Michael Ruf1, Robert Melcher, Jürgen Harms. 1. Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. michael.ruf@kkl.srh.de
Abstract
STUDY DESIGN: Retrospective study with clinical and radiologic evaluation of transoral reduction and osteosynthesis of C1 in the treatment of unstable Jefferson fractures. OBJECTIVE: Assessment of a new method, which preserves the function of the C1-C2 joint in young patients. SUMMARY OF BACKGROUND DATA: Unstable Jefferson fractures with rupture of the transverse ligament and high-grade dislocation of the lateral masses of C1 are usually treated conservatively by immobilization or traction or surgical by posterior fusion C1-C2. METHODS: Six patients with Jefferson fractures with rupture of the transverse ligament were treated by a transoral approach. Reduction was performed by direct manipulation followed by the osteosynthesis of the anterior ring and the lateral masses of C1. RESULTS: Total average lateral displacement of the lateral masses was 13.5 mm before surgery (range, 8-19 mm) and improved to 4.3 mm after surgery (range 1-8 mm). The total average difference of the atlantal-dens interval in flexion-extension after surgery was 2.0 mm (range 1-3 mm). The average postoperative rotation in the atlantoaxial joint, evaluated by rotation MRI, was in total 39.2 degrees (range 10 degrees - 61 degrees). CONCLUSIONS: Transoral reduction and osteosynthesis C1 is a new technique that allows maintenance of rotatory mobility in the C1-C2 joint and restoration of congruency in the atlanto-occipital and atlantoaxial joints. None of the patients had symptoms of postoperative instability of C1-C2.
STUDY DESIGN: Retrospective study with clinical and radiologic evaluation of transoral reduction and osteosynthesis of C1 in the treatment of unstable Jefferson fractures. OBJECTIVE: Assessment of a new method, which preserves the function of the C1-C2 joint in young patients. SUMMARY OF BACKGROUND DATA: Unstable Jefferson fractures with rupture of the transverse ligament and high-grade dislocation of the lateral masses of C1 are usually treated conservatively by immobilization or traction or surgical by posterior fusion C1-C2. METHODS: Six patients with Jefferson fractures with rupture of the transverse ligament were treated by a transoral approach. Reduction was performed by direct manipulation followed by the osteosynthesis of the anterior ring and the lateral masses of C1. RESULTS: Total average lateral displacement of the lateral masses was 13.5 mm before surgery (range, 8-19 mm) and improved to 4.3 mm after surgery (range 1-8 mm). The total average difference of the atlantal-dens interval in flexion-extension after surgery was 2.0 mm (range 1-3 mm). The average postoperative rotation in the atlantoaxial joint, evaluated by rotation MRI, was in total 39.2 degrees (range 10 degrees - 61 degrees). CONCLUSIONS:Transoral reduction and osteosynthesis C1 is a new technique that allows maintenance of rotatory mobility in the C1-C2 joint and restoration of congruency in the atlanto-occipital and atlantoaxial joints. None of the patients had symptoms of postoperative instability of C1-C2.
Authors: Heiko Koller; Herbert Resch; Mark Tauber; Juliane Zenner; Peter Augat; Rainer Penzkofer; Frank Acosta; Klaus Kolb; Anton Kathrein; Wolfgang Hitzl Journal: Eur Spine J Date: 2010-04-13 Impact factor: 3.134
Authors: M Re; M Iacoangeli; L Di Somma; L Alvaro; D Nasi; G Magliulo; F M Gioacchini; D Fradeani; M Scerrati Journal: Acta Otorhinolaryngol Ital Date: 2016-04-29 Impact factor: 2.124
Authors: Heiko Koller; Frank Acosta; Rosemarie Forstner; Juliane Zenner; Herbert Resch; Mark Tauber; Stefan Lederer; Alexander Auffarth; Wolfgang Hitzl Journal: Eur Spine J Date: 2009-02-18 Impact factor: 3.134