Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent
Introduction: Motion preserving atlas ring osteosynthesis (C1-RO) for unstable Jefferson burst fractures (JBF) with insufficiency of the transverse atlantal ligament (TAL) is under debate. There is controversy about when to apply C1-RO and when further stabilization is needed. Research question:: Is...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | Brain and Spine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529422008098 |
| _version_ | 1828087439990718464 |
|---|---|
| author | Andy Ottenbacher Ahmed R. Rizk Marcus Mehlitz Martin Bettag |
| author_facet | Andy Ottenbacher Ahmed R. Rizk Marcus Mehlitz Martin Bettag |
| author_sort | Andy Ottenbacher |
| collection | DOAJ |
| description | Introduction: Motion preserving atlas ring osteosynthesis (C1-RO) for unstable Jefferson burst fractures (JBF) with insufficiency of the transverse atlantal ligament (TAL) is under debate. There is controversy about when to apply C1-RO and when further stabilization is needed. Research question:: Is intraoperative stability testing after C1-RO with restoration of secondary stabilizers feasible, and what are mid-to long-term results of posterior C1-RO vs. C1–C2 ORIF in unstable Jefferson burst fractures with Dickman type I or II transverse atlantal ligament lesions based on intraoperative decision using this stability testing? Material and methods: Five consecutive patients with unstable JBF were treated with posterior C1-RO or C1–C2 ORIF based on the findings after intraoperative reduction and posterior C1-RO and stability testing. This newly developed intraoperative stability test based on the findings of biomechanical studies is a fluoroscopically controlled manual C1–C2 test with a force of approximately 50 N posterior-anterior stress and a tilting maneuver after C1-RO with repositioning. Clinical and radiological results of the cases with C1-RO were analyzed 3.5–21 months postoperatively. Results: Posterior C1-RO was performed in four patients. One case required C1–C2 fixation due to significant instability. In cases of C1-RO, stable bony fusions of the atlas ring were observed within a year. In flexion-extension views, the anterior atlanto-dental interval (AADI) did not increase until the latest follow-up. No complications were observed. Discussion and conclusion: The described intraoperative stability test after posterior C1-RO in unstable JBF enables the determination if C1-RO is sufficient or C1–C2 ORIF is necessary for treatment. |
| first_indexed | 2024-04-11T05:12:19Z |
| format | Article |
| id | doaj.art-cbabf177415143688a14bf43422b6641 |
| institution | Directory Open Access Journal |
| issn | 2772-5294 |
| language | English |
| last_indexed | 2024-04-11T05:12:19Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj.art-cbabf177415143688a14bf43422b66412022-12-25T04:20:48ZengElsevierBrain and Spine2772-52942022-01-012101668Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extentAndy Ottenbacher0Ahmed R. Rizk1Marcus Mehlitz2Martin Bettag3Corresponding author. Department of Neurosurgery, Spine Center, Krankenhaus der Barmherzigen Brüder, 54292 Trier, Nordallee 1, Rhineland-Palatinate, Germany.; Krankenhaus der Barmherzigen Brüder, Department of Neurosurgery, Trier, GermanyKrankenhaus der Barmherzigen Brüder, Department of Neurosurgery, Trier, GermanyKrankenhaus der Barmherzigen Brüder, Department of Neurosurgery, Trier, GermanyKrankenhaus der Barmherzigen Brüder, Department of Neurosurgery, Trier, GermanyIntroduction: Motion preserving atlas ring osteosynthesis (C1-RO) for unstable Jefferson burst fractures (JBF) with insufficiency of the transverse atlantal ligament (TAL) is under debate. There is controversy about when to apply C1-RO and when further stabilization is needed. Research question:: Is intraoperative stability testing after C1-RO with restoration of secondary stabilizers feasible, and what are mid-to long-term results of posterior C1-RO vs. C1–C2 ORIF in unstable Jefferson burst fractures with Dickman type I or II transverse atlantal ligament lesions based on intraoperative decision using this stability testing? Material and methods: Five consecutive patients with unstable JBF were treated with posterior C1-RO or C1–C2 ORIF based on the findings after intraoperative reduction and posterior C1-RO and stability testing. This newly developed intraoperative stability test based on the findings of biomechanical studies is a fluoroscopically controlled manual C1–C2 test with a force of approximately 50 N posterior-anterior stress and a tilting maneuver after C1-RO with repositioning. Clinical and radiological results of the cases with C1-RO were analyzed 3.5–21 months postoperatively. Results: Posterior C1-RO was performed in four patients. One case required C1–C2 fixation due to significant instability. In cases of C1-RO, stable bony fusions of the atlas ring were observed within a year. In flexion-extension views, the anterior atlanto-dental interval (AADI) did not increase until the latest follow-up. No complications were observed. Discussion and conclusion: The described intraoperative stability test after posterior C1-RO in unstable JBF enables the determination if C1-RO is sufficient or C1–C2 ORIF is necessary for treatment.http://www.sciencedirect.com/science/article/pii/S2772529422008098Motion preservingIntraoperative stability testC1-ring osteosynthesisUnstable jefferson burst fractureC1-RO |
| spellingShingle | Andy Ottenbacher Ahmed R. Rizk Marcus Mehlitz Martin Bettag Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent Brain and Spine Motion preserving Intraoperative stability test C1-ring osteosynthesis Unstable jefferson burst fracture C1-RO |
| title | Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent |
| title_full | Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent |
| title_fullStr | Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent |
| title_full_unstemmed | Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent |
| title_short | Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent |
| title_sort | unstable jefferson burst fractures jbf intraoperative stability testing after posterior atlas ring osteosynthesis c1 ro allows determination of surgical procedure extent |
| topic | Motion preserving Intraoperative stability test C1-ring osteosynthesis Unstable jefferson burst fracture C1-RO |
| url | http://www.sciencedirect.com/science/article/pii/S2772529422008098 |
| work_keys_str_mv | AT andyottenbacher unstablejeffersonburstfracturesjbfintraoperativestabilitytestingafterposterioratlasringosteosynthesisc1roallowsdeterminationofsurgicalprocedureextent AT ahmedrrizk unstablejeffersonburstfracturesjbfintraoperativestabilitytestingafterposterioratlasringosteosynthesisc1roallowsdeterminationofsurgicalprocedureextent AT marcusmehlitz unstablejeffersonburstfracturesjbfintraoperativestabilitytestingafterposterioratlasringosteosynthesisc1roallowsdeterminationofsurgicalprocedureextent AT martinbettag unstablejeffersonburstfracturesjbfintraoperativestabilitytestingafterposterioratlasringosteosynthesisc1roallowsdeterminationofsurgicalprocedureextent |