Orthopedic & Trauma-Surgery Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Spine (Phila Pa 1976). 2011 Jul 1;36(15):E1046-51. doi: 10.1097/BRS.0b013e3181fef78c.
Technical case report.
To investigate a new concept and surgical technique in the treatment of unstable Jefferson fractures, which preserves the motion of upper cervical spine, avoiding fusion.
The management of unstable Jefferson fractures remains controversial. Conservative treatment usually involves a long time of immobilization in halo vest, whereas surgical intervention generally performs fusion, eliminating the range of motion of upper cervical spine.
Two patients with unstable Jefferson fractures were surgically treated via direct posterior C1 lateral mass screws compression reduction and osteosynthesis technique, aiming at restoring the C0-C2 height and maintaining the vertical ligamentous tension for C0-C1-C2 complex stability despite the incompetent transverse ligament, achieving physiologic repair instead of traditional fusion. The clinical and radiographic results were documented.
The postoperative CT showed that C1 lateral mass screws were well positioned. At 1-year follow-up, plain radiographs, and CT scan revealed no implant failure, good cervical alignment, and bony healing of the fractures; no C1-C2 instability was observed on the flexion-extension radiographs. The patients were completely pain-free, with full range of motion of the cervical spine.
The ideal treatment of unstable Jefferson fractures is expected to preserve the function of C0-C1-C2. Unstable Jefferson fractures involve the concomitant failure of the vertical ligamentous tension because of the loss of C0-C2 height. Reduction of the displaced lateral masses to restore the C0-C2 height and maintain the ligamentous tension is the key to the surgery. Direct posterior C1 lateral mass screws compression reduction and osteosynthesis is a valid technique, avoiding fusion of upper cervical spine.
技术案例报告。
探讨一种治疗不稳定 Jefferson 骨折的新理念和手术技术，该技术保留上颈椎的活动度，避免融合。
不稳定 Jefferson 骨折的治疗仍然存在争议。保守治疗通常需要长时间佩戴 halo 背心固定，而手术干预通常需要进行融合，消除上颈椎的活动度。
通过直接后路 C1 侧块螺钉压缩复位和骨合成技术对 2 例不稳定 Jefferson 骨折患者进行手术治疗，旨在恢复 C0-C2 高度，并在横向韧带功能不全的情况下维持 C0-C1-C2 复合体的稳定性，保持垂直韧带张力，实现生理修复，而不是传统的融合。记录了临床和影像学结果。
术后 CT 显示 C1 侧块螺钉位置良好。在 1 年随访时，X 线平片和 CT 扫描显示无植入物失败、颈椎对线良好、骨折愈合良好；屈伸位 X 线片未见 C1-C2 不稳定。患者完全无痛，颈椎活动度完全正常。
不稳定 Jefferson 骨折的理想治疗方法是保留 C0-C1-C2 的功能。不稳定 Jefferson 骨折涉及 C0-C2 高度丧失导致的垂直韧带张力丧失。复位移位的侧块以恢复 C0-C2 高度并维持韧带张力是手术的关键。直接后路 C1 侧块螺钉压缩复位和骨合成是一种有效的技术，避免了上颈椎的融合。
