Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct

Jo, Kwang-Wook; Park, Ik-Seong; Hong, Jae Taek

doi:10.1016/j.jocn.2010.08.033

Cited by 36 publications

(21 citation statements)

References 25 publications

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“…Therefore, we adopted osteosynthesis, which mechanically brings the ends of a fractured bone together via wires or metal plates. Osteosynthesis was proposed by Abeloos et al 2 and Jo et al 9 for the Jefferson fracture and by Johnson and Wang 10 for spontaneous bilateral lumbar pedicle fracture. This procedure can maintain the motion segment of the vertebrae.…”

Section: Discussionmentioning

confidence: 99%

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

Han¹,

Hyun²,

Jahng³

et al. 2016

SPI

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Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.

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Section: Discussionmentioning

confidence: 99%

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

Han¹,

Hyun²,

Jahng³

et al. 2016

SPI

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“…Treatment strategies would involve limited fixation of the fracture to preserve the function of the atlantoaxial and atlanto-occipital joints while maintaining cervical alignment, possibly using either transoral limited internal fixation or limited posterior lateral mass fixation 816222529. C 1 posterior osteosynthesis does expose the patient to the risks of vertebral artery and greater occipital nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Unstable Jefferson fractures: Results of transoral osteosynthesis

Albert

Kepler

et al. 2014

IJOO

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Background:Majority of C1 fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods.Materials and Methods:A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C1 between July 2008 and December 2011 was performed. A steel plate and C1 lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years).Results:Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°), average extension 42° (range 30-48°). Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively). The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°). Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm), which improved to 3.5 mm after surgery (range 1-6.5 mm). The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm).Conclusions:Transoral osteosynthesis of the anterior ring using C1 lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

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“…This technique results in good biomechanical stability while preserving some degree of joint mobility. Recently, motion-preserving C1-ring osteosynthesis techniques using a C1 lateral mass screw construct with a transverse rod have been demonstrated [35,36]. However, none of these posterior approach techniques can fully address anterior 1/2 Jefferson fractures.…”

Section: Discussionmentioning

confidence: 99%

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

et al. 2013

Eur Spine J

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Study design A retrospective study was conducted to evaluate anterior plate fixation of unstable atlas fractures using a transoral approach. Objective To further investigate the safety and efficacy of this surgical technique, as there is currently a paucity of available data. Summary of background data While most atlas fractures can be managed by external immobilization with favorable results, surgery is usually preferable in highly unstable cases. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1-C2 or C0-C2, but these techniques usually result in loss of joint function and cannot fully stabilize anterior arch fractures of the atlas. Although a transoral approach circumvents these issues, only nine cases were described in the literature to our knowledge. Methods Twenty patients with unstable atlas fractures were treated with this technique during a 6-year period. Screw and plate placement, bone fusion, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, strength, pain levels, and signs of infection were assessed clinically upon follow-up.Results There were no incidents of screw loosening or breakage, plate displacement, spinal cord injury, or vertebral artery injury. A total of 20 plates were placed and all 40 screws were inserted into the atlas lateral masses. CT scans demonstrated that two screws were placed too close to the vertebral artery canal, but without clinical consequences. Imaging demonstrated that bone fusion was achieved in all cases by 6 months postoperatively, without intervertebral instability. No plate-related complications were observed in any patients during the follow-up period. Conclusions C1 anterior plate fixation using a transoral approach appears to be a safe, reliable, and function-preserving surgical method for the management of unstable atlas fractures. For this type of fracture, a transoral approach with anterior fixation should be considered as an alternative to posterior approaches or conservative treatments.

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Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct

Cited by 36 publications

References 25 publications

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

Unstable Jefferson fractures: Results of transoral osteosynthesis

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

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