Journal article
Surgical Management of Unstable Atlas Fractures: A Single Institutional Retrospective Review with Comparison of Occipitocervical and Atlantoaxial Fusion Outcomes
World neurosurgery, Vol.199, 124024
07/2025
DOI: 10.1016/j.wneu.2025.124024
PMID: 40306414
Abstract
Atlas fractures represent 25% of craniocervical injuries, most common in elders. Unstable C1 fractures with lateral mass displacement require surgical fixation. Options include atlantoaxial fusion (AAF) or occiput-cervical fusion (OCF), each have their respective merits and detractors. Here, we compare the clinical and neurological outcomes of patients with unstable atlas fractures treated with AAF and OCF.
Retrospective review of patients with unstable atlas fractures that underwent either AAF or OCF between 2005-2023 was performed. Demographics, clinical characteristics, radiographic parameters, and outcomes were collected. Cervical sagittal balance was measured by O-C2 angle, C2-7 lordosis, and C2-7 sagittal vertical axis (SVA).
44 patients with unstable atlas fractures were included (25 underwent AAF and 19 OCF). Median age was 73 years, 52% were male. Demographics, mechanism of injury, and other clinical characteristics were similar. Landell's Type 2 atlas fractures and lateral mass displacement were significantly in OCF group. Median number of levels was significantly greater in the OCF group (3 versus 2 in AAF, p=<.001). C2-7 lordosis was less in OCF vs. AAF (p=.045). SVA was less in the AAF group vs. OCF (p=.044). Cervical SVA was decreased 4.5 mm in average in the AAF group vs. 5.2 mm increase in OCF (p=0.040). There were no significant differences in the rates of postoperative complication, surgical revision, or neurologic function.
OCF results in significant loss of lordosis and increase in cervical SVA relative to AAF, which may impact long-term quality of life and disability not directly measured in this study.
Details
- Title: Subtitle
- Surgical Management of Unstable Atlas Fractures: A Single Institutional Retrospective Review with Comparison of Occipitocervical and Atlantoaxial Fusion Outcomes
- Creators
- Juan Vivanco-Suarez - Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA. Electronic address: juan-vivancosuarez@uiowa.eduClayton Rosinski - University of IowaMichael Kritikos - University of IowaHashim Syed - University of IowaNahom Teferi - University of IowaSatoshi Yamaguchi - University of IowaGirish Bathla - Mayo ClinicPatrick Hitchon - University of Iowa
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.199, 124024
- DOI
- 10.1016/j.wneu.2025.124024
- PMID
- 40306414
- NLM abbreviation
- World Neurosurg
- ISSN
- 1878-8769
- eISSN
- 1878-8769
- Publisher
- ELSEVIER SCIENCE INC
- Language
- English
- Electronic publication date
- 04/28/2025
- Date published
- 07/2025
- Academic Unit
- Neurosurgery; Otolaryngology
- Record Identifier
- 9984816011902771
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