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Posterior open reduction and internal fixation of C1 fractures: the C-clamp technique

  • Technical Note - Spine trauma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The treatment of isolated atlas (C1) fractures is still controversial. The surgical management usually involves an arthrodesis of the atlanto-axial (C1-C2) joint with or without occipital fixation. We reviewed the senior author’s series of posterior only open reduction and internal fixation (ORIF) of isolated C1 fractures.

Methods

Retrospective analysis of consecutive patients with isolated C1 fractures, treated in one institution by posterior only ORIF between 2005 and 2017. All fractures of C1 with concomitant C2 or occipital condyle fractures were excluded. The C1 arch was reduced with C1 lateral mass screws, connected with a transverse rod in a C-clamp fashion. We analyzed neck pain on the visual analog scale (VAS) and imaging signs of instability on follow-up.

Results

We identified eight patients, six males, and two females with a mean age of 37.9 years (range 20–71 years). All were neurologically intact before surgery, none had a documented transverse ligament disruption, and the mean gap between the fractured pieces was 5.3 mm. Five patients were treated < 72 h of injury, two patients had failed halo vest for 8–10 weeks, and one patient was operated after 6 months because of painful pseudarthrosis despite wearing a hard collar. One patient developed a transient neurological deficit due to vertebral artery dissection that had resolved completely at time of follow-up. The mean follow-up after surgery was 12.6 months (range 1–49 months) and mean preoperative neck pain (VAS 5.1) was significantly decreased (VAS 0.8; p < 0.001). On follow-up radiological evaluation, no instability was noted in any patient.

Conclusions

Posterior ORIF of C1 fractures may be an option for patients who fail or do not wish to pursue conservative management. The particular advantage of this technique over C1-C2 arthrodesis is the preserved range of rotational motion. Mono-axial screws seem to provide better reduction capacity.

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Abbreviations

AANS:

American Association of Neurological Surgeons

AAOS:

American Academy of Orthopedic Surgeons

ADI:

Atlantodental interval

C:

Cervical segment

CDG:

Clavien-Dindo grading scale

CNS:

Congress of Neurological Surgeons

CT:

Computed tomography

hrQoL:

Health-related quality of life

MCID:

Minimum clinically-important difference

MRI:

Magnetic resonance imaging

N:

Newton

NASS:

North-American Spine Society

ORIF:

Open reduction and internal fixation

ROM:

Range of motion

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Neurosurgery, Stanford Hospital and Clinics, Stanford University, 300 Pasteur Drive, Edwards Bldg., R-201, Stanford, CA, 94305, USA

    Nicholas Gelinas-Phaneuf, Martin Nikolaus Stienen & Jon Park

Authors
  1. Nicholas Gelinas-Phaneuf
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  2. Martin Nikolaus Stienen
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  3. Jon Park
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Correspondence to Jon Park.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

The institutional review board of Stanford Hospital and Clinics approved the study, registered under the file number FWA00000934. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of the Topical Collection on Spine trauma

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Gelinas-Phaneuf, N., Stienen, M.N. & Park, J. Posterior open reduction and internal fixation of C1 fractures: the C-clamp technique. Acta Neurochir 160, 2451–2457 (2018). https://doi.org/10.1007/s00701-018-3710-x

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  • DOI: https://doi.org/10.1007/s00701-018-3710-x

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