Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures

Kim, Moon Kyu; Shin, Jae‐Gook

doi:10.1007/s00701-019-03824-5

“…However, a follow-up study of 22 patients with atlas burst fractures by Dvorak et al [ 15 ] showed that patients that underwent conservative treatments failed to regain functional preoperative levels, and hinted that nonsurgical treatments were not optimal management options. The strongest Halo-vest has only 75% restriction on cervical flexion and extension activity, so that, preservative treatment with a Halo-vest has a high risk of nonunion [ 5 ]. Immobilization of the cervical spine for several months may result in significant discomfort and other complications especially in elderly patients [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of unstable atlas fractures is still controversial. Nonsurgical treatments of unstable atlas fractures have the disadvantages of deficient reduction and high rates of nonunion, and even neurological damage [ 5 ]. Although surgical treatments with C1–C2 or C0–C2 fusion can achieve satisfactory stability and bone fusion in unstable atlas fractures, the normal C1–C2 motion is lost [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

Zou

¹

,

Ouyang

²

,

Wang

³

et al. 2020

BMC Musculoskelet Disord

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Background C1-ring osteosynthesis is a valid alternative to posterior C1–C2 or C0–C2 fusion to preserve important C1–C2 motion in the treatment of unstable atlas fractures. Nevertheless, the fixation instruments used in current studies for transoral anterior C1-ring osteosynthesis were not suitable for anterior anatomy of the atlas or did not have reduction mechanism. We therefore present this report to investigate preliminary clinical effects of transoral anterior C1-ring osteosynthesis using a laminoplasty plate in unstable atlas fractures. Methods From January 2014 to December 2017, 13 patients with unstable atlas fractures were retrospectively reviewed. All patients were treated with transoral anterior C1-ring osteosynthesis using a laminoplasty plate. Pre- and postoperative images were obtained to assess reduction of the fracture, internal fixation placement, and bone union. Neurological function, range of motion, and pain levels were evaluated clinically on follow-up. Results The surgeries were successfully performed in all cases. The average follow-up duration was 16.6 ± 4.4 months (range 12–24 months). One patient suffered screw loosening after operation and underwent replacement operation subsequently. Satisfactory clinical outcomes were achieved in all patients with ideal fracture reduction, reliable plate placement, well-preserved range of motion, and neck pain alleviation. All patients achieved bone union of fractures without loss of reduction or implant failure or C1–C2 instability during the follow-up. No vascular or neurological complication was noted during the operation and follow-up. Conclusions Transoral anterior C1-ring osteosynthesis using a laminoplasty plate is a effective surgical treatment for unstable atlas fractures. This technique has a ingenious reduction mechanism, and can provide satisfactory bone union and preservation of C1–C2 motion.

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“…However, a follow-up study of 22 patients with atlas burst fractures by Dvorak et al [15] showed that patients that underwent conservative treatments failed to regain functional preoperative levels, and hinted that nonsurgical treatments were not optimal management options. The strongest Halo-vest has only 75% restriction on cervical flexion and extension activity, so that, preservative treatment with a Halovest has a high risk of nonunion [5]. Immobilization of the cervical spine for several months may result in significant discomfort and other complications especially in elderly patients [16].…”

