Atlantoaxial Posterior Pedicle Fixation For Atlantoaxial Complex Fractures

Objective:To study the therapeutic effect of posterior atlantoaxial pedicle fixation for atlantoaxial compound fractures,and to evaluate the changes of Neck Disability Index(NDI),Visual Analog Scale(VAS)and Japanese Orthopaedic Association(JOA)scores before and after treatment and during follow-up and changes in Frankel grading before and 12 months after treatment.Methods:Selecting the patients with atlantoaxial compound fractures with complete medical records in our hospital,including 20 males and 12 females.The average age was47.75±12.47 years(ranged: 29 to 69 years).According to Dickman,there were 18 cases of C1-II odontoid fracture,7 cases of C1-Hangman fracture,4 case of C1-III odontoid fracture and 3 case of C1-axial body fracture.Three cases of C1-II odontoid fracture,C1-III odontoid fracture and C1-axial body fracture in patients with atlantal-dens interval(ADI)<5mm or atlas lateral mass displacement(LMD)≤7mm and three cases of C1-Hangman fracture in patients with C2-3 angled<11° were treated conservatively.All the other patients were treated by surgery.Before surgery,8 patients had sensory,motor,and reflexology disorders in the limbs,Frankel grade was C.All patients were followed up to 12 months after discharge.Results:The ratio of men to women in the surgical group was 12:8,the ratio of men to women in the non-surgical group was 8:4,the average age of the non-surgical group was45.25±9.86 years,and the average age of the surgical group was 49.25±13.83 years.The mean operation time was 138.40±42.27 minutes(68-215 minutes).All patients were followed.Before surgery,the Frankel grading of 8 patients was grade C,which were improved to grade D or Grade E,respectively,at 12 months after surgery.NDI and VAS scores were significantly decreased after treatment(P<0.05).JOA scores were increased significantly after treatment(P<0.05).Up to the last follow-up,none of the 32 patients had any complications such as vertebral artery injury or spinal cord injury.Conclusion:Posterior atlantoaxial pedicle fixation is a safe and feasible method for the treatment of unstable atlantoaxial complex fractures.It can significantly improve patients’ JOA score,significantly reduce the NDI and VAS scores,and improve the Frankel grade.The conservative treatment effect of stable atlantoaxial fractures is also satisfactory.