Management of Isolated Atlas Fractures: A Retrospective Study of 65 Patients

Hyun Su Kim, Michael Brendan Cloney, Tyler Robert Koski, Zachary Adam Smith, Nader S Dahdaleh*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Jefferson fractures, or burst fractures of the C1 vertebra, can be managed surgically or conservatively, depending on their stability. Methods: We identified all patients who were treated for a C1 fracture at our institution between 1999 and 2016 for retrospective analysis. Patients with any other concurrent cervical fractures or nontraumatic etiology of fracture were excluded. Stability was defined as either lateral mass displacement ≥7 mm on computed tomography or presence of transverse atlantal ligament disruption on magnetic resonance imaging. We collected data on patients' demographic, clinical, and radiographic presentation and identified variables independently associated with instability at presentation and failure to achieve fusion at follow-up. Results: We identified 65 patients. On multivariable regression, instability at presentation was independently associated with atlantodens interval (odds ratio [OR] 2.357, 95% confidence interval [CI] [0.0629-1.271], P = 0.099) and type 3 fracture (OR 6.081, 95% CI [1.068-34.612], P = 0.042). Failure to achieve fusion was independently associated with age (OR 1.226, 95% CI [1.007-1.495], P = 0.043), motor vehicle collision as mechanism of injury (OR 22834.3, 95% CI [3.135-1.66e8], P = 0.027), and type 2 fracture (OR 168.537, 95% CI [1.743-16292.92], P = 0.028). Type 3 fracture was positively associated with halo vest for management (OR 17.171, 95% CI [2.882-102.289], P = 0.002) and negatively associated with a rigid cervical collar for management (OR 0.0616, 95% CI [0.0104-0.3653], P = 0.002). All 4 patients who underwent surgery presented with unstable fracture (P = 0.0187). Conclusions: Atlantodens interval, mechanism of injury, and fracture type affect Jefferson fracture management decisions and outcomes, including instability at presentation and fusion at follow-up. Most fractures were managed nonsurgically regardless of stability.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Atlas
  • C1
  • Fracture
  • Jefferson fracture
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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