Placement of unilateral lag screw through the lateral mass of C-1: description of a novel technique

Tabbosha, Monir; Dowdy, Justin; Pait, T. Glenn

doi:10.3171/2013.4.spine12826

Cited by 5 publications

(1 citation statement)

References 26 publications

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“…[ 4 7 8 9 10 ] However, due to high infection risk as high as 9-22%[ 11 12 13 14 15 16 ] and technical difficulty, which increases the postoperative complication rate to as high as 75%,[ 17 ] posterior approaches are preferred although there is still a risk of venous plexus and C 2 nerve root injury during exposure of the C 1 lateral mass. [ 18 19 ] The indications for limited posterior lateral mass fixation include fresh isolated atlas posterior 3/4 Jefferson fracture and semi-ring Jefferson fractures[ 9 20 21 22 23 ] associated with C 1 lateral mass, either together with type II transverse ligament injury or that do not heal after external immobilization for 3 months. [ 24 ] Isolated atlas fractures combined with type I ligament injury may have atlantoaxial or atlantooccipital joint instability, and should be treated with C 1 -C 2 or C 0 -C 2 fusion.…”

Section: Introductionmentioning

confidence: 99%

Unilateral lag-screw technique for an isolated anterior 1/4 atlas fracture

Keskil

Göksel

Yüksel

2016

J Craniovert Jun Spine

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Study Design:Fractures of the atlas are classified based on the fracture location and associated ligamentous injury. Among patients with atlas fractures treated using external immobilization, nonunion of the fracture could be seen.Objective:Ideally, treatment strategy for an unstable atlas fracture would involve limited fixation to maintain the fracture fragments in a reduced position without restricting the range of motion (ROM) of the atlantoaxial and atlantooccipital joints.Summary of Background Data:Such a result can be established using either transoral limited internal fixation or limited posterior lateral mass fixation. However, due to high infection risk and technical difficulty, posterior approaches are preferred but none of these techniques can fully address anterior 1/4 atlas fractures such as in this case.Materials and Methods:A novel open and direct technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening isolated right-sided anterior 1/4 single fracture of C1 that was initially treated with a rigid cervical collar is described.Results:Radiological studies made after the surgery showed no implant failure, good cervical alignment, and good reduction with fusion of C1.Conclusions:It is suggested that isolated C1 fractures can be surgically reduced and immobilized using a lateral compression screw to allow union and maintain both C1-0 and C1-2 motions, and in our knowledge this is the first description of the use of a lag screw to achieve reduction of distracted anterior 1/4 fracture fragments of the C1 from a posterior approach. This technique has the potential to become a valuable adjunct to the surgeon's armamentarium, in our opinion, only for fractures with distracted or comminuted fragments whose alignment would not be expected to significantly change with classical lateral mass screw reduction.

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