Management of C2 fractures using Iso-C3D guidance: a single institution's experience

Abstract

About 20 % of cervical fractures involve the C2 vertebra. Many surgical techniques have been proposed according to the type of fracture. However, morbidity and mortality of these procedures is often high, which can be attributed to the old age and significant co-morbidities of the affected population and the complex anatomy of C2. To target the latter, several authors have applied iso-C(3D) guidance for most of the common techniques. We here present our experience using a fixed protocol and iso-C(3D) guidance in all cases of traumatic C2 fractures. Sixteen patients were operated upon between April 2011 and April 2012 using Iso-C(3D) guidance, following a fixed routine protocol. The screw position was verified by CT-scanning. Intraoperative and clinical parameters were evaluated. Six patients received anterior lag-screw fixation of odontoid fractures. Two underwent isolated posterior lag-screw fixation of hangman's fracture. C1 and/or C3 lateral mass, and/or C2 isthmic screws were placed in eight patients. No screw had to be revised, 3 minor breachings of the cortical bone of <2 mm were observed.The same standard protocol for draping, registration of the navigation and Iso-C(3D) guided drilling could be applied for anterior and posterior procedures, leaving only two variables. This led to rapid acceptance of the technique among OR-staff and surgeons, who felt comfortable with iso-C(3D) guidance after only five cases. Iso-C(3D) guidance is a safe and straightforward technique for anterior and posterior screw placement in the upper cervical spine.