Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures

Qiang Tu,Yuyue Chen,Jianzhong Xu,Changrong Zhu,Xianhua Huang,Hu Chen,Hong Xia,Zhan Li,Aihong Xu,Jianhua Wang,Qingshui Yin,Xiangyang Ma,Kai Zhang

doi:10.1186/s12891-021-04628-4

Abstract

BackgroundTo introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas.MethodsFrom January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans.ResultsAll 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain.ConclusionsTransoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II).

Highlights

To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas
We described a novel Jefferson-fracture reduction plate (JeRP) system (Wego Corporation, China) via the transoral approach
According to Gehweiler’s classification system, 7 of 22 patients presented with type I fractures, and 15 of 22 patients had type III fractures

Summary

Introduction

To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas. The atlas has a unique ring structure with no vertebral body or spinous processes, which provides more flexibility and a greater range of motion (ROM) than other vertebrae of the spine [1]. The junctions of the lateral mass connected to both the anterior and posterior arches are relatively thinner, making them the weakest points of C1 and more susceptible to fracture [2]. The types of atlas fracture can be described as stable and unstable based on the integrity of transverse atlantal ligament (TAL) and adjacent vertebrae. Unstable C1 fractures are characterized by the high-grade transverse spread of lateral mass on an openmouth radiograph

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