Management of combined atlas-axis fractures: a review of forty one cases

• Published in: International orthopaedics Vol. 40; no. 6; pp. 1179 - 1186
• Main Authors: Lin, Bin, Wu, Jin, Chen, Zhi-da, Zeng, Wenrong, Liu, Qingjun, Dai, LiLin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2016
• Subjects: Adult; Aged; Bone Screws - adverse effects; Bone Screws - statistics & numerical data; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Pain Measurement; Spinal Fractures - therapy; Spinal Fusion - methods; Splints - adverse effects; Splints - statistics & numerical data; Young Adult; Pedicle screw fixation; Management; Combination atlas-axis fractures; Nonoperative treatment
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-015-3076-0

Purpose To outline a management principle for the combined atlas (C1)-axis (C2) fractures and assess its therapeutic effects. Methods Forty-one patients with combined C1-C2 fractures were treated according to their C2 fracture types. Non-operative external immobilization in the form of a cervical collar or halo vest was used in 22 patients. Early posterior pedicle screw fixations were performed in 19 patients whose fractures had a combination of any of the three conditions: an atlantodens interval (ADI) ≥ 5 mm, lateral mass displacement (LMD) > 7 mm, and/or C2-C3 angulation > 11°. Thirty-nine patients were followed up regularly with an average of 19.3 months (range, 12 to 45 months). Clinical and radiographic data were then collected and compared. Results At three months following treatment, patients’ visual analog scale (VAS), Neck Disability Index (NDI), American Spinal Injury Association (ASIA) scale, and Frankel grades were all significantly improved when compared to pretreatment. These results indicated that the cervical collar, halo vest, and posterior pedicle screw fixation approaches were all able to effectively treat cases of combined C1-C2 fractures. One patient in the non-surgical group developed nonunion which required late surgical treatment and one patient had pin site infection in the non-surgical group (2/22), while there were three minor complications in the surgical group. Conclusion We propose a management principle that bases the treatment of a combined C1-C2 fracture on the nature of the C2 fracture. This treatment strategy has yielded promising results as a satisfactory means for the management of combined C1-C2 fractures.