Unilateral atlantoaxial pedicle screw fixation plus structural iliac bone graft for treatment of unstable atlas fractures

Abstract

Objective To evaluate the efficacy of unilateral atlanto-axial transpedicle screw fixation plus iliac bone graft for treatment of unstable atlas fractures combined with unilateral pedicle dysplasia or comminuted fractures. Methods A retrospective case control study was made on 44 patients with unstable atlas fractures surgically treated between January 2012 to June 2016. Unilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients combined with unilateral pedicle dysplasia or comminuted fractures in Group A[15 males, seven females; (37.5±13.4)years], and bilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients without unilateral pedicle dysplasia or comminuted fractures in Group B [14 males, eight females; (38.1±13.3)years]. Between-group differences were compared concerning operation time, intraoperative blood loss, length of hospital stay, success rate of screw placement, postoperative atlanto-axial stability, surgery-related complications, visual analog scale (VAS), Japanese orthopedic association score (JOA) and bone fusion. Results Mean duration of follow-up was 28.4 months (range, 14-48 months). In Group A, operation time was (123.4±18.2)min, blood loss was (218.5±80.2)ml, hospital stay was (7.1±1.0)d, success rate of screw placement was 100%, postoperative atlanto-axial stability of all patients was obtained, and no complications occurred. In Group B, operation time was (173.4±12.4)min, blood loss was (318.2±61.7)ml, hospital stay was (7.2±0.8)d, success rate of screw placement was 100%, postoperative atlanto-axial stability of all patients was obtained, and no complications occurred. There were significant differences in operation time and blood loss between the two groups (P 0.05). Conclusion Both treatments are effective, but unilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft is associated with relatively shorter operation time and less blood loss and hence is considered as a better choice for treatment of unstable atlas fractures. Key words: Atlanto-occipital joint; Spinal fractures; Spinal fusion; Pedicle screws