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Surgical management of the fractures of axis body: indications and surgical strategy

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Abstract

Purpose

The axis body fractures are relatively uncommon and have a variety of presentations. Surgical management to them has been only reported as case reports or included as a minor part of clinical management. The objective of this study is to summarize the indications for surgery and report the clinical outcome of surgical treatment based on different fracture patterns.

Methods

A retrospective analysis of 28 consecutive patients presenting with the axis body fractures was undertaken. The indications for surgical treatment were defined as: (1) fractures associated with instability of adjacent joints; (2) irreducible displaced superior articular facet fracture; (3) fractures resulting in spinal cord compression. The fractures were classified as sagittal, coronal, transverse and lateral mass fracture. One of the following surgical procedures was applied according to the fracture pattern: posterior C1–C2 pedicle screws fixation and fusion (I); posterior C1–C3 screws fixation and fusion (II); posterior osteosynthesis with C2 transpedicular half-thread lag screws (III).

Results

13 patients were successfully managed operatively. Two transverse and two unilateral lateral mass fractures were treated with surgical procedure I, five sagittal fractures with II, four coronal fractures with III. Complications of malposition of screws and neurologic deficit did not occur during operation. Satisfactory reduction and bony union were demonstrated on postoperative radiographics.

Conclusions

Conservative treatment is still advocated as primary management for most axis body fractures. But for patients with obvious adjacent joints instability or irreducible displaced superior articular facet fracture, surgical intervention based on the different fracture pattern is necessary.

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References

  1. Starr JK, Eismont FJ (1993) Atypical hangman’s fractures. Spine (Phila Pa 1976) 18:1954–1957

    Article  CAS  Google Scholar 

  2. Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M (1994) Fractures of the C2 vertebral body. J Neurosurg 81:206–212

    Article  CAS  PubMed  Google Scholar 

  3. Fujimura Y, Nishi Y, Kobayashi K (1996) Classification and treatment of axis body fractures. J Orthop Trauma 10:536–540

    Article  CAS  PubMed  Google Scholar 

  4. Hahnle UR, Wisniewski TF, Craig JB (1999) Shear fracture through the body of the axis vertebra. Spine (Phila Pa 1976) 24:2278–2281

    Article  CAS  Google Scholar 

  5. Pryputniewicz DM, Hadley MN (2010) Axis fractures. Neurosurgery 66:68–82

    Article  PubMed  Google Scholar 

  6. Korres DS, Papagelopoulos PJ, Mavrogenis AF, Benetos IS, Kyriazopoulos P, Psycharis I (2005) Chance-type fractures of the axis. Spine (Phila Pa 1976) 30:E517–E520

    Article  Google Scholar 

  7. German JW, Hart BL, Benzel EC (2005) Nonoperative management of vertical C2 body fractures. Neurosurgery 56(516–521):516–521

    Article  PubMed  Google Scholar 

  8. Jakim I, Sweet MB (1988) Transverse fracture through the body of the axis. J Bone Jt Surg Br 70:728–729

    CAS  Google Scholar 

  9. Maki NJ (1985) A transverse fracture through the body of the axis. A case report. Spine (Phila Pa 1976) 10:857–859

    Article  CAS  Google Scholar 

  10. Craig JB, Hodgson BF (1991) Superior facet fractures of the axis vertebra. Spine (Phila Pa 1976) 16:875–877

    Article  CAS  Google Scholar 

  11. Koller H, Acosta F, Forstner R, Zenner J, Resch H, Tauber M, Lederer S, Auffarth A, Hitzl W (2009) C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Eur Spine J 18:1135–1153

    Article  PubMed Central  PubMed  Google Scholar 

  12. Korres DS, Papagelopoulos PJ, Mavrogenis AF, Sapkas GS, Patsinevelos A, Kyriazopoulos P, Evangelopoulos D (2004) Multiple fractures of the axis. Orthopedics 27:1096–1099

    PubMed  Google Scholar 

  13. Rainov NG, Heidecke V, Burkert W (1998) Coronally oriented vertical fracture of the axis body: surgical treatment of a rare condition. Minim Invasive Neurosurg 41:93–96. doi:10.1055/s-2008-1052024

