C1 fractures: a review of diagnoses, management options, and outcomes

Mead, Loren B.; Millhouse, Paul W.; Krystal, Jonathan; Vaccaro, Alexander R.

doi:10.1007/s12178-016-9356-5

Cited by 66 publications

(34 citation statements)

References 32 publications

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“…In this context, it must be noted that the decision for and the type of surgery was frequently made based on concomitant injuries of the adjacent cervical spine segments. The in-hospital complications observed in this study were in the range of what is known from other case series [1,10]. Nosocomial infections as well as the development of a delirium must be considered as high-risk complications after surgery of elderly patients.…”

Section: Discussionsupporting

confidence: 58%

“…In contrast to the literature, however, almost every fourth Gehweiler 4 fracture in our population was treated operatively. The literature mainly recommends conservative treatment for isolated fractures of the lateral masses [10]. However, recent studies observed frequently a lateral displacement of the lateral mass fragments associated with subluxation of the occipital condyle resulting in neck pain, head malposition and impaired head rotation [17].…”

Section: Discussionmentioning

confidence: 99%

“…Resulting therapy options for treatment of C1 fractures have been repeatedly discussed in the literature. Surgical stabilization has become a more established treatment modality in certain fracture patterns because modern implant systems and better intraoperative imaging [8] have changed and broadened the range of indications [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and management of atlas fractures

et al. 2020

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Purpose The purpose of this study was to gain new insights into the epidemiologic characteristics of patients with atlas fractures and to retrospectively evaluate complication rates after surgical and non-surgical treatment. Methods In a retrospective study, consecutive patients diagnosed with a fracture of the atlas between 01/2008 and 07/2018 were analyzed. Data on epidemiology, concomitant injuries, fracture patterns and complications were obtained by chart and imaging review. Results In total, 189 patients (mean age 72 years, SD 19; 57.1% male) were treated. The most frequent trauma mechanism was a low-energy trauma (59.8%). A concomitant injury of the cervical spine was found in 59.8%, a combined C1/C2 injury in 56.6% and a concomitant fracture of the thoraco-lumbar spine in 15.4%. When classified according to Gehweiler, there were: 23.3% type 1, 22.2% type 2, 32.8% type 3, 19.0% type 4 and 1.1% type 5. Treatment of isolated atlas fractures (n = 67) consisted of non-operative management in 67.1%, halo fixation in 6.0% and open surgical treatment in 26.9%. In patients with combined injuries, the therapy was essentially dictated by the concomitant subaxial cervical injuries. Conclusions Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).1. Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. 2.A concomitant injury of the cervical spine was found in 59.8 %, a combined C1/C2 injury in 56.6 %.3. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Epidemiology and management of atlas fractures

et al. 2020

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“…Based on ratings of experienced spine surgeons, the aims of this study were to evaluate (1) the interobserver reliability of the Gehweiler classification and (2) the C1-fracture stability as well as (3) to assess treatment strategies according to their prior fracture classification.…”

Section: Introductionmentioning

confidence: 99%

Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

Laubach

Pishnamaz

Scholz

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Atlas (C1) fractures are commonly rated according to the Gehweiler classification, but literature on its reliability is scarce. In addition, evaluation of fracture stability and choosing the most appropriate treatment regime for C1-injuries are challenging. This study aimed to investigate the interobserver reliability of the Gehweiler classification and to identify whether evaluation of fracture stability as well as the treatment of C1-fractures are consistent among spine surgeons. Methods Computed tomography images of 34 C1-fractures and case-specific information were presented to six experienced spine surgeons. C1-fractures were graded according to the Gehweiler classification, and the suggested treatment regime was recorded in a questionnaire. For data analyses, SPSS was used, and interobserver reliability was calculated using Fleiss’ kappa (κ) statistics. Results We observed a moderate reliability for the Gehweiler classification (κ = 0.50), the evaluation of fracture stability (κ = 0.50), and whether a surgical or non-surgical therapy was indicated (κ = 0.53). Type 1, 2, 3a, and 5 fractures were rated stable and treated non-surgically. Type 3b fractures were rated unstable in 86.7% of cases and treated by surgery in 90% of cases. Atlas osteosynthesis was most frequently recommended (65.4%). Overall, 25.8% of type 4 fractures were rated unstable, and surgery was favoured in 25.8%. Conclusion We found a moderate reliability for the Gehweiler classification and for the evaluation of fracture stability. In particular, diverging treatment strategies for type 3b fractures emphasise the necessity of further clinical and biomechanical investigations to determine the optimal treatment of unstable C1-fractures.

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“…The atlas has two lateral masses with concavities that match the condyles of the occiput and the dens of the axis, forming the occipito-atlantoaxis complex. The occipito-atlanto-axis complex provides approximately 50% of its lateral rotation and exion-extension of the entire cervical spine [2]. In order to preserve the mobility of occipito-atlanto-axis articulation, direct posterior C1 pedicle screw xation of unstable fractures of the atlas has been reported.…”

Section: Introductionmentioning

confidence: 99%

Personalized Rapid Prototyping Template for Direct C1 Pedicle Screw Fixation of Unstable C1 Semi-Ring Fractures

Dong

Spiker

et al. 2020

Preprint

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Background: Placement of C1 pedicle screws carries an inherent risk of injury to the spinal cord and vertebral artery. Use of a personalized rapid prototyping template may be able to improve the safety of C1 pedicle fixation. To evaluate the clinical and radiographic outcomes of direct posterior C1 pedicle screw fixation using a personalized rapid prototyping template for unstable C1 semi-ring fractures.Methods: From May of 2010 to September of 2015, 38 patients with unstable C1 semi-ring fractures were treated with direct posterior C1 pedicle screw fixation. A standard open technique was utilized in 20 patients (Free-hand group) and 18 patients underwent C1 pedicle screw fixation with the aid of a personalized rapid prototyping template (RP group). The operative time, intraoperative blood loss, preoperative ADI, LMD and VAS were recorded. The postoperative ADI, LMD and VAS score were recorded at 180 days postoperatively.Results: No spinal cord or vertebral artery injuries were encountered in either group. Similarly, no post-operative instrumentation failures or cases of postoperative C1-2 instability were reported in either group. There was no statistically significant difference in intraoperative blood loss and operative time between RP and Free-hand group. In both groups, all patients obtained radiographic fusion at 6 months, reported no residual neck pain and were found to have a full range of motion at final follow up.Conclusion: Use of a personalized rapid prototyping template for the placement of direct posterior C1 pedicle screws is safe and effective in the treatment of unstable C1 semi-ring fractures with similar radiographic and clinical outcomes to more traditional techniques.

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C1 fractures: a review of diagnoses, management options, and outcomes

Cited by 66 publications

References 32 publications

Epidemiology and management of atlas fractures

Epidemiology and management of atlas fractures

Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

Personalized Rapid Prototyping Template for Direct C1 Pedicle Screw Fixation of Unstable C1 Semi-Ring Fractures

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