Direct Posterior C1 Lateral Mass Screws Compression Reduction and Osteosynthesis in the Treatment of Unstable Jefferson Fractures

Study Design. Technical case report. Objective. To investigate a new concept and surgical technique in the treatment of unstable Jefferson fractures, which preserves the motion of upper cervical spine, avoiding fusion. Summary of Background Data. The management of unstable Jefferson fractures remains controversial. Conservative treatment usually involves a long time of immobilization in halo vest, whereas surgical intervention generally performs fusion, eliminating the range of motion of upper cervical spine. Methods. Two patients with unstable Jefferson fractures were surgically treated via direct posterior C1 lateral mass screws compression reduction and osteosynthesis technique, aiming at restoring the C0-C2 height and maintaining the vertical ligamentous tension for C0-C1-C2 complex stability despite the incompetent transverse ligament, achieving physiologic repair instead of traditional fusion. The clinical and radiographic results were documented. Results. The postoperative CT showed that C1 lateral mass screws were well positioned. At 1-year follow-up, plain radiographs, and CT scan revealed no implant failure, good cervical alignment, and bony healing of the fractures; no C1-C2 instability was observed on the flexion-extension radiographs. The patients were completely pain-free, with full range of motion of the cervical spine. Conclusion. The ideal treatment of unstable Jefferson fractures is expected to preserve the function of C0-C1-C2. Unstable Jefferson fractures involve the concomitant failure of the vertical ligamentous tension because of the loss of C0-C2 height. Reduction of the displaced lateral masses to restore the C0-C2 height and maintain the ligamentous tension is the key to the surgery. Direct posterior C1 lateral mass screws compression reduction and osteosynthesis is a valid technique, avoiding fusion of upper cervical spine.