Posterior osteosynthesis with a new self-designed lateral mass screw-plate system for unstable atlas burst fractures

Abstract

Background In the treatment of unstable atlas fractures using the combined anterior–posterior approach or the posterior monoaxial screw-rod system, factors such as severe trauma or complex surgical procedures still need to be improved despite the favourable reduction effect. This research described and evaluated a new technique for the treatment of unstable atlas fracture using a self-designed lateral mass screw-plate system. Methods A total of 10 patients with unstable atlas fractures using this new screw-plate system from January 2019 to December 2021 were retrospectively reviewed. All patients underwent posterior open reduction and internal fixation (ORIF) with a self-designed screw-plate system. The medical records and radiographs before and after surgery were noted. Preoperative and postoperative CT scans were used to determine the type of fracture and evaluate the reduction of fracture. Results All 10 patients were successfully operated with this new system, with an average follow-up of 16.7 ± 9.6 months. A total of 10 plates were placed, and all 20 screws were inserted into the atlas lateral masses. The mean operating time was 108.7 ± 20.1 min and the average estimated blood loss was 98.0 ± 41.3 ml. The lateral mass displacement (LMD) averaged 7.1 ± 1.9 mm before surgery and almost achieved satisfactory reduction after surgery. All the fractures achieved bony healing without reduction loss or implant failure. No complications (vertebral artery injury, neurologic deficit, or wound infection) occurred in these 10 patients. At the final follow-up, the anterior atlantodens interval (AADI) was 2.3 ± 0.8 mm and the visual analog scale (VAS) was 0.6 ± 0.7 on average. All patients preserved almost full range of motion of the upper cervical spine and achieved a good clinical outcome at the last follow-up. Conclusions Posterior osteosynthesis with this new screw-plate system can provide a new therapeutic strategy for unstable atlas fractures with simple and almost satisfactory reduction.

Direct osteosynthesis in the treatment of atlas burst fractures: a systematic review

“…Following this, Gumpert et al [ 22 ] and Zhang et al [ 7 ] utilized a monoaxial lateral mass screw-rod system for posterior osteosynthesis of atlas fractures. The convergence of the front of the two monoaxial screws and the compression of the screw end during tightening can effectively reduce the anterior arch fractures, but the reduction system still had significant shortcomings, and the technical requirements were too high to be generalized [ 23 ]. Building on this, Yang et al [ 23 ], employing a self-made lateral mass screw-plate system, successfully achieved satisfactory reduction of both the anterior and posterior arches, while also simplifying the surgical procedure.…”

“…Additionally, due to the angled U-shaped slot of the monoaxial screw relative to the transverse connecting rod, if the screw fails to maintain pressure during locking, it may shift to both ends of the connecting rod. Furthermore, controlling the rotation of the transverse connecting rod can also be challenging [ 23 ]. Therefore, the operation is intrinsically complicated, potentially resulting in postoperative challenges such as impaired reduction of paravertebral muscles, chronic bursitis, and chronic neck pain [ 23 ].…”

“…Furthermore, controlling the rotation of the transverse connecting rod can also be challenging [ 23 ]. Therefore, the operation is intrinsically complicated, potentially resulting in postoperative challenges such as impaired reduction of paravertebral muscles, chronic bursitis, and chronic neck pain [ 23 ]. Recently, Yang et al [ 23 ] demonstrated that effective repositioning of both anterior and posterior arches could be accomplished using a self-made lateral mass screw-plate system through a simpler procedure.…”

Fractura de Jefferson y trauma subaxial de columna cervical, resolución quirúrgica, abordaje 360o; C1 tornillos a masas laterales y corpectomía C7: reporte de un caso

“…Sin embargo, la calidad de vida de los pacientes puede verse seriamente afectada por la pérdida de la movilidad de la columna cervical superior y la degeneración acelerada de los segmentos adyacentes. 2,4,11 Se ha propuesto un abordaje transoral para la fijación de C1 y evitar la fusión occipitocervical o atlantoaxial, pero cuenta con mayor riesgo de infección.…”

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

“…To prevent the potential disadvantages associated with polyaxial screws and rod fixation, there is a need to identify a surgical method with a high degree of reduction and ease of operation. Our team had previously initiated a series of clinical studies for the treatment of unstable atlas fractures [ 27 ]. A novel atlas LMSP was used to treat unstable atlas fractures (Fig.…”