Posterior atlantoaxial transpedicular screw fixation of unstable atlas fractures combined with rupture of transverse ligament

Objective To determine the outcome of unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation. Methods A retrospective case series study was made on 17 patients with unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation and fusion from January 2008 to December 2015. There were 13 males and 4 females, with age range of 34-69 years (mean, 47.8 years). All atlas fractures were Jefferson fractures (Levine-Edwards type Ⅲ). Classification of transverse ligament rupture was typeⅠin 12 patients and type Ⅱ in 5 patients. No patients had neurologic deficit [American spinal injury association (ASIA) classification grade E]. Operation time, blood loss, implant failure, bone fusion and visual analogue scale (VAS) were recorded after operation. Results Operation time was 85-120 min (mean, 102 min). Blood loss was 90-150 ml (mean, 115 ml). All patients were followed up for 10-20 months (mean, 17.8 months). At the final follow-up, all patients achieved bone union, with no implant loosening or breakage happened. VAS was improved from preoperative (5.5±1.8) points to (2.4±1.5) points at the final follow-up (P<0.05). ASIA Grade E remained in all patients. Conclusion Posterior atlantoaxial transpedicular screw fixation of unstable atlas fractures combined with rupture of transverse ligament is a safe and effective surgical procedure that is able to restore the atlanto-axial vertebral stability and relieve pain. Key words: Spinal fractures; Atlanto-axial joint; Fracture fixation, internal