Direct Fixation of C1 Jefferson Fracture Using C1 Lateral Mass Screws: A Case Report

Abstract

Background: Jefferson fractures are classically described as burst fractures of C1. Traditional surgical treatment of these unstable fractures is either occipito-cervical or posterior C1-C2 fusion, resulting in a significant loss of range of cervical neck movement. This case report discusses the fixation of a Jefferson fracture using C1 lateral mass screws to achieve surgical stabilization while preserving the range of movement. We aim to add to the body of evidence supporting this fixation method. Methods: A 39-year-old male presented to our emergency department with an unstable Jefferson fracture caused by trauma. The various treatment options, such as cervical collar, HALO immobilization, occipito-cervical fusion, and atlanto-axial fusion and direct fixation of C1, were evaluated and discussed with the patient. Informed consent was obtained from the patient prior to writing this case report. Results: At 3 months postoperation, the patient demonstrated near full range of movement in his neck. He had also resumed driving. By 6 months, the patient returned to work, and at 12 months, imaging confirmed union. Conclusions: This case report adds to the body of evidence supporting the technique of C1 lateral mass screws for direct stable fixation of Jefferson fractures. This fixation method preserves the cervical spine range of motion with minimal functional restriction.

Hemiparesis resulting from an unusual C1 fracture: A case report and literature review

“…Surgical options include C1–C2 fixation, with occipitocervical fusion reserved for those with the most complex findings. Although there have been reports of direct fixation of C1 only,[ 4 ] pseudoarthrosis is not a viable option in our opinion. Our case of an unstable Type III fracture involving both anterior, posterior, and lateral mass is cited to have a 33.3% prevalence of nonunion with either operative and nonoperative management.…”

Jefferson fracture as sport injury in weight-lifting athlete: A rare case report and literature review

“…The clinical implication of this report was that the treatment options for the Jefferson fracture vary depending on the presence of other cervical injuries related to the main injury. [ 1 , 14 , 22 , 23 ] For a nonoperative treatment, the use of a halo-thoracic brace, rigid collar, or sterno-occipitomandibular immobilization is effective for a stable fracture. [ 1 , 2 , 6 , 14 ] Meanwhile, operative treatment is used for more unstable and complex fracture cases [ 22 ].…”

“…[ 1 , 14 , 22 , 23 ] For a nonoperative treatment, the use of a halo-thoracic brace, rigid collar, or sterno-occipitomandibular immobilization is effective for a stable fracture. [ 1 , 2 , 6 , 14 ] Meanwhile, operative treatment is used for more unstable and complex fracture cases [ 22 ]. More importantly, this report showed that sport injury can cause cervical injury, therefore complete neurologic examination should be performed cautiously.…”

Design of a novel lateral mass screw–plate system for the treatment of unstable atlas fractures: a finite element analysis

“…ORIF is an emerging surgical technique in recent years, and scholars have tried a variety of surgical approaches and methods. Currently, the surgical methods include anterior transoral screws and plate reduction and fixation [ 21 , 22 ], posterior screws and plate or PSR reduction and fixation [ 23 , 24 ], as well as anterior and posterior combined approach reduction and fixation [ 25 ]. Among these, PSR fixation is the most common one, typically involving the placement of polyaxial pedicle screws in the lateral masses of the atlas, connected by a titanium rod, and then repositioned under pressure.…”