Abstract
ObjectivePrevious studies have demonstrated that the posterior pedicle screw fixation is an effective and safe method to treat atlantoaxial fractures. However, no report focuses on only the complex atlantoaxial fractures with atlanto-dental interval (ADI) of ≥5 mm or C2-C3 angulation of ≥11°.MethodsThis study was to retrospectively evaluate the outcome of 15 patients (six females and nine males; age, 27–55 years) who underwent posterior pedicle screw fixation for the above complex atlantoaxial fractures between July 2006 and March 2011. Fracture combinations included three Jefferson-type II odontoid, four anterior ring-type II odontoid, two posterior ring-type II odontoid, one lateral mass-type II odontoid, one Jefferson-hangman’s fracture, three anterior ring-hangman’s fracture, and one lateral mass-hangman’s fracture. Fracture healing and bone fusion were determined on X-ray scan. Upper limbs, lower limbs, and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. The Frankel grading system was used to determine the neurological situation.ResultsThe mean operative time, blood loss, and hospital stays were 108.9 ± 25.8 min, 508.0 ± 209.6 ml, and 13.3 ± 2.0 days. Fracture healing and graft fusion were obtained in all patients within 9 months. The ADI or C2-C3 angulation was reduced to ≤5 mm or ≤11°. The JOA score was significantly improved from 7.27 ± 1.10 preoperatively to 15.7 ± 2.1 postoperatively (P <0.001), with 88.1 ± 18.3% recovery rate and 93.3% excellent and good rate. The neurological situation was improved in all patients by at least 1 grade in the Frankel scale. After a mean of 36.5 months of follow-up (range, 18 to 58 months), no operative complications (spinal cord injury, vertebral artery injury, or cerebrospinal fluid leakage) were observed.ConclusionPosterior pedicle screw fixation is a reliable, effective, and minimally invasive procedure for patients suffering from complex atlantoaxial fractures.
Highlights
Complex atlantoaxial fracture is a relatively rare clinical injury, accounting for 3% of all acute cervical spine injuries, 43% of atlas fractures, and 16% of axis fractures [1]
Fracture healing and graft fusion were obtained in all patients within 9 months
The Japanese Orthopaedic Association (JOA) score was significantly improved from 7.27 ± 1.10 preoperatively to 15.7 ± 2.1 postoperatively (P
Summary
Complex atlantoaxial fracture is a relatively rare clinical injury, accounting for 3% of all acute cervical spine injuries, 43% of atlas fractures, and 16% of axis fractures [1]. II odontoid fractures, C1-miscellaneous axis fractures, C1-type III odontoid fractures, and C1-hangman’s fractures [2]. According to the previous guidelines [3,4], patients with C1-stable type II odontoid fractures, Department of Orthopaedics, Shanghai Jiaotong University Affiliated First. C1-miscellaneous axis body fractures, C1-type III odontoid fractures, and stable C1-hangman’s fractures can be successfully treated with the use of a halo or collar immobilization device. Atlantoaxial instability can be treated by the posterior atlantoaxial short segment fixation and fusion, including the Gallie wire [5], Brooks wire [6], interlaminar clamps [7], and transarticular screw [8,9,10].
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