Original surgical technique of unstable atlas fracture osteosynthesis: case series analysis

Objective. To evaluate the effectiveness of the original technique of surgical treatment of unstable fractures of the atlas.
Material and Methods. The study included 8 patients with isolated unstable Gehweiler type III B atlas fractures (Jefferson fracture) operated on using original surgical technique of osteosynthesis. Two-part fractures were present in five patients, and three-part fractures – in three patients. Dickman’s type I transverse ligament injury was observed in 2 cases, and that of type II – in 6. All patients underwent osteosynthesis through the posterior approach using the developed method for eliminating atlantoaxial instability.
Results. In the postoperative period, a decrease in the VAS pain intensity by 5–7 points (on average 6.6) was noted. Control examination confirmed consolidation of the atlas fractures in all patients. The average value of the anterior atlantodental interval after surgery did not exceed 3.10 ± 0.54 mm. The amplitude of head rotation reached 145.00° ± 8.29°. Complications included surgical site infection in one case and cerebrospinal fluid leakage in another.
Conclusion. The described original surgical technique of reconstructing the transverse ligament function during osteosynthesis makes it possible to eliminate instability, while avoiding the rotation block in the atlantoaxial joint, which improves the functional outcomes of surgical treatment. The presented results indicate the effectiveness of the method and allow considering the proposed new technique of atlas osteosynthesis as a method of choice in the surgical treatment of unstable C1 fractures with Dickman’s type I and II transverse ligament injury. Further studies on sufficient clinical material are necessary for a reliable assessment of the method. 

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