Artikel
Ventral C1 fracture combined with congenital posterior cleft: what to do?
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Autoren
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Oliver Gembruch
- Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
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Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Department of Neurosurgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland
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Tobias Schoemberg
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
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Michael Payer
- Department of Neurosurgery, Hirslanden Klinik, Zürich, Switzerland; Department of Neurosurgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland
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Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
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Enrico Tessitore
- Department of Neurosurgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland, Geneva, Switzerland
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Neriman Özkan
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
Text
Objective: We present a treatment approach for a rare condition of patients with a ventral C1 fracture and a congenital cleft in the posterior arch (half-ring Jefferson fracture) with an intact transverse atlantal ligament. Our technique aims to achieve stability of the atlanto-occipital and atlanto-axial joints while preserving mobility of the upper cervical spine.
Methods: Two male patients, 43-year-old and 29-year-old, were admitted to our hospital due to a fracture of the ventral arch of the atlas with no damage of the transverse atlantal ligament. Both individuals also presented a congenital cleft of the posterior arch. Initial conservative management with a Halo-Thoracic-Vest was performed in one case and failed. As a result, surgical treatment was carried out in both cases using bilateral C1 mass screws and a transverse connector.
Results: The patients showed no neurological deficits on follow-up examination four weeks after surgery with a full range of head and neck motion. The CT-scan showed no dislocation of the implanted material with a good dorsal alignment and a stable ventral fracture distance. Furthermore, follow up CT-scan showed osseous stability in both cases with beginning bony ossification of the bone graft.
Conclusion: Isolated instable fractures of the ventral arch of the atlas with a congenital cleft of the posterior arch with no damage of the transverse atlantal ligament can be stabilized using bilateral C1 mass screws and a transverse connector preserving upper cervical spine mobility.
