Posterior pedicle screw-plate system for unstable Jefferson fracture

English Keywords:Jefferson fracture  Posterior C1-2 pedicle screw-plate system  Internal fixation

English Abstract:

  【Abstract】 Objectives: To investigate the feasibility and the clinical outcome of posterior pedicle screw-plate system for unstable Jefferson fracture. Methods: From February 2005 to October 2009, 10 patients suffering from traumatic unstable Jefferson fracture underwent posterior instrumentation by pedicle screw-plate system. Among them there were 7 males and 3 females, all cases presented with neck pain and limit of cervical range of motion(ROM), the preoperative average visual analogue score(VAS) was 7.5. 4 cases suffered from neurological deficit, including 1 Frankel C and 3 Frankel D. After surgery, the clinical efficacy, reduction and stability, surgical complications were reviewed retrospectively. Results: The average operative time was 90min(range, 70-120min), and the average blood loss was 200ml(range, 110-300ml). The complications including spinal cord injury, dural matter tear and vertebral artery injury did not occur. The neck pain relief was achieved. The average postoperative VAS was 2.1, and neurofunction returned to normal. The radiograph confirmed anatomic reduction and well placement of screw. All cases were followed up for 8-48 months(average, 25 months), and all cases had bony union with a mean time of 6 months. The ROM of cervical spine was 35°-42° for flexion-extension(average, 38°), 60°-73° for rotation(average, 66°) and 40°-45° for lateral bending(average, 42°), with the cervical ROM returning to normal. Conclusions： Posterior pedicle screw-plate system for unstable Jefferson fracture is reliable, with high fusion rate and less complication, which can be used as an alternative to conventional approachs.