    Article  CAS  PubMed  Google Scholar 

  14. Marotta TR, White L, TerBrugge KG, Spiegel SM, Stevens JK, Tator CM (1990) An unusual type of hangman’s fracture. Neurosurgery 26(848–850):850–851

    Google Scholar 

  15. Lozano-Requena JA, Pina-Medina A, Aracil-Silvestre J, Torro-Belenguer V, Baixauli-Castella F (1994) Sagittal fracture of the second cervical vertebral body. Int Orthop 18:114–115

    Article  CAS  PubMed  Google Scholar 

  16. Bohay D, Gosselin RA, Contreras DM (1992) The vertical axis fracture: a report on three cases. J Orthop Trauma 6:416–419

    Article  CAS  PubMed  Google Scholar 

  17. Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Zhong SZ (2005) Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine (Phila Pa 1976) 30:1519–1523

    Article  Google Scholar 

  18. Resnick DK, Lapsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine (Phila Pa 1976) 27:1494–1498

    Article  Google Scholar 

  19. Resnick DK, Benzel EC (2002) C1–C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50:426–428

    PubMed  Google Scholar 

  20. Chen JF, Wu CT, Lee SC, Lee ST (2005) Posterior atlantoaxial transpedicular screw and plate fixation. Technical note. J Neurosurg Spine 2:386–392. doi:10.3171/spi.2005.2.3.0386

    Article  PubMed  Google Scholar 

  21. Lee MJ, Cassinelli E, Riew KD (2006) The feasibility of inserting atlas lateral mass screws via the posterior arch. Spine (Phila Pa 1976) 31:2798–2801. doi:10.1097/01.brs.0000245902.93084.12

    Article  Google Scholar 

  22. Burke JT, Harris JJ (1989) Acute injuries of the axis vertebra. Skeletal Radiol 18:335–346

    Article  CAS  PubMed  Google Scholar 

  23. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Jt Surg Br 63-B:319–327

    CAS  Google Scholar 

  24. Andrews RJ (1990) Hangman’s fractures involving the body of C2. Neurosurgery 27:845–846

    Article  CAS  PubMed  Google Scholar 

  25. Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Jt Surg Am 67:217–226

    CAS  Google Scholar 

  26. ElMiligui Y, Koptan W, Emran I (2010) Transpedicular screw fixation for type II Hangman’s fracture: a motion preserving procedure. Eur Spine J 19:1299–1305. doi:10.1007/s00586-010-1401-2

    Article  PubMed Central  PubMed  Google Scholar 

  27. Rajasekaran S, Tubaki VR, Shetty AP (2012) Results of direct repair of type 2 hangman fracture using Iso-C3D navigation: 20 cases. J Spinal Disord Tech 25:E134–E139. doi:10.1097/BSD.0b013e31825bcfe9

    Article  CAS  PubMed  Google Scholar 

  28. Hakalo J, Wronski J (2008) Operative treatment of hangman’s fractures of C2. Posterior direct pars screw repair or anterior plate-cage stabilization? Neurol Neurochir Pol 42:28–36

    PubMed  Google Scholar 

  29. Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Jt Surg Am 56:1663–1674

    CAS  Google Scholar 

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Acknowledgments

No funds were received in support of this article. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest

None.

Ethical standards

This study was approved by the Institutional Review Board and the Ethics Committee of our institution.

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Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of AnHui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, 230022, China

    Yin-Shun Zhang, Jian-Xiang Zhang, Qing-Guo Yang, Cai-Liang Shen, Wei Li & Zong-Sheng Yin

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  1. Yin-Shun Zhang
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  2. Jian-Xiang Zhang
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  3. Qing-Guo Yang
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  4. Cai-Liang Shen
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  5. Wei Li
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  6. Zong-Sheng Yin
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Correspondence to Qing-Guo Yang or Zong-Sheng Yin.

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Zhang, YS., Zhang, JX., Yang, QG. et al. Surgical management of the fractures of axis body: indications and surgical strategy. Eur Spine J 23, 1633–1640 (2014). https://doi.org/10.1007/s00586-013-3158-x

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  • DOI: https://doi.org/10.1007/s00586-013-3158-x

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