Starnoni Daniele, Ecker Timo, Barges-Coll Juan
Neurosurgical and Spine division, Centre Hospitaliere Universitaire Vadois, Lausanne, Switzerland.
J Neurol Surg B Skull Base. 2021 Feb;82(Suppl 1):S61-S62. doi: 10.1055/s-0040-1701692. Epub 2020 Mar 20.
C1 fractures with an intact transverse ligament are usually treated conservatively. Patients who present with a progressive diastasis of bone fragments and a progressive articular subluxation mainly attributed to progressive lengthening of the transverse ligament (TAL) fibers can be treated with a C1 "C-clamp" fusion. A 75-year-old male who sustained a motor vehicle accident was neurologically intact. A computed tomography (CT) imaging demonstrated a Jefferson's type-C1 fracture with a slight lateral displacement of the C1 left lateral mass (LM) and a rotatory subluxation on the right. MRI showed an intact TAL and demonstrated an isolated rupture of the left alar ligament. Conservative treatment was chosen. Radiographic follow-up showed, at 3 months, progressive lateral mass displacement, most likely due to elongation of the TAL fibers; this was also associated with a persistent mechanical neck pain. For this reason, we performed a posterior reduction and internal fixation in a C-clamp fashion by placement of C1 lateral mass screws and posterior compression sparing the C1-2 joint. Using navigation, a 3.5-mm screw was inserted into the LM bilaterally. The screw heads were then connected with a rod and compression was applied before tightening. Postoperative CT scan demonstrated a satisfying reduction and further imaging will be made during the follow-up. The patient had a considerable relief of neck pain. Simple lateral mass fixation with C-clamp technique is a reasonable option in case of isolated C1 fractures in patients who have failed conservative management while preserving the range of motion (ROM) at the atlanto-axial joint. The link to the video can be found at: https://youtu.be/x8bsVwzCt_M .
横韧带完整的C1骨折通常采用保守治疗。对于出现骨块进行性分离和主要归因于横韧带（TAL）纤维进行性延长的进行性关节半脱位的患者，可采用C1“C形夹”融合术治疗。一名75岁男性因机动车事故受伤，神经功能完好。计算机断层扫描（CT）成像显示为Jefferson氏C1型骨折，C1左侧块（LM）有轻微侧方移位，右侧有旋转半脱位。磁共振成像（MRI）显示TAL完整，左侧翼状韧带孤立性断裂。选择保守治疗。影像学随访显示，3个月时出现进行性侧块移位，很可能是由于TAL纤维延长所致；这也与持续的机械性颈部疼痛有关。因此，我们通过置入C1侧块螺钉并保留C1-2关节进行后路减压和C形夹内固定。使用导航系统，在双侧LM置入3.5毫米螺钉。然后用一根棒连接螺钉头，并在拧紧前施加压力。术后CT扫描显示复位满意，随访期间将进行进一步影像学检查。患者颈部疼痛明显缓解。对于保守治疗失败的孤立性C1骨折患者，采用C形夹技术进行单纯侧块固定是一种合理的选择，同时可保留寰枢关节的活动范围（ROM）。视频链接可在：https://youtu.be/x8bsVwzCt_M 找到。
