Osteosynthesis of C1-C2 fractures
What is it?
Fractures of the C1 (atlas) and C2 (axis) vertebrae in the cervical spine can result from various causes, including trauma, such as motor vehicle accidents or falls. They can lead to severe instability and neurological deficits. Osteosynthesis procedures for C1-C2 fractures aim to restore stability, prevent spinal cord injury, and promote functional recovery.
The choice of technique should be made carefully, considering factors such as spinal stability, neurological status, and the surgical team’s expertise.
Procedure
There are three primary surgical approaches:
- Posterior C1-C2 Fusion (Posterior Fixation) involves posterior fixation and fusion of the C1 and C2 vertebrae using screws, rods, and bone grafts. Posterior fixation is suitable for many C1-C2 fractures, especially those with intact anterior ligamentous structures. It provides excellent stability and can be used for fractures that involve the odontoid process (C2), lateral masses of C1, or fractures of the posterior elements. It is effective in preventing further displacement and provides good long-term outcomes. However, it limits some cervical range of motion.
- Anterior Odontoid Screw Fixation (Anterior Fixation) involves the insertion of screws or pins into the odontoid process (C2) through an anterior approach. It is less invasive than posterior fixation and preserves the cervical range of motion. Anterior fixation provides excellent stabilization of odontoid fractures and allows for early mobilization. However, it may not be suitable for other types of C1-C2 fractures.
- Transarticular Screw Fixation (C1-C2 Screw Fixation) involves the placement of screws through the C1 lateral masses into the C2 vertebral body. This technique creates a rigid construct, stabilizing the C1-C2 joint. This approach is primarily used for C1-C2 instability or fractures involving the C1 lateral masses and C2 vertebral body. It may require specialized instrumentation and expertise.