Unstable Jefferson fractures: Results of transoral osteosynthesis

BACKGROUND: Majority of C(1) fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods. MATERIALS AND METHODS: A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C(1) between July 2008 and December 2011 was performed. A steel plate and C(1) lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years). RESULTS: Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°), average extension 42° (range 30-48°). Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively). The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°). Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm), which improved to 3.5 mm after surgery (range 1-6.5 mm). The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm). CONCLUSIONS: Transoral osteosynthesis of the anterior ring using C(1) lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C(1)-C(2) joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.