Neurospine.
2022 Dec;19(4):1013-1025. 10.14245/ns.2244352.176.
Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study
- Affiliations
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- 1Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- 2Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, College of Medicine, Incheon, Korea
- 3Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- 4Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
- 5Department of Neurosurgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 6Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- 7Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea
- 8POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Korea
- KMID: 2537366
- DOI: http://doi.org/10.14245/ns.2244352.176
Abstract
Objective
This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures.
Methods
We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).
Results
Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman’s classification of transverse atlantal ligament injuries.
Conclusion
Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.
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