Burst C2 Fractures Combined with Traumatic Spondylolisthesis: Can Atlantoaxial Motion Be Preserved? Including Some Technical Tips for Reduction and Fixation

STUDY DESIGN: Retrospective comparative clinical case series. OBJECTIVE: Burst C2 fractures are very rare. Treatment options include conservative treatment or fusion (anterior, posterior, or anterior and posterior). Anterior fusion addresses mainly hangman component. The bursting body usually needs posterior or combined anterior-posterior fusion, but both permanently sacrifice atlantoaxial motion. Can anterior-“first” approach preserve C1–C2 motion and restore function? METHODS: We report nine cases of burst C2 combined with C2–C3 spondylolisthesis and an odontoid fracture. The surgical group included six patients treated initially with an anterior approach, moving to a posterior one when necessary. All were treated with anterior diskectomy fusion using one session and one incision. The halo group included three patients treated conservatively using halo traction followed by rigid collar. Assessments included self-reported, physiologic, and functional measures. Reduction was assessed using Roy-Camille's criteria and improvement of canal compression ratio. Clinical outcome was graded excellent, very good, good, or poor according to pain, range of motion, and work status. RESULTS: Mean follow-up was 44.5 ± 8.3 (range 36.0 to 62.0) weeks. Results in the surgical group were judged to be excellent in four and good in two. One patient developed atlantoaxial osteoarthritis. Results were good in one patient and poor in two patients in the halo group. Two patients developed atlantoaxial osteoarthritis. All three cases had work limitations. CONCLUSION: A single anterior approach achieved union and preserved C1–C2 motion and function in some cases. Conservative treatment achieved union but failed to achieve good reduction or good clinical outcome in grossly instable fractures. However, we believe that the ideal management is yet to evolve.