Comparison of Transoral Anterior Jefferson-Fracture Reduction Plate and Posterior Screw-Rod Fixation in C1-Ring Osteosynthesis for Unstable Atlas Fractures

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Abstract

Objective

To compare the clinical outcomes of transoral anterior Jefferson-fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis.

Methods

From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at General Hospital of Southern Theatre Command of PLA; 30 males and 19 females were included. The visual analogue scale (VAS) score, Neck Disability Index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed.

Results

Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (p < 0.05).

Conclusion

Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.

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Most cited references 28

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Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries.

C A Dickman, K A Greene, V K Sonntag (1996)

Comprehensive anatomic and clinical analyses of 39 patients with injuries involving the transverse atlantal ligament or its osseous insertions were performed to assess the morphology of the injured ligaments and the patients' capacity to heal. Injuries of the upper cervical spine were screened with plain radiographs, thin-section computed tomography, and magnetic resonance imaging studies. The injuries were classified as disruptions of the substance of the ligament (Type I injuries, n = 16) or as fractures and avulsions involving the tubercle for insertion of the transverse ligament on the C1 lateral mass (Type II injuries, n = 23). These two types of injuries had distinctly different clinical characteristics that were useful for determining treatment. Type I injuries were incapable of healing satisfactorily without internal fixation; they should be treated with early surgery. Type II injuries, which rendered the transverse ligament physiologically incompetent even though the ligament substance was not torn, should be treated initially with a rigid cervical orthosis, because they had a 74% success rate nonoperatively. Surgery should be reserved for patients with Type II injuries that have nonunion with persistent instability after 3 to 4 months of immobilization. Type II injuries had a 26% rate of failure of immobilization; therefore, close monitoring is needed to detect patients who will require delayed operative intervention.

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Fractures of the atlas.

A. Levine, N. C. Edwards (1991)

Thirty-four patients who had fractures of the atlas (the first cervical vertebra) were reviewed at an average follow-up of 4.5 years. Seventeen patients had bilateral fracture of the posterior arch of the first cervical vertebra. Eight were treated with immobilization in a cervical orthosis, with no long-term problems secondary to the injury. Nine of these patients had additional fractures in the first and second cervical vertebral complex, complicating the management of the fractures of the posterior arch. Two of the nine patients died, and the treatment of the other seven was dependent on the additional fractures. A second group of six patients had a fracture in the area of the lateral mass, with one fracture just anterior to or within the anterior portion of the lateral mass of the first cervical vertebra and a second fracture posterior to the lateral mass of the first cervical vertebra on the same side; resultant asymmetrical displacement of the lateral masses was seen on the open-mouth roentgenogram that was made for each patient. A third group of eleven patients sustained a Jefferson, or burst, fracture of the first cervical vertebra. These patients had either four fractures (two in the anterior arch and two in the posterior arch) or three fractures (one in the anterior arch and two in the posterior arch). Spreading of the lateral masses was relatively symmetrical on the open-mouth roentgenogram. Patients who had fractures with displacement of two to seven millimeters were treated with immobilization in a halo vest. Patients who had fractures with severe spreading of the lateral masses (more than seven millimeters) were treated with reduction of the lateral masses by axial traction until healing of the arch had occurred. No atlanto-axial instability was evident in any patient at follow-up.

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Fractures of the atlas: classification, treatment and morbidity.

Koert van Ittersum, C Landells (1988)

Fractures of the atlas vertebra are generally considered to be innocuous injuries. A review of 35 patients with C1 fractures treated in the Acute Spinal Cord Injury Unit of Shaughnessy Hospital indicated that long-term morbidity is not as low as was previously thought. Thirteen of 23 patients (56%) followed up a minimum of 1 year post-trauma had significant symptoms of scalp dysesthesia, neck pain, and/or neck stiffness. A classification is presented, and the results of treatment modalities used are reviewed. Based on the findings, the simplest orthosis consistent with appropriate treatment of any of the often associated other spine fractures is recommended. Surgery is reserved for late instability or pain.

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Author and article information

Journal

Journal ID (nlm-ta): Neurospine

Journal ID (iso-abbrev): Neurospine

Journal ID (publisher-id): NS

Title: Neurospine

Publisher: Korean Spinal Neurosurgery Society

ISSN (Print): 2586-6583

ISSN (Electronic): 2586-6591

Publication date (Print): June 2024

Publication date (Electronic): 1 February 2024

Volume: 21

Issue: 2

Pages: 544-554

Affiliations

[1 ]The First School of Clinical Medicine, Southern Medical University, Guangzhou, China

[2 ]Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China

Author notes

Corresponding Author Xiangyang Ma The First School of Clinical Medicine, Southern Medical University, No. 1838 North of Guangzhou Road, Guangzhou 510515, China Email: maxy1001@ 123456126.com

Co-corresponding Author Xiaobao Zou Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, 111 Liuhua Road, Guangzhou 510010, China Email: zouxb6478@ 123456126.com

[*]

Mandi Cai and Yifeng Wu contributed equally to this study as co-first authors.

Author information

Mandi Cai http://orcid.org/0000-0003-2581-4353

Chenfu Deng http://orcid.org/0000-0003-0253-5650

Xiaobao Zou http://orcid.org/0000-0002-2101-1900

Article

Publisher ID: ns-2347230-615

DOI: 10.14245/ns.2347230.615

PMC ID: 11224759

PubMed ID: 38317544

SO-VID: c2b84e6b-0fe4-437e-98f4-3833ccac4f94

License:

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 18 November 2023

Date revision received : 14 January 2024

Date accepted : 14 January 2024

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Comparison of Transoral Anterior Jefferson-Fracture Reduction Plate and Posterior Screw-Rod Fixation in C1-Ring Osteosynthesis for Unstable Atlas Fractures

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Abstract

Objective

Methods

Results

Conclusion

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Fracture and Structural Integrity

Most cited references 28

Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries.

Fractures of the atlas.

Fractures of the atlas: classification, treatment and morbidity.

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