Page Paul S, Lee Seung, Clifton William
Neurological Surgery, Cleveland Clinic Foundation, Cleveland, USA.
Neurological Surgery, Mayo Clinic, Jacksonville, USA.
Cureus. 2024 Dec 10;16(12):e75492. doi: 10.7759/cureus.75492. eCollection 2024 Dec.
Traumatic burst fractures of the atlas occur with axial loading of the cervical spine. Many of these injuries can be treated by nonsurgical management with external orthosis; however, cases with transverse ligament disruption or significant C1 lateral mass displacement require internal reduction and fixation. In patients with poor bone quality in the setting of osteoporosis or chronic illness, atlanto-axial fixation and reduction of the fracture can be a challenge, necessitating extension of fusion to the occiput, which significantly limits the range of motion. A 63-year-old man with a history of HIV, Parkinson's disease, and osteoporosis presented with neck pain after a fall from sitting height. Imaging studies revealed an unstable C1 burst fracture with displacement of the C1 lateral masses. A novel four-point C2 fixation technique was used to reduce the fracture and provide stability to the construct in the setting of poor bone quality. To our knowledge, this is the first manuscript to describe the technique of four-point axis fixation for surgical reduction and fixation of an unstable atlas fracture.
寰椎创伤性爆裂骨折发生于颈椎受到轴向负荷时。这些损伤中的许多可以通过使用外部矫形器进行非手术治疗；然而，伴有横韧带断裂或C1侧块明显移位的病例需要进行内固定复位。在骨质疏松或慢性病导致骨质质量较差的患者中，寰枢椎固定和骨折复位可能具有挑战性，需要将融合范围扩大到枕骨，这会显著限制活动范围。一名63岁男性，有人类免疫缺陷病毒（HIV）感染史、帕金森病和骨质疏松症，从坐姿高度跌倒后出现颈部疼痛。影像学检查显示C1爆裂骨折不稳定，伴有C1侧块移位。采用一种新型的四点C2固定技术来复位骨折，并在骨质质量较差的情况下为结构提供稳定性。据我们所知，这是第一篇描述用于手术复位和固定不稳定寰椎骨折的四点枢椎固定技术的手稿。
