Management of combined atlas and axis fractures: a systematic review
ABSTRACT: Background: Combined atlas-axis fractures are rare occurrences with substantially higher rates of neurologic deficits compared with isolated injuries. Given the intricate anatomic relationship between the atlas and axis vertebra, variable fracture patterns may occur, warranting special co...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | North American Spine Society Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548423000264 |
| _version_ | 1827917650804604928 |
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| author | Neil V. Mohile, MD Alexander S. Kuczmarski, MD Arya Minaie, MD Alina Syros, MPH Joseph S. Geller, MD Motasem Al Maaieh, MD |
| author_facet | Neil V. Mohile, MD Alexander S. Kuczmarski, MD Arya Minaie, MD Alina Syros, MPH Joseph S. Geller, MD Motasem Al Maaieh, MD |
| author_sort | Neil V. Mohile, MD |
| collection | DOAJ |
| description | ABSTRACT: Background: Combined atlas-axis fractures are rare occurrences with substantially higher rates of neurologic deficits compared with isolated injuries. Given the intricate anatomic relationship between the atlas and axis vertebra, variable fracture patterns may occur, warranting special considerations from surgeons. Methods: A systematic search of PubMed and EMBASE was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies on acute combined atlas-axis fractures that provided data on patient demographics, presentation (injury mechanism, neurologic deficits, fracture type), management, complications, and study conclusions were reviewed. Results: A total of 22 articles published from 1977 to 2022, comprising 230 patients, were included in the final analysis. Thirty-seven of the 213 patients (17%) presented with neurologic deficits. The most common atlas injuries were posterior arch fractures (54/169 patients; 32%), combined posterior arch/anterior arch fractures (44/169 patients; 26%), and anterior arch fractures (43/169 patients; 25%). The most common axis injuries were type II odontoid fractures (115/175 patients; 66%). Of the 127 patients managed operatively (127/230 patients; 55%), 45 patients (35%) were treated with C1-C2 posterior spinal fusion, 33 patients (26%) were treated with odontoid screw fixation and anterior/posterior C1-C2 trans-articular screws, 16 patients (13%) were treated with occiputocervical fusion and 12 patients (9%) were treated with odontoid screw fixation alone. Conclusions: Management strategies are generally based on the type of axis fracture as well as the condition of the transverse ligament. Patients with stable fractures can be successfully managed nonoperatively with a cervical collar or halo immobilization. Combined atlas-axis fractures with an atlantodental interval >5 mm, C1 lateral mass displacement >7 mm, C2-C3 angulation >11° or an MRI demonstrating a disrupted transverse ligament are suggestive of instability and are often successfully managed with surgical intervention. There is no consensus regarding surgical technique. |
| first_indexed | 2024-03-13T03:31:27Z |
| format | Article |
| id | doaj.art-7f4b9b3a360e410fb7d688ad5ed05480 |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-03-13T03:31:27Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-7f4b9b3a360e410fb7d688ad5ed054802023-06-24T05:19:21ZengElsevierNorth American Spine Society Journal2666-54842023-06-0114100224Management of combined atlas and axis fractures: a systematic reviewNeil V. Mohile, MD0Alexander S. Kuczmarski, MD1Arya Minaie, MD2Alina Syros, MPH3Joseph S. Geller, MD4Motasem Al Maaieh, MD5Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United States; Corresponding author. Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, USA. Tel.: (937) 542-9185.Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United StatesDepartment of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United StatesDepartment of Medical Education, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United StatesDepartment of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United StatesDepartment of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Health System, 1611 NW 12th Ave, Miami, FL 33136, United StatesABSTRACT: Background: Combined atlas-axis fractures are rare occurrences with substantially higher rates of neurologic deficits compared with isolated injuries. Given the intricate anatomic relationship between the atlas and axis vertebra, variable fracture patterns may occur, warranting special considerations from surgeons. Methods: A systematic search of PubMed and EMBASE was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies on acute combined atlas-axis fractures that provided data on patient demographics, presentation (injury mechanism, neurologic deficits, fracture type), management, complications, and study conclusions were reviewed. Results: A total of 22 articles published from 1977 to 2022, comprising 230 patients, were included in the final analysis. Thirty-seven of the 213 patients (17%) presented with neurologic deficits. The most common atlas injuries were posterior arch fractures (54/169 patients; 32%), combined posterior arch/anterior arch fractures (44/169 patients; 26%), and anterior arch fractures (43/169 patients; 25%). The most common axis injuries were type II odontoid fractures (115/175 patients; 66%). Of the 127 patients managed operatively (127/230 patients; 55%), 45 patients (35%) were treated with C1-C2 posterior spinal fusion, 33 patients (26%) were treated with odontoid screw fixation and anterior/posterior C1-C2 trans-articular screws, 16 patients (13%) were treated with occiputocervical fusion and 12 patients (9%) were treated with odontoid screw fixation alone. Conclusions: Management strategies are generally based on the type of axis fracture as well as the condition of the transverse ligament. Patients with stable fractures can be successfully managed nonoperatively with a cervical collar or halo immobilization. Combined atlas-axis fractures with an atlantodental interval >5 mm, C1 lateral mass displacement >7 mm, C2-C3 angulation >11° or an MRI demonstrating a disrupted transverse ligament are suggestive of instability and are often successfully managed with surgical intervention. There is no consensus regarding surgical technique.http://www.sciencedirect.com/science/article/pii/S2666548423000264Spine traumaCervical spineSystematic reviewCombined atlas axis fracturesAtlantoaxial fracturesCervical fractures |
| spellingShingle | Neil V. Mohile, MD Alexander S. Kuczmarski, MD Arya Minaie, MD Alina Syros, MPH Joseph S. Geller, MD Motasem Al Maaieh, MD Management of combined atlas and axis fractures: a systematic review North American Spine Society Journal Spine trauma Cervical spine Systematic review Combined atlas axis fractures Atlantoaxial fractures Cervical fractures |
| title | Management of combined atlas and axis fractures: a systematic review |
| title_full | Management of combined atlas and axis fractures: a systematic review |
| title_fullStr | Management of combined atlas and axis fractures: a systematic review |
| title_full_unstemmed | Management of combined atlas and axis fractures: a systematic review |
| title_short | Management of combined atlas and axis fractures: a systematic review |
| title_sort | management of combined atlas and axis fractures a systematic review |
| topic | Spine trauma Cervical spine Systematic review Combined atlas axis fractures Atlantoaxial fractures Cervical fractures |
| url | http://www.sciencedirect.com/science/article/pii/S2666548423000264 |
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