) and 4/5 (80%)), and mortality (2/16 (13%) and 1/5 (20%)) was similar between the two fracture types. No patient required operative intervention for their C2 body fracture. All patients, regardless of fracture type, were treated conservatively with using a collar or Minerva jacket. Average follow–up of 6.9 months for type I fractures and 4.3 months for type II fractures revealed adequate fusion in all cases and resolution of neck pain in 1 7/18 (94%) of surviving patients.

Conclusions: Vertical C2 body fractures have a favorable outcome when managed conservatively.