Unstable Atlas Fractures Treatment By Posterior Spinal Fusion And Fixation

Objective To evaluate clinical effect of the posterior internal fixation and bone graft fusion(atlantoaxial fusion or occiput-cervical fusion)in the treatment of unstable atlas fractures, as a reference for the selection of internal fixation method.Methods A retrospective study was performed in 27 patients(23 male,4 female) with unstable fractures treated in the First Affiliated Hospital of Fujian Medical University from September 2010 to September 2013. There were 6 patients with typical Jefferson fractures, 10 with semiring fractures, 3 with anterior 1/2 Jefferson fractures, 3 with anterior 3/4 Jefferson fractures, and 5 with posterior 3/4 Jefferson fractures. 3 typical Atlas fractures combined with Dickman type I rupture of transverse ligament, 2 semiring fracture combined with Anderson Ⅱ odontoid process fracture,1 semiring fracture combined with wing ligaments injury,1 anterior 3/4 Jefferson fracture combined with Edwards typeⅠHangman’s fractures. According to the severity of the fractures and the damage of surrounding tissues, 6 patients with typical Jefferson fractures and 3 patients with instability of atlas around were treated with occiput-cervical fusion, other 18 patients were treated with atlantoaxial fusion. Evaluating the therapeutic effect of operation according to the operation time, intraoperative bleeding, combined with preoperative and postoperative ADI, LMD values, JOA score and neck activity.Results AIl the patients were successfully operated. The operation time of atlantoaxial fusion group is(140±58) min, with(162±172) m L intraoperative blood loss. The operation time of occipitu-cervical fusion is(244±73) min, with(322±139) m L intraoperative blood loss. There was no spinal cord injury, nerve or vertebral artery injury, no cerebrospinal fluid leakage, infection or other complications in all the patients during the surgical operation. One patient suffered a massive hemorrhage due to the injury of intervertebral venous plexus during the dissecting, and was achieved hemostasis by gauze and gelatin sponge, with no symptoms of cerebral ischemia. All the patients without severe spinal cord injuryleaved the bed in 3 to 5 days after the operations, and remove the neck support after one month, with no discernible cervical instability. The followed up X-ray or CT after three months showed osseous fusion in all the patients, without any looseness, fracture or reduction lose. The index of ADI and LMD improved compared with preoperative, the atlantoaxial fusion LMD reduction significantly(P < 0.05); Both Suffered the loss of rotation, flexion and extension function, the higher rate of occipitu-cervical fusion(P < 0.05); JOA score were significantly improved compared with preoperative, but there was no significant difference in both groups(P > 0.05).Conclusions Both of them can heal fracture and reduce neural symptoms. Compared with occipitu-cervical fusion, atlantoaxial fusion can save time, reduce the bleeding, and reset fracture during operation, with less effect on cervical rotation, flexion and extension, so we insist in it for the first choice for cervical vertebra disease. Occipitu-cervical fusion should be strictly selected.