Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures: a new surgical technique.

Abstract

Case report and surgical technique. To describe a new technique to treat atlas burst fractures by selectively reconstructing the atlas from a posterior approach. The two surgical techniques reported until now for stabilizing atlas burst fractures are associated with some drawbacks. Posterior C0-C2 or C1-C2 fixations significantly reduce head rotation, while the transoral C1 lateral masses osteosynthesis can be associated with oropharyngeal and neurological complications. We propose a new surgical technique for the treatment of unstable Jefferson fractures aimed at avoiding these problems. A 25-year-old man presented with a Jefferson type III atlas fracture after a traffic accident. The fracture failed to consolidate after 3 months of halo brace immobilization. Surgery consisted in inserting bilateral posterior C1 lateral mass screws interconnected by a transversal rod, thereby creating a second C1 posterior arch under the fractured one. Postoperative course was uneventful. Immediate postoperative stability was confirmed on dynamic X-ray films and head rotation was preserved. Delayed computed tomography scan demonstrated fracture consolidation. The surgical technique described is new and effective for treating atlas burst fractures. This posterior procedure allows mobility preservation, with a low morbidity rate.