Comparison of occipitocervical and atlantoaxial fusion in treatment of unstable Jefferson fractures

Background: Controversy exists regarding the management of unstable Jefferson fractures, with some surgeons performing reduction and immobilization of the patient in a halo vest and others performing open reduction and internal fixation. This study compares the clinical and radiological outcome parameters between posterior atlantoaxial fusion (AAF) and occipitocervical fusion (OCF) constructs in the treatment of the unstable atlas fracture. Materials and Methods: 68 consecutive patients with unstable Jefferson fractures treated by AAF or OCF between October 2004 and March 2011 were included in this retrospective evaluation from institutional databases. The authors reviewed medical records and original images. The patients were divided into two surgical groups treated with either AAF (n = 48, F/M 30:18) and OCF ( n = 20, F/M 13:7) fusion. Blood loss, operative time, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, atlanto-dens interval, lateral mass displacement, complications, and the bone fusion rates were recorded. Results: Five patients with incomplete paralysis (7.4%) demonstrated postoperative improvement by more than 1 grade on the American Spinal Injury Association impairment scale. The JOA score of the AAF group improved from 12.5 +/- 3.6 preoperatively to 15.7 +/- 2.3 postoperatively, while the JOA score of the OCF group improved from 11.2 +/- 3.3 preoperatively to 14.8 +/- 4.2 postoperatively. The VAS score of AAF group decreased from 4.8 +/- 1.5 preoperatively to 1.0 +/- 0.4 postoperatively, the VAS score of the OCF group decreased from 5.4 +/- 2.2 preoperatively to 1.3 +/- 0.9 postoperatively. Conclusions: The OCF or AAF combined with short-term external immobilization can establish the upper cervical stability and prevent further spinal cord injury and nerve function damage.