Abstract
A 70-year-old male sustained a Jefferson burst fracture with unilateral vertebral artery dissection and occlusion by displaced fragments. We performed reduction and posterior C1-ring osteosynthesis. We present a description of the intraoperative manual assessment of atlantoaxial stability. The vertebral artery was found with a good anterograde flow posteroperatively, and MRA showed reperfusion of the vessel. The patient was free of pain with preserved C1–C2 rotation after 6 weeks. Function-preserving posterior C1-ring osteosynthesis after reduction in a displaced Jefferson burst fracture complicated by vertebral artery dissection and occlusion may restore blood flow.
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References
Jefferson G (1920) Fractures of the atlas vertebra. Report of four cases and a review of those previously recorded. Br J Surg 7(27):407–422
Muratsu H, Doita M, Yanagi T et al (2005) Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture. J Spinal Disord Tech 18(3):293–296
Peltier J, Toussaint P, Page C et al (2004) Dissection of the vertebral artery complicating Jefferson fracture. Eur J Orthop Surg Traumatol 14:230–233
Walsh GS, Cusimano MD (1995) Vertebral artery injury associated with a Jefferson fracture. Can J Neurol Sci 22(4):308–311
Bednar DA, Almansoori KA (2016) Solitary C1 posterior fixation for unstable isolated atlas fractures: case report and systematic review of the literature. Global Spine J 6:375–382
Böhm H, Kayser R, El Saghir H, Heyde C-E (2006) Direct osteosynthesis of unstable atlas fractures. Unfallchirurg 109:754–760
Li-jun L, Teng H, Pan J et al (2011) Direct posterior C1 lateral mass screws compression reduction and osteosynthesis in the treatment of unstable Jefferson fractures. Spine (Phila Pa 1976) 36(15):E1046–E1051
Shatsky J, Bellabarba C, Nguyen Q, Bransford RJ (2016) A retrospective review of fixation of C1 ring fractures—does the transverse atlantal ligament (TAL) really matter? Spine J 16(3):372–379
Koller H, Resch H, Tauber M et al (2010) A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. Eur Spine J 19(8):1288–1298
Li-jun L, Ying-chao H, Ming-jie Y et al (2014) Biomechanical analysis of the longitudinal ligament of upper cervical spine in maintaining atlantoaxial stability. Spinal Cord 52:342–347
Vaccaro AR, Klein GR, Flanders AE et al (1998) Long-term evaluation of vertebral artery injuries following cervical spine trauma using magnetic resonance angiography. Spine (Phila Pa 1976) 23(7):789–794 Discussion 795
Tessitore E, Momjian A, Payer M (2008) Posterior reduction and fixation of an unstable Jefferson fracture with C1 lateral mass screws, C2 isthmus screws, and crosslink fixation: technical case report. Neurosurgery 63(1 Suppl 1):ONSE100–ONSE101 discussion ONSE101
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Ottenbacher, A., Bettag, M. Resolution of traumatic vertebral artery dissection and occlusion after repositioning and posterior C1-ring osteosynthesis of a displaced Jefferson burst fracture. Acta Neurochir 159, 1561–1564 (2017). https://doi.org/10.1007/s00701-017-3241-x
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DOI: https://doi.org/10.1007/s00701-017-3241-x