Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures

Background To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas. Methods From January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans. Results All 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain. Conclusions Transoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II).

Anterior Reduction and C1-ring Osteosynthesis With Jefferson-fracture Reduction Plate (JeRP) via Transoral Approach for Unstable Atlas Fractures

Objective:To introduce a novel transoral instrumentation in the treatment of unstable fractures of atlas.Methods: From January 2008 to May 2018, 22 patients with unstable C1 fractures were retrospective analyzed, who received Jefferson-fracture reduction plate (JeRP) via transoral approach. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture and position of the internal fixation were assessed by preoperative and postoperative CT scans.RESULTS: All 22 patients successfully underwent anterior C1-ring osteosynthesis using JeRP system, with a follow-up of 26.84±9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13±7.08 mm to 1.02±0.65 mm after operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, 3 patients with Dickman type I TAL injury occured atlantoaxial dislocation 3 months postoperatively without any neurological symptoms or neck pain.CONCLUSIONS: Transoral C1-ring osteosynthesis with JeRP is an effective surgical strategy of unstable atlas fractures, achieving direct and satisfactory reduction safely. The primary indication for JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II).

Hemiparesis resulting from an unusual C1 fracture: A case report and literature review

Background: Jefferson fractures are burst fractures involving both the anterior and posterior arches of C1. They typically result from axial compression or hyperextension injuries. Most are stable, and neurological deficits are rare. They are often successfully treated with external immobilization, but require surgery (e.g., fusion/ stabilization). Case Description: An 89-year-old male presented with a left-sided hemiplegia following a trivial fall. The cervical computed tomography scan revealed a left-sided displaced comminuted C1 fracture involving the arch and lateral mass. The MR revealed posterior cord compression and focal myelomalacia. Six months following an emergent C1–C3 decompression with occiput to C4 instrumented fusion, the patient was neurologically intact and pain-free. Conclusion: An 89-year-old male presented with a left-sided hemiplegia due to a Type 3/4 C1 Jefferson fracture. Following posterior C1–C3 surgical decompression with C0–C4 instrumented fusion, the patient sustained a complete bilateral motor recovery.

Classic but unexpected: a case of Jefferson fracture

A man was found lying dead next to a ladder, with only a laceration surrounded by an abrasion visible upon external examination. No skull fractures were palpable. A CT scan and MRI showed a Jefferson fracture of the atlas, associated to a posterior displacement of the skull, a fracture of the dens of the axis, and fractures of the bodies of C5 and C6. Jefferson fractures typically result from a blow to the apex of the skull. In such cases, forensic pathologists should suspect the existence of a Jefferson fracture, particularly when no severe injuries are visible externally.