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Review
. 2016 Jun;6(4):375-82.
doi: 10.1055/s-0035-1564806. Epub 2015 Sep 29.

Solitary C1 Posterior Fixation for Unstable Isolated Atlas Fractures: Case Report and Systematic Review of the Literature

Drew A Bednar  1 , Khaled A Almansoori  1
Affiliations
Review

Solitary C1 Posterior Fixation for Unstable Isolated Atlas Fractures: Case Report and Systematic Review of the Literature

Drew A Bednar et al. Global Spine J. 2016 Jun.

Abstract

Study Design A systematic review of the literature. Objectives To review the published results to date of motion-preserving direct reconstruction of C1 ring fractures with combined coronal plane displacement of at least 7 mm (rule of Spence) and so at risk for Dickman type I or II disruption of the transverse atlantal ligament (TAL). Methods A structured literature review prompted by successful management of a typical case. Results To date only 65 such cases are reported and follow-up is almost uniformly short. Although reported clinical success is uniform, the case mix is heterogenous and confirmation/classification of ligamentous injury at baseline is often lacking. Conclusions Direct C1 stabilization shows promise as a "more selective" option in managing displaced atlas fractures with probable TAL disruption but cannot yet be recommended as a practice standard. Prospective clinical studies are indicated and should be structured so as to differentiate between Dickman type I and type II injuries of the TAL.

Keywords: atlas; displacement; fracture; instability; transverse atlantal ligament.

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Conflict of interest statement

Disclosures Drew A. Bednar, none Khaled A. Almansoori, none

Figures

Fig. 1
Fig. 1
Anteroposterior radiograph at 3 weeks postinjury showing widening of C1.
Fig. 2
Fig. 2
Coronal plane computed tomography scan demonstrating the displaced injury at C1.
Fig. 3
Fig. 3
(A) Axial computed tomography (CT) at 6 months showing arch approximation and early healing. (B) Corresponding coronal CT image at 6 months.
Fig. 4
Fig. 4
(A) Late radiograph, extension. (B) Late radiograph, flexion.
Fig. 5
Fig. 5
Search methodology.
See this image and copyright information in PMC

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