title: Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures.
abstract: METHODS
  Retrospective study with clinical and radiologic evaluation of transoral reduction and osteosynthesis of C1 in the treatment of unstable Jefferson fractures.
  
  
  OBJECTIVE
  Assessment of a new method, which preserves the function of the C1-C2 joint in young patients.
  
  
  BACKGROUND
  Unstable Jefferson fractures with rupture of the transverse ligament and high-grade dislocation of the lateral masses of C1 are usually treated conservatively by immobilization or traction or surgical by posterior fusion C1-C2.
  
  
  METHODS
  Six patients with Jefferson fractures with rupture of the transverse ligament were treated by a transoral approach. Reduction was performed by direct manipulation followed by the osteosynthesis of the anterior ring and the lateral masses of C1.
  
  
  RESULTS
  Total average lateral displacement of the lateral masses was 13.5 mm before surgery (range, 8-19 mm) and improved to 4.3 mm after surgery (range 1-8 mm). The total average difference of the atlantal-dens interval in flexion-extension after surgery was 2.0 mm (range 1-3 mm). The average postoperative rotation in the atlantoaxial joint, evaluated by rotation MRI, was in total 39.2 degrees (range 10 degrees - 61 degrees).
  
  
  CONCLUSIONS
  Transoral reduction and osteosynthesis C1 is a new technique that allows maintenance of rotatory mobility in the C1-C2 joint and restoration of congruency in the atlanto-occipital and atlantoaxial joints. None of the patients had symptoms of postoperative instability of C1-C2.
authors.affiliation: Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. michael.ruf@kkl.srh.de
authors.forename: Michael
authors.initials: M
authors.lastname: Ruf
authors.forename: Robert
authors.initials: R
authors.lastname: Melcher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harms
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome