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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Ventral C1 fracture combined with congenital posterior cleft: what to do?

Meeting Abstract

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  • Oliver Gembruch - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • 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
  • Tobias Schoemberg - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Michael Payer - Department of Neurosurgery, Hirslanden Klinik, Zürich, Switzerland; Department of Neurosurgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland
  • Ulrich Sure - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Enrico Tessitore - Department of Neurosurgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland, Geneva, Switzerland
  • Neriman Özkan - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 124

doi: 10.3205/17dgnc687, urn:nbn:de:0183-17dgnc6875

Published: June 9, 2017

© 2017 Gembruch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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.