Treatment strategy of atlas fractures in adults

English Keywords:Atlas fractures  Treatment strategy  Atlas transverse ligament

English Abstract:

  【Abstract】 Objectives: To discuss the treatment strategy of atlas fractures in adults. Methods: From May 2013 to December 2015, 58 adults with isolated atlas fractures(31 males and 27 females, average age 45.3±14.0, range 18-72 years) were treated in our hospital. Seven stable C1 fractures were treated by collar; while 22 unstable C1 fractures without transverse ligament injury were treated by skull-neck-thorax brace or halo-vest; 29 unstable C1 fractures patients with transverse ligament injury were treated by C1-C2 fusion or C1 fixation. Patients were followed up regularly. American Spinal Injury Association(ASIA) grades, visual analogue scale(VAS) and complications were recorded. Fracture healing and fusion were evaluated by computed tomography(CT) scan, and stability was evaluated by dynamic radiograph. Results: The mean follow-up period was 14.3±4.0(range 12-24) months. Stable fractures treated by collar and unstable fractures without transverse ligament injury treated by skull-neck-thorax brace or halo-vest healed. 18 of 20 who underwent C1-C2 fusion surgery got bony fusion, two failed, but the internal implant was still rigid. Atlantoaxial stability was confirmed by dynamic radiographs in all the 9 patients undergoing C1 fixation. ASIA grade was D in 4 cases and E in 54 cases before treatment. At final follow-up, ASIA grade was E in 58 cases(Z=-2.000, P=0.046). The average VAS score was 6.6±1.0(range 4-8) before treatment and 0.4±0.7(range 0-2) at final follow-up(Z=-6.682, P＜0.001). For those treated by external fixation, 2 suffered from skin contact ulcer. For those treated by surgery, no intraoperative blood vessel or nerve injury was observed, but two suffered from skin pressure ulcer. Conclusions: Collar immobilization is effective for stable C1 fractures. Both skull-neck-thorax brace and halo-vest immobilization are effective for unstable C1 fractures without transverse ligament injury. Both C1-C2 fusion and C1 fixation are effective for unstable C1 fractures with transverse ligament injury.