Coronally oriented vertical fracture of the axis body: surgical treatment of a rare condition.

The neurosurgical management in a rare case of vertical axis fracture is presented along with discussion of the supposed pathogenetic mechanisms and the biomechanics underlying this type of cervical spine injury. Comprehensive neuroradiological investigation prior to surgery clearly demonstrated the dislocation of the anterior part of the axis body with concomitant C 2/C 3-disk injury. Therefore, the unstable fracture had to be managed by a one-time combined ventrodorsal approach using anterior C 2-C 3 locking plate fusion and C 2 bilateral dorsal transpedicular screw fixation. No operative morbidity resulted from this procedure, and stable bony fusion was achieved with minimal restriction of head mobility and with minor residual complaints. This case illustrates the variable biomechanical response of the upper cervical spine to trauma and the advantages of a non-standard surgical approach for internal fixation of the injured cervical spine.