PDF herunterladen
CC BY 4.0 · Indian Journal of Neurotrauma 2023; 20(02): 140-147
DOI: 10.1055/s-0042-1759854
Original Article

Technical Considerations in Surgical Fixation of Jefferson Fracture

Hitesh Kumar Gurjar
1   Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
,
Hitesh Inder Singh Rai
1   Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
,
Shashwat Mishra
1   Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
,
Kanwaljeet Garg
1   Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben Source/Disclosure of Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Jefferson fracture is defined as the simultaneous disruption of the continuity of the anterior and posterior arches of the atlas vertebra. It generally results from an axial impact to the head. Most of these fractures are amenable to nonoperative management. Significant disruption of the transverse atlantal ligament that is the main stabilizing ligament of the atlantoaxial articulation and contiguous spinal injuries often form the indications for operative intervention in these fractures. The outward and caudal displacement of the C1 lateral masses observed in these fractures often requires significant deviation from the standard operative technique of atlantoaxial fixation when the osseous elements are intact. Accordingly, we have described the surgical nuances relevant to the exposure and instrumentation of the atlantoaxial region in the setting of Jefferson fracture, through our experience in two cases.

Keywords

atlantoaxial fractures - biomechanics - Jefferson fracture - lateral displacement - rule of spence - transverse atlantal ligament


