Nonoperative Treatment of an Unstable Jefferson Fracture Using a Cervical Collar

Haus, Brian M.; Harris, Mitchel B.

doi:10.1007/s11999-008-0143-5

Cited by 32 publications

(21 citation statements)

References 18 publications

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“…Most recent biomechanical studies of atlas fractures have concluded that these fractures are usually caused by axial loading through the occiput 161718. Although there is agreement regarding treatment of stable Jefferson fractures, the optimal management of unstable Jefferson fractures remains controversial 619. The integrity of the transverse atlantal ligament (TAL) is the single most important factor in determining the method of treatment 20.…”

Section: Discussionmentioning

confidence: 99%

“…There is a high prevalence of concomitant fractures of the axis, especially odontoid fractures 34. The unstable Jefferson fracture of C 1 is characterized by outward displacement of the lateral masses (LMD) in response to axial load 56. Treatment algorithms in determining surgical versus nonsurgical treatment of unstable Jefferson fractures have not reached a consensus, but treatment decisions are often based on the integrity of the transverse ligament and on the fact whether fractures occur in combination with other unstable spinal injuries.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unstable Jefferson fractures: Results of transoral osteosynthesis

Albert

Kepler

et al. 2014

IJOO

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“…Until today, there are no definitive guidelines to treat atlas fractures, surgically or conservatively. Several authors argue that even unstable Jefferson fractures heal with a sufficient immobilization [ 10 – 12 ]. In contrast, critics report about high rates of nonunion and persisting pain following conservative treatment [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, critics report about high rates of nonunion and persisting pain following conservative treatment [ 13 , 14 ]. Atlas fractures appear unstable when the transverse atlantal ligament is ruptured [ 5 , 10 , 15 , 16 ]. If there is proven ligamentous insufficiency, many surgeons recommend operative stabilization.…”

Section: Discussionmentioning

confidence: 99%

Computer-aided analysis for optimal screw insertion in lateral mass of C1: An anatomical study

Krassnig

Orlandi

Tackner

et al. 2017

Arch Orthop Trauma Surg

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IntroductionMotion preserving techniques in C1 ring fractures are increasingly used especially in young patients. Therefore, lateral mass screws are inserted in the first vertebra and connected by a rod. The purpose of this study was to determine safe zones regarding the vertebral arteries and the medulla oblongata for optimal lateral mass screw positioning when fusing the C1-ring.Materials and methodsImages of the cervical spine of 50 patients (64-line CT scanner) were evaluated and virtual screws were positioned in both lateral masses of the first vertebra using 3D-reconstructions of CT scans. The length of the screws, the insertion angles in two planes, the distance to the vertebral artery, and the spinal canal was investigated. Descriptive statistics was used and gender-dependent differences were calculated using student t-test. A diameter of 4 mm was chosen for the screws.ResultsThe mean screw length was 30.0 ± 2.3 mm on the right and 30.1 ± 2.1 mm on the left side. The arithmetic mean for the transverse angle was 16.4 ± 5.6° on the right and 15.6 ± 6.3° on the left, the sagittal angle averaged 8.3 ± 3.8° on the right, and 11.0 ± 4.9° on the left side. The mean distance between screw and spinal canal has been determined on the right with 2.4 ± 0.7 mm and 2.2 ± 0.6 mm on the left side. The distance from the C1 lateral mass screw to the vertebral artery was on average 7.1 ± 1.5 mm on the right side (significant correlation with gender, p value: 0.03) and 7.4 ± 1.4 mm on the left side.ConclusionsScrews should be positioned with a slightly converging angle of 16° and a slightly ascending angle of 10°. Due to the required high precision technique intraoperatively multiplanar 2 D or 3 D imaging is recommended to avoid harm to the vertebral artery or the spinal canal.

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“…[ 13 14 ] Fractures are best assessed by multidetector computed tomography (CT),[ 15 ] and although a lateral mass spread >6.9 mm shows disruption of the transverse ligament, magnetic resonance imaging (MRI) is a more sensitive indicator of ligament disruption or partial avulsion. [ 16 17 18 ] Long-term nonsurgical immobilization can cause irreversible arthrosis of the atlantoaxial joint,[ 19 ] and surgical fusion of C 1 to either C 2 or occiput restricts range of motion[ 20 ] causing degeneration of the subaxial cervical spine. [ 21 ] Recently, posterior motion-preserving ring osteosynthesis techniques that fix the fracture fragments in a reduced position so as to implement internal immobilization have been described.…”

Section: Introductionmentioning

confidence: 99%

Transoral screw and wire fixation for unstable anterior ½ atlas fracture

Keskil

Göksel

Yüksel

2017

J Craniovert Jun Spine

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Study Design:Atlas fractures are evaluated according to the fracture type and ligamentous injury. External immobilization may result in fracture nonunion.Objective:The ideal treatment method for non-stabilized atlas fractures is limited fixation without restricting the range of motion of the atlantoaxial and atlantooccipital joints.Summary of Background Data:Such a result can be established by using either anterior fixation or posterior lateral mass fixation. However, none of these techniques can fully address anterior 1/2 atlas fractures such as in this case.Materials and Methods:A transoral technique in which bilateral screws were placed intralaminarly and connected with wire was used to reduce and stabilize an anterior 1/2 fracture of C1.Result:Radiological studies after the surgery showed good cervical alignment, no screw or wire failure and good reduction with fusion of anterior arcus of C1.Conclusions:Internal immobilization by this screw and wire osteosynthesis technique protects the mobility of the atlanto-occipital and atlantoaxial joints. The main advantage is that neither the twisted wires inserted under the anterior lamina, nor the laterally placed screw heads interfere with midline wound closure; unlike the plate/cage and rod systems used together with anterior screws. A computer navigation system with intraoperative 3D imaging facilities will be of benefit for safe placement of the screw, however we preferred a free-hand technique, as the starting point was at the fracture line along the trajectory of the routinely accessible anterior lamina.

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Nonoperative Treatment of an Unstable Jefferson Fracture Using a Cervical Collar

Cited by 32 publications

References 18 publications

Unstable Jefferson fractures: Results of transoral osteosynthesis

Unstable Jefferson fractures: Results of transoral osteosynthesis

Computer-aided analysis for optimal screw insertion in lateral mass of C1: An anatomical study

Transoral screw and wire fixation for unstable anterior ½ atlas fracture

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