Confused with Cervical Spondylosis? Delaying Treatment Can Lead to Quadriplegia! Fortunately, There’s This New Technology
- Elva Chen
- Jan 14
- 5 min read
After work one day, 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 delicious taste of 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. At that moment, he thought: "Oh no, I've messed up."
Falling to the ground, he immediately felt severe pain in the back of his neck. He instinctively reached out to touch it, hissing and gasping in pain. Kind passersby saw his condition and immediately called 120, rushing him to the First Affiliated Hospital of Zhejiang University School of Medicine. Emergency examinations revealed that Mr Zhao had an "odontoid fracture of the axis vertebra."
The axis vertebra is the second cervical vertebra from top to bottom in the cervical spine and also the strongest one. Its shape is similar to that of a general cervical vertebra, but it has a tooth-like protrusion on the upper part of the vertebral body, called the odontoid process.
Odontoid fracture of the axis vertebra is a cervical spine fracture caused by violent external forces in different directions such as flexion, extension, and rotation of the neck, accounting for about 15% of all cervical spine fractures.
The axis vertebra can be called the "god in charge of the neck," controlling the flexible rotation of our necks. As an important hub connecting the head and the 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 to the hospital, fixed and protected his neck with a cervical collar, and repeatedly emphasized to him that he had a Type II odontoid fracture, which is prone to displacement, unlikely to heal on its own, and may lead to nonunion, or even acute delayed cervical spinal cord compression that endangers life. Surgery should be performed as soon as possible.
"You really can’t have cervical spine surgery! Your uncle had a cervical spine surgery a few years ago, and his neck still hurts all the time. He even struggles to turn his head normally now." Mr Zhao’s brother-in-law, who came to visit him in the ward, said seriously, citing various examples. After hearing this, Mr Zhao hesitated and finally refused the surgery, strongly demanding to be discharged for conservative treatment. Unable to dissuade him, the doctors could only repeatedly remind him to wear the cervical collar strictly and return for regular re-examinations.
Second Hospital Admission: Conservative Treatment or Surgery?
After being discharged, Mr Zhao wore the cervical collar at first, but later found it uncomfortable and gradually slacked off, not wearing it at all, let alone returning for regular re-examinations.
Two months after the fall, Mr Zhao still felt severe neck pain and couldn’t bow his head or rotate his neck. He had no choice but to return to the hospital for a re-examination.
Chief Physician Jin Yongming, Deputy Director of the Orthopedics Department at the First Affiliated Hospital of Zhejiang University, was shocked when he saw that Mr Zhao was not wearing a cervical collar. He told him to get a cervical collar immediately and re-examined his cervical spine with a CT scan. The results were not good—Mr Zhao’s cervical spine fracture not only failed to heal but also displaced severely forward, causing atlantoaxial dislocation. Emergency surgery was needed to fix the atlantoaxial vertebrae.
After researching extensively, Mr Zhao became even more worried.
Atlantoaxial surgery is often accompanied by extremely high risks of surgical complications. If the vertebral artery or spinal cord is damaged, it can cause brainstem infarction, paralysis, or even death. Therefore, it is also regarded as the "jewel in the crown" of spinal surgery.
On one side was his deteriorating cervical spine injury; on the other side were the potential surgical risks and complications. If something went wrong, he might not be able to rotate his neck in the future, and his daily life would be more affected.
"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," Chief Physician Jin Yongming explained patiently to Brother Zhao. Recently, the orthopedic team has successfully performed minimally invasive posterior intermuscular approach internal fixation surgery for the upper cervical spine, which is one of the most minimally invasive upper cervical spine technologies in the world. It can greatly reduce intraoperative muscle damage and blood loss, allowing patients to get out of bed and move around soon after the operation. Generally, patients can be discharged and go home 1-2 days after the surgery. After the fracture heals and the internal fixation is removed, it will not affect the rotational movement of the neck.
This surgery is also suitable for patients with old axis vertebra fractures like Mr Zhao. After careful consideration, Mr Zhao accepted the experts’ suggestions and the surgical plan. The surgery went very smoothly! Chief Physician Jin Yongming’s team approached through the intermuscular space of the cervical spine, reduced and fixed the displaced atlantoaxial vertebrae, minimizing trauma. The intraoperative blood loss was only 20ml, and no drainage tube was needed.
As soon as the anesthetic wore off, Mr Zhao found that the cervical pain that had plagued him for months was much better, and he could get out of bed and move around freely. He was discharged the next day.
Now, he tells everyone he meets that cervical spine surgery can be done—as long as you find the right professional team.
Three Major Advantages: Small Incision, Few Complications, Short Hospital Stay
Chief Physician Jin Yongming said that in addition to acute trauma, long-term rheumatoid arthritis and other conditions may also lead to atlantoaxial dislocation, causing gradual progression of upper cervical spine problems. 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. Congenital malformations, tumors, infections, degenerative diseases, etc. may also cause upper cervical spine instability, all of which require surgical intervention.
Professor Hu Yihe, Director of the Orthopedics Department, introduced that the classic surgical method for the upper cervical spine often requires a large incision to expose the surgical area, causing significant trauma to muscle tissue, more intraoperative blood loss, and obvious perioperative pain. In contrast, the minimally invasive posterior intermuscular atlantoaxial fusion (Mis-PALF) is like "dissecting an ox with a skillful knife." Following the natural anatomical structure of the upper cervical spine, the scalpel enters along the intermuscular space, skillfully avoiding various key blood vessels and nerves, thus minimizing damage to cervical spine tissue.
This surgical 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. Currently, the efficacy and surgical volume have reached advanced levels domestically and even internationally. The surgery causes less trauma and muscle damage, can reduce surgery-related complications, improve postoperative cervical spine function, and bring good news to patients with upper cervical spine problems.
The Orthopedics Department of the First Affiliated Hospital of Zhejiang University 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. These technologies not only ensure patients’ surgical safety but also promote rapid recovery, safeguarding patients’ health!
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