Publikationsverlauf

Artikel online veröffentlicht:
27. Dezember 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jefferson G. Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. Br J Surg 1919; 7 (27) 407-422
    CrossrefPubMedSuche in Google Scholar
  • 2 Landells CD, Van Peteghem PK. Fractures of the atlas: classification, treatment and morbidity. Spine 1988; 13 (05) 450-452
    CrossrefPubMedSuche in Google Scholar
  • 3 Dickman CA, Greene KA, Sonntag VKH. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 1996; 38 (01) 44-50
    CrossrefPubMedSuche in Google Scholar
  • 4 Lipson SJ. Fractures of the atlas associated with fractures of the odontoid process and transverse ligament ruptures. J Bone Joint Surg Am 1977; 59 (07) 940-943
    CrossrefPubMedSuche in Google Scholar
  • 5 Dickman CA, Hadley MN, Browner C, Sonntag VK. Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases. J Neurosurg 1989; 70 (01) 45-49
    CrossrefPubMedSuche in Google Scholar
  • 6 Guiot B, Fessler RG. Complex atlantoaxial fractures. J Neurosurg 1999; 91 (2, Suppl): 139-143
    PubMedSuche in Google Scholar
  • 7 Kontautas E, Ambrozaitis KV, Kalesinskas RJ, Spakauskas B. Management of acute traumatic atlas fractures. J Spinal Disord Tech 2005; 18 (05) 402-405
    CrossrefPubMedSuche in Google Scholar
  • 8 Fowler JL, Sandhu A, Fraser RD. A review of fractures of the atlas vertebra. J Spinal Disord 1990; 3 (01) 19-24
    CrossrefPubMedSuche in Google Scholar
  • 9 Gebauer M, Goetzen N, Barvencik F. et al. Biomechanical analysis of atlas fractures: a study on 40 human atlas specimens. Spine 2008; 33 (07) 766-770
    CrossrefPubMedSuche in Google Scholar
  • 10 Kalantar SB. Fractures of the C1 and C2 vertebrae. Inj Cerv Spine. 2013; 25 (01) 23-35
    PubMedSuche in Google Scholar
  • 11 Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015; 38 (04) E2
    Suche in Google Scholar
  • 12 Dickman CA, Mamourian A, Sonntag VKH, Drayer BP. Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 1991; 75 (02) 221-227
    CrossrefPubMedSuche in Google Scholar
  • 13 Tubbs RS, Hallock JD, Radcliff V. et al. Ligaments of the craniocervical junction. J Neurosurg Spine 2011; 14 (06) 697-709
    CrossrefPubMedSuche in Google Scholar
  • 14 Puttlitz CM, Melcher RP, Kleinstueck FS, Harms J, Bradford DS, Lotz JC. Stability analysis of craniovertebral junction fixation techniques. J Bone Joint Surg Am 2004; 86 (03) 561-568
    CrossrefPubMedSuche in Google Scholar
  • 15 Spence Jr KF, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am 1970; Apr; 52 (03) 543-549
    CrossrefPubMedSuche in Google Scholar
  • 16 Dvorak J, Schneider E, Saldinger P, Rahn B. Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 1988; 6 (03) 452-461
    CrossrefPubMedSuche in Google Scholar
  • 17 Perez-Orribo L, Snyder LA, Kalb S. et al. Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 1: a clinical study. J Neurosurg Spine 2016; 24 (06) 897-902
    CrossrefPubMedSuche in Google Scholar
  • 18 Liu P, Zhu J, Wang Z. et al. “Rule of Spence” and Dickman's classification of transverse atlantal ligament injury revisited: discrepancy of prediction on atlantoaxial stability based on clinical outcome of nonoperative treatment for atlas fractures. Spine 2019; 44 (05) E306-E314
    CrossrefPubMedSuche in Google Scholar
  • 19 Kopparapu S, Mao G, Judy BF, Theodore N. Fifty years later: the “rule of Spence” is finally ready for retirement. J Neurosurg Spine 2022; x: 1-8
    PubMedSuche in Google Scholar
  • 20 Lin P, Chuang TC, Baker JF. C1:C2 ratio is a potential tool assessing atlas fracture displacement and transverse ligament injury. J Craniovertebr Junction Spine 2019; 10 (03) 139-144
    CrossrefPubMedSuche in Google Scholar
  • 21 Deora H, Behari S, Sardhara J, Singh S, Srivastava AK. Is cervical stabilization for all cases of Chiari-I Malformation an overkill? Evidence speaks louder than words!. Neurospine 2019; 16 (02) 195-206
    CrossrefPubMedSuche in Google Scholar
  • 22 Domenicucci M, Dugoni DE, Mancarella C, D'Elia A, Missori P. Vincenzo Quercioli (1876-1939), researcher and pioneer of the atlas fracture. J Neurosurg Spine 2015; 22 (03) 253-258
    CrossrefPubMedSuche in Google Scholar
  • 23 Gehweiler JA, Osborne RL, Becker RF. The Radiology of Vertebral Trauma. St. Louis, MO: WB Saunders; 1980
    Suche in Google Scholar
  • 24 Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM. Fractures of the atlas vertebra. Skeletal Radiol 1976; 1 (02) 97-102
    CrossrefPubMedSuche in Google Scholar
  • 25 Levine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg Am 1991; 73 (05) 680-691
    CrossrefPubMedSuche in Google Scholar
  • 26 Heller JG, Viroslav S, Hudson T. Jefferson fractures: the role of magnification artifact in assessing transverse ligament integrity. J Spinal Disord 1993; 6 (05) 392-396
    CrossrefPubMedSuche in Google Scholar
  • 27 Woods RO, Inceoglu S, Akpolat YT, Cheng WK, Jabo B, Danisa O. C1 lateral mass displacement and transverse atlantal ligament failure in Jefferson's fracture: a biomechanical study of the “Rule of Spence”. Neurosurgery 2018; 82 (02) 226-231
    CrossrefPubMedSuche in Google Scholar
  • 28 Oda T, Panjabi MM, Crisco III JJI, Oxland TR, Katz L, Nolte LP. Experimental study of atlas injuries. II. Relevance to clinical diagnosis and treatment. Spine 1991; 16 (10, Suppl): S466-S473
    CrossrefPubMedSuche in Google Scholar
  • 29 Koller H, Resch H, Tauber M. et al. A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. Eur Spine J 2010; 19 (08) 1288-1298
    CrossrefPubMedSuche in Google Scholar
  • 30 Kakarla UK, Chang SW, Theodore N, Sonntag VKH. Atlas fractures. Neurosurgery 2010; 66 (3, Suppl): 60-67
    CrossrefPubMedSuche in Google Scholar