Section: Discussionmentioning

confidence: 99%

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

Zou

¹

,

Ouyang

²

,

Wang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background C1-ring osteosynthesis is a valid alternative to posterior C1–C2 or C0–C2 fusion to preserve important C1–C2 motion in the treatment of unstable atlas fractures. Nevertheless, the fixation instruments used in current studies for transoral anterior C1-ring osteosynthesis were not suitable for anterior anatomy of the atlas or did not have reduction mechanism. We therefore present this report to investigate preliminary clinical effects of transoral anterior C1-ring osteosynthesis using a laminoplasty plate in unstable atlas fractures. Methods From January 2014 to December 2017, 13 patients with unstable atlas fractures were retrospectively reviewed. All patients were treated with transoral anterior C1-ring osteosynthesis using a laminoplasty plate. Pre- and postoperative images were obtained to assess reduction of the fracture, internal fixation placement, and bone union. Neurological function, range of motion, and pain levels were evaluated clinically on follow-up. Results The surgeries were successfully performed in all cases. The average follow-up duration was 16.6 ± 4.4 months (range 12–24 months). One patient suffered screw loosening after operation and underwent replacement operation subsequently. Satisfactory clinical outcomes were achieved in all patients with ideal fracture reduction, reliable plate placement, well-preserved range of motion, and neck pain alleviation. All patients achieved bone union of fractures without loss of reduction or implant failure or C1–C2 instability during the follow-up. No vascular or neurological complication was noted during the operation and follow-up. Conclusions Transoral anterior C1-ring osteosynthesis using a laminoplasty plate is a effective surgical treatment for unstable atlas fractures. This technique has a ingenious reduction mechanism, and can provide satisfactory bone union and preservation of C1–C2 motion.

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“…The dysphagia scale was evaluated as follows: "normal" refers to patients without any swallowing di culties; "mild" refers to patients with rare, intermittent episodes of dysphagia; "moderate" refers to patients with some di culty when swallowing some special food; and "severe" refers to patients with di culty even swallowing liquid [16]. The neck pain visual analogue scale (VAS) and neck disability index (NDI) [4] were assessed, and scores were recorded by an independent examiner.…”

Section: Evaluation Criteriamentioning

confidence: 99%

“…There is still much controversy about the treatment of C1 fractures [2]. The most common fracture classi cation is the Gehweiler classi cation: type I fractures are isolated fractures of the anterior ring of the atlas, type II refers to isolated fractures of the posterior arch of the atlas, type III are combined fractures of the anterior and posterior arches of the atlas, type IV refers to isolated fractures of the lateral mass, and type V refers to fractures of the transverse process [3][4]. Types III and IV are considered unstable fractures and often require surgery [4].…”

Section: Introductionmentioning

confidence: 99%

3D-Printed Screw-Rod Auxiliary System for Unstable Atlas Fractures: A Retrospective Analysis

Wu

¹

,

Deng

²

,

Li

³

et al. 2020

Preprint

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Objective To develop and validate a 3D-printed screw-rod auxiliary system for unstable atlas fractures.Methods Fourteen patients who underwent occipitocervical fusion with the 3D-printed screw-rod auxiliary system enrolled in our hospital from 2017 to 2019 were reviewed. The operation time, blood loss and radiation times during the operation were recorded. The maximum fracture displacement values pre- and post-operation were measured based on CT imaging. All screw grades were evaluated after surgery. The O-C2 angle and OCI angle pre-operation, post-operation and at the last follow-up were measured. The dysphagia scale 3 and 12 months after surgery and the NDI 3 and 12 months after surgery were assessed.Results The average surgery time, average blood loss and average radiation times for the 14 patients were 112.14 minutes, 171.43 ml and 5.07 times, respectively. There was a significant difference in maximum fracture displacement between pre- and post-operation values (P<0.05). A total of 56 screws were inserted; 3 screws were classified as grade 1, and the others were classified as grade 0. There was a significant difference in the O-C2 and OCI angles from pre-operation values to values 3 days after the operation (P=0.002, P<0.05); there was no significant difference in the O-C2 or OCI angle from 3 days after the operation to the last follow-up (P=0.079; P=0.201). The dysphagia scales of two patients were assessed as mild 3 months after surgery, and the others were assessed as normal. All patients’ dysphagia scores returned to normal 12 months after surgery. The average NDI and average neck VAS scores 12 months after surgery were 2.53 and 8.41, respectively.Conclusion It is clinically feasible with the assistance of a screw-rod auxiliary system to perform occipitocervical fusion for unstable atlas fractures. This novel technique can objectively restore the occipitocervical angle of patients, and there are few postoperative complications.

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Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures

Cited by 13 publications

References 30 publications

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

3D-Printed Screw-Rod Auxiliary System for Unstable Atlas Fractures: A Retrospective Analysis

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