![]() Patients with fractures of the adjacent vertebrae of the axis or occipital condyle were excluded. Each patient signed a medical informed consent document preoperatively.įrom Jan 2008 to May 2018, 22 patients with unstable C1 fractures who received JeRP via transoral approach were retrospectively analyzed. This research program was approved by the institutional review committee of People’s Liberation Army (PLA) General Hospital of Southern Theatre Command. It is originally designed and clinically applied to treat unstable atlas fractures to preserve the motion function of the atlantoaxial joint. In this study, we described a novel Jefferson-fracture reduction plate (JeRP) system (Wego Corporation, China) via the transoral approach. To our knowledge, there is no report on specialized apparatus for C1 osteosynthesis using a transoral approach. However, the internal fixation device used in C1-ring osteosynthesis is not specialized for atlas fractures, and it is unlikely to achieve near anatomical reduction for C1 fracture directly and safely, particularly in the case of C1 anterior arch fractures. The study by Ma demonstrated that the anterior technique of C1-ring ORIF with direct manipulation at the lateral masses was safe and effective for the treatment of highly unstable cases. In 2004, Ruf first reported a C1-C2 rotation function-preserving technique of C1 osteosynthesis via transoral approach, which not only enabled an anatomic reconstruction of the anterior arch of C1 but also achieved bony union. However, surgeons preferred the posterior C1-ring osteosynthesis to avoid surgical site infection, even if this technique cannot completely reduce and stabilize C1 anterior arch fractures. ![]() Regarding this problem, the anterior C1-ring osteosynthesis is an appropriate option to safely and effectively perform ORIF via the transoral approach. However, posterior fusion techniques decrease the ROM of the craniocervical junction. To date, posterior atlantoaxial and occipitocervical fusion techniques have been widely used in the treatment of unstable C1 fractures and have achieved satisfactory results. Unstable C1 fractures are characterized by the high-grade transverse spread of lateral mass on an open-mouth radiograph. In general, the types of atlas fracture can be described as stable and unstable based on the integrity of transverse atlantal ligament (TAL) and adjacent vertebrae. That’s why fractures with two or more breaks commonly occur in the C1-ring. The junctions of the lateral mass connected to both the anterior and posterior arches are relatively thinner, making them the weakest points of C1 and more susceptible to fracture. As a transitional structure, it is an indispensable part of the craniovertebral junction, allowing the axial loading to be transferred from the occiput to the axis. The atlas has a unique ring structure with no vertebral body or spinous processes, which provides more flexibility and a greater range of motion (ROM) than other vertebrae of the spine. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II). Transoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. Bone union was achieved in all patients without implant failure or loss of reduction. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. ResultsĪll 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans. The case history and the radiographs before and after surgery were noted. Methodsįrom January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas.
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