Efficacy of posterior atlantoaxial fusion for C1 / C2 fractures combined with ponticulus posticus / 中华创伤杂志

ABSTRACT

Objective To observe the efficacy of posterior atlantoaxial fusion for C1/C2 fractures combined with ponticulus posticus.Methods A retrospective case series review was performed on data of 12 cases of C1/C2 fractures combined with ponticulus posticus treated from January 2008 to January 2014.There were 7 males and 5 females,aged 35.5 (23.5-49.25) years.Three cases were diagnosed with C1 lateral mass fractures combined with other injury,seven type Ⅱ odontoid fractures,and two type Ⅲ odontoid fractures.Nine cases whose C1 pedicle height ≥4 mm in both sides underwent posterior C1-C2 screw-rod fixation and fusion,and three cases whose C1 pedicle height was ＜ 4 mm underwent posterior C1-C2 hook-screw fixation and fusion.Operation time,blood loss and complications were recorded.Variations in American Spinal Injury Association (ASIA) grade and Visual Analogue Scale (VAS) were compared before operation and at final follow-up.Position of internal implant,fracture healing and fusion were observed.Results Surgery was successful in all cases.Operation time was 145 (120-160) min,and blood loss was 200 (200-300)ml.No intraoperative injury to the vertebral artery injury,venous plexus,spine and nerve root occurred,and no cases showed ponticulus posticus after operation.Follow-up period was 24 (12-33) months.Postoperative imaging demonstrated satisfactory implant placement in all eases.Before operation,one case was rated as ASIA grade A,two as grade D and nine as grade E.One case was rated as ASIA grade A and 11 as grade E at the final follow-up.VAS was improved from preoperative 7 (6-8) points to 0(0-1) points at the final follow-up (P ＜ 0.05).Fracture healing and fusion were observed in all cases at the final follow-up.Conclusion Posterior atlantoaxial fusion for C1/C2 fractures combined with ponticulus posticus is a safe and effective procedure that can promote fracture union without increasing the risk of vertebral artery injury.