Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

Yakubu Ibrahim; Hao Li; Geng Zhao; Suomao Yuan; Yiwei Zhao; Wubo Liu; Yonghao Tian; Lianlei Wang; Xinyu Liu

doi:10.1177/21925682211039186

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

Global Spine J. 2023 Jul;13(6):1522-1532. doi: 10.1177/21925682211039186. Epub 2021 Aug 19.

Authors

Yakubu Ibrahim^{1

2}, Hao Li^{1

2}, Geng Zhao^{1

2}, Suomao Yuan^{1

2}, Yiwei Zhao^{1

2}, Wubo Liu^{1

2}, Yonghao Tian^{1

2}, Lianlei Wang^{1

2}, Xinyu Liu^{1

2}

Affiliations

¹ Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
² Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.

Abstract

Study design: Retrospective.

Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization.

Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients.

Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° (P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 (P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation (P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out (P < 0.001).

Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

Keywords: 3-part fracture; Hangman’s fracture; Jefferson fracture; odontoid fracture; posterior temporary screws fixation; unstable C1-C2 complex fractures; upper cervical spine injuries.