Confused with Cervical Spondylosis? Delaying Treatment Can Lead to Quadriplegia — Fortunately, There's This New Technology

One evening after work, Mr Zhao couldn't resist his colleague's warm invitation and went to eat a steaming hot lamb hot pot. After saying goodbye, he got on his "commuting partner" — an electric bike — still savoring the lamb, feeling warm all over. He hummed a tune and "flew" along his familiar way home.

It got dark early. Halfway there, with the help of street lights, he saw a cat suddenly dart out. Mr Zhao slammed on the brakes urgently, but lost his balance and fell sideways. Falling to the ground, he immediately felt severe pain in the back of his neck. Kind passersby called 120, rushing him to the First Affiliated Hospital of Zhejiang University School of Medicine. Emergency examinations revealed an "odontoid fracture of the axis vertebra."

The axis is the second cervical vertebra from top to bottom, and the strongest one. Its shape is similar to a general cervical vertebra, but it has a tooth-like protrusion on the upper part of the body, called the odontoid process.

Odontoid fracture of the axis is a cervical spine fracture caused by violent external forces in different directions such as flexion, extension, and rotation, accounting for about 15% of all cervical spine fractures.

The axis can be called the "god in charge of the neck," controlling flexible rotation. As an important hub connecting head and neck, it is adjacent to crucial structures such as the medulla oblongata, vertebral artery, and internal carotid artery. Once displaced, it may damage the spinal cord, causing severe quadriplegia or even death. Associate Chief Physician Wang Shuo immediately admitted Mr Zhao, fixed his neck with a cervical collar, and emphasized that he had a Type II odontoid fracture, prone to displacement, unlikely to heal on its own, possibly leading to nonunion or acute delayed cervical spinal cord compression endangering life. Surgery should be performed as soon as possible.

"You really can't have cervical spine surgery! Your uncle had one a few years ago, and his neck still hurts all the time. He even struggles to turn his head now." Mr Zhao's brother-in-law, visiting the ward, cited various examples. Mr Zhao hesitated and finally refused surgery, demanding discharge for conservative treatment. Unable to dissuade him, the doctors could only remind him to wear the collar strictly and return for regular re-examinations.

Second Hospital Admission: Conservative Treatment or Surgery?

After discharge, Mr Zhao wore the collar at first, but later found it uncomfortable and gradually stopped, not returning for re-examinations. Two months after the fall, he still had severe neck pain and couldn't bow or rotate his neck, so he returned for a re-examination.

Chief Physician Jin Yongming, Deputy Director of Orthopedics, was shocked to see Mr Zhao not wearing a collar. A CT scan showed bad results — the fracture not only failed to heal but also displaced severely forward, causing atlantoaxial dislocation. Emergency surgery was needed to fix the atlantoaxial vertebrae.

Atlantoaxial surgery carries extremely high risks of complications. If the vertebral artery or spinal cord is damaged, it can cause brainstem infarction, paralysis, or death. It is regarded as the "jewel in the crown" of spinal surgery.

"Although upper cervical spine surgery is highly difficult, it is routinely performed at the First Affiliated Hospital of Zhejiang University. There's no need to worry excessively," Jin Yongming explained. Recently, the orthopedic team successfully performed minimally invasive posterior intermuscular approach internal fixation for the upper cervical spine — one of the most minimally invasive upper cervical spine technologies in the world. It greatly reduces intraoperative muscle damage and blood loss, allowing patients to get out of bed soon. Generally, patients are discharged 1-2 days after surgery.

This surgery also suits patients with old axis fractures like Mr Zhao. After careful consideration, he accepted the surgical plan. The surgery went very smoothly. Jin Yongming's team approached through the intermuscular space, reduced and fixed the displaced atlantoaxial vertebrae, minimizing trauma. Intraoperative blood loss was only 20ml, and no drainage tube was needed. As soon as the anesthetic wore off, Mr Zhao found the neck pain much better and could move freely. He was discharged the next day.

Three Major Advantages: Small Incision, Few Complications, Short Hospital Stay

Jin Yongming said that besides acute trauma, long-term rheumatoid arthritis and other conditions may also lead to atlantoaxial dislocation. This disease often presents with intractable neck pain and limited mobility. In severe cases, it can lead to respiratory failure due to respiratory muscle paralysis, endangering life.

Professor Hu Yihe, Director of Orthopedics, noted that the classic method for the upper cervical spine often requires a large incision, causing significant muscle trauma, more blood loss, and obvious perioperative pain. In contrast, minimally invasive posterior intermuscular atlantoaxial fusion (Mis-PALF) is like "dissecting an ox with a skillful knife." Following the natural anatomy, the scalpel enters along the intermuscular space, skillfully avoiding key blood vessels and nerves.

This method was first proposed and summarized by Chief Physician Wang Shenglin from Peking University Third Hospital, who published relevant data in the top international orthopedic journal JBJS. The First Affiliated Hospital of Zhejiang University maintains good academic exchanges with Peking University Third Hospital and took the lead in carrying out Mis-PALF surgery, with efficacy and surgical volume reaching advanced levels domestically and internationally.

The Orthopedics Department has also introduced the world's most advanced Mako joint robot and ROSA spinal robot, committed to more precise and minimally invasive joint and spinal surgeries, ensuring surgical safety and promoting rapid recovery.