Abstract
Background Whether an unstable C1 burst fracture should be treated surgically or conservatively is controversial. The purpose of this study is to evaluate the effectiveness and motion-preserving function of temporary fixation of C1-2 screw-rod system for the reduction and fixation of unstable C1 burst fracture (type 3 and 4 according to the Gehweiler classification).Patients and Methods We retrospectively reviewed 10 patients who were treated with posterior temporary C1-C2 fixation. We assessed age at surgery, gender, pre- and post-operative VAS, NDI, atlanto-dens interval, lateral mass distance and rotation function of C1-C2 complex.Results 6 males and 4 females were included in our study. The average follow-up duration was 14.1± 1.37 months. The left-to-right ROMs of C1-C2 rotation was 9.6±1.42°. The pre-operative cervical VAS was 8.30±0.48; the post-operative cervical VAS of C1-C2 fusion was 2.90±0.57. The pre-operative VAS for removal was 2.0±0.00, the post-operative VAS for removal was 2.3±0.48; The pre-operative cervical NDI was 81.40%±2.07%, the post-operative cervical NDI of C1-C2 fusion was 18.10%±1.52%. The preoperative NDI for removal was 15.9%±1.20%, The post-operative NDI for removal was 14.5%±1.08%. The pre-operative ADI was 4.43±0.34mm, post-operative ADI was 1.94±0.72mm. The pre-operative LMD was 6.36±0.58mm, post-operative LMD was 1.64±0.31mm.Conclusion Posterior temporary C1-2 fixation can achieve a good fusion, satisfied reduction of C1 burst fracture, relieve the pain, improve the cervical function outcome, but may reduce the rotational ROM of C1-2. Temporary C1- C2 fixation is an alternative technique to manage the C1 burst fracture, but the need for implant removal needs to be questioned. For patients with CT scan before implant removal showing spontaneous fusion, they may potentially not profit from implant removal.
Retro-odontoid cystic mass treated by laminectomy and C1-C2 fixation
