Surgical Management of the Fractures of Axis Body: Indications and Surgical Strategy

Abstract

Introduction The axis body fractures are relatively uncommon and have a variety of presentations. Surgical management to them has been only reported as case reports or included as a minor part of clinical management. The objective of this study is to summarize the indications for surgery and report the clinical outcome of surgical treatment based on different fracture patterns. Materials and Methods A retrospective analysis of 28 consecutive patients presenting with the axis body fractures was undertaken. The indications for surgical treatment were defined as follows: (1) fractures associated with instability of adjacent joints; (2) irreducible displaced superior articular facet fracture; (3) fractures resulting in spinal cord compression. The fractures were classified as sagittal, coronal, transverse and lateral mass fracture. One of the following surgical procedures was applied according to the fracture pattern: posterior C1-C2 pedicle screws fixation and fusion (I); posterior C1-C3 screws fixation and fusion (II); posterior osteosynthesis with C2 transpedicular half-thread lag screws (III). Results Thirteen patients were successfully managed operatively. Two transverse and two unilateral lateral mass fractures were treated with surgical procedure I, five sagittal fractures with II, four coronal fractures with III. Complications of malposition of screws and neurologic deficit did not occur during operation. Satisfactory reduction and bony union were demonstrated on postoperative radiographs. Conclusion The axis body fractures should be treated with individualized clinical management. Conservative remedies with external immobilization are still advocated as primary management for most cases. But for cases with adjacent joints instability or irreducible displaced superior articular facet fracture, surgical intervention is necessary. The optimal surgical choice should be based on the type of fracture pattern. Disclosure of Interest None declared References Starr JK, Eismont FJ. Atypical hangman's fractures. Spine 1993;18(14):1954–1957 Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M. Fractures of the C-2 vertebral body. J Neurosurg 1994;81(2):206–212 Fujimura Y, Nishi Y, Kobayashi K. Classification and treatment of axis body fractures. J Orthop Trauma 1996;10(8):536–540 Korres DS, Papagelopoulos PJ, Mavrogenis AF, Benetos IS, Kyriazopoulos P, Psycharis I. Chance-type fractures of the axis. Spine 2005;30(17):E517-E520 German JW, Hart BL, Benzel EC. Nonoperative management of vertical C2 body fractures. Neurosurgery 2005;56(3):516-521, discussion 516–521 Koller H, Acosta F, Forstner R, et al. C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Eur Spine J 2009;18(8):1135–1153 Rainov NG, Heidecke V, Burkert W. Coronally oriented vertical fracture of the axis body: surgical treatment of a rare condition. Minim Invasive Neurosurg 1998;41(2):93–96 Bohay D, Gosselin RA, Contreras DM. The vertical axis fracture: a report on three cases. J Orthop Trauma 1992;6(4):416–419 Lozano-Requena JA, Pina-Medina A, Aracil-Silvestre J, Torro-Belenguer V, Baixauli-Castella F. Sagittal fracture of the second cervical vertebral body. Int Orthop 1994;18(2):114–115 Marotta TR, White L, TerBrugge KG, Spiegel SM, Stevens JK, Tator CM. An unusual type of hangman's fracture. Neurosurgery 1990;26(5):848-850, discussion 850–851 Jakim I, Sweet MB. Transverse fracture through the body of the axis. J Bone Joint Surg Br 1988;70(5):728–729 Maki NJ. A transverse fracture through the body of the axis. A case report. Spine 1985;10(9):857–859 Craig JB, Hodgson BF. Superior facet fractures of the axis vertebra. Spine 1991;16(8):875–877