Cerebellar infarction after posterior direct reduction and fixation to treat an unstable Jefferson fracture: a case report
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A 42-year-old man had an unstable Jefferson type IV atlas fracture with unilateral vertebral artery occlusion after a diving accident. We performed C1-ring reconstruction with a crosslink rod and C2 fixation to directly reduce the fracture fissure. Within 6 h, cerebellar hemisphere infarction developed. After decompressive craniectomy, duroplasty, and release of the vertebral artery occlusion caused by the transfixing rod, a postoperative computed tomography angiogram showed that blood flow in the right vertebral artery improved. We suggest cautiously inserting screws into the fractured C1 lateral mass and gently tightening the crosslink rod to prevent distal migration of a thrombus.
KeywordsCervical trauma Jefferson fracture Atlas fracture Vertebral artery compression Cerebellar infarction
The authors thank Hyun Kyung Park, Ph.D., for her contributions to drafting the manuscript and revising it for important intellectual content. The authors also extend their gratitude to Soo Hyun Kim, M.D., for her help creating the figures.
SHB and JJS revised the manuscript critically for important intellectual content and approved the final version to be submitted. SHY and KRC conceived the study, participated in its design and coordination, and helped to draft the manuscript. All authors have read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from the patient whose details are presented in this report.
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