Abstract
The aim of this study was to explore the role of treatment for complex Atlas-Axis fractures, and compare the JOA score of surgical and conservation methods. From June 2008 to May 2012, 33 patients suffering from Atlas-Axis fracture were included in our study. Fifteen patients received posterior cervical pedicle screw fixation, and 18 patients received the conservation treatment. All the patients were followed up for 12 months after discharge. The mean operative time was about 128 minutes (ranged: 92 to 165 minutes), the mean hospital stay time was 15.5 days (ranged: 8-21 days), and the mean follow-up of all the patients was 27months (ranged: 7 to 43 months). All patients gained a solid fusion, and no one showed any disability at the end of the follow-up. The JOA scores before treatment were 6.4±0.3 and 7.1±0.4 before and after treatment, and they significantly increased to 13.8±0.8 and 13.7±0.9 when following up for 12 months (P<0.05). Posterior cervical pedicle screw fixation is a feasible, effective and safe method for complex atlantoaxial fractures. This technique could achieve high JOA score, decreased blood loss and post-operative complications.
Highlights
Complex Atlas-axis fractures often represent about 3% of all acute cervical spine injuries, 12% of upper cervical fractures,[1,2,3] and it frequently occurs in elderly populaiton.[4]
Previous studies showed that the posterior cervical pedicle screw in the lateral mass of C1 and the pedicle of C2 was an option for atlantoaxial fixation.[10,11,12]
The mean operative time was about 128 minutes, the mean hospital stay was 15.5 days, and the mean follow-up of all the patients was 27months. 15 patients who received posterior cervical pedicle screw fixation were regarded as surgery group, and 18 patients received conservation treatment as conservation group
Summary
Complex Atlas-axis fractures often represent about 3% of all acute cervical spine injuries, 12% of upper cervical fractures,[1,2,3] and it frequently occurs in elderly populaiton.[4] Most of Atlas-axis fracture may be resulted from trauma in traffic accidents or a fall in elderly populations.[2] Compared with the isolated atlas or axis fractures, complex Atlas-axis fractures have higher incidence of neurological impairment and mortality,[5,6,7] and require early surgical stabilization. Fixation is required to reduce deformity, provide stability, and prevent impending neurological compromise till bony fusion occurs. The posterior cervical pedicle screw can be incorporated as part of a modular system for fusions to the occiput and subaxial cervical spine, and the method could gain satisfactory results Previous studies showed that the posterior cervical pedicle screw in the lateral mass of C1 and the pedicle of C2 was an option for atlantoaxial fixation.[10,11,12] Nitising reported that posterior cervical pedicle screw is effective for obtaining fusion of the atlantoaxial complex, and the fusion rate are estimated to approach 100%.12 The posterior cervical pedicle screw can be incorporated as part of a modular system for fusions to the occiput and subaxial cervical spine, and the method could gain satisfactory results
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