title: Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures: a new surgical technique.
abstract: METHODS
  Case report and surgical technique.
  
  
  OBJECTIVE
  To describe a new technique to treat atlas burst fractures by selectively reconstructing the atlas from a posterior approach.
  
  
  BACKGROUND
  The two surgical techniques reported until now for stabilizing atlas burst fractures are associated with some drawbacks. Posterior C0-C2 or C1-C2 fixations significantly reduce head rotation, while the transoral C1 lateral masses osteosynthesis can be associated with oropharyngeal and neurological complications. We propose a new surgical technique for the treatment of unstable Jefferson fractures aimed at avoiding these problems.
  
  
  METHODS
  A 25-year-old man presented with a Jefferson type III atlas fracture after a traffic accident. The fracture failed to consolidate after 3 months of halo brace immobilization. Surgery consisted in inserting bilateral posterior C1 lateral mass screws interconnected by a transversal rod, thereby creating a second C1 posterior arch under the fractured one.
  
  
  RESULTS
  Postoperative course was uneventful. Immediate postoperative stability was confirmed on dynamic X-ray films and head rotation was preserved. Delayed computed tomography scan demonstrated fracture consolidation.
  
  
  CONCLUSIONS
  The surgical technique described is new and effective for treating atlas burst fractures. This posterior procedure allows mobility preservation, with a low morbidity rate.
authors.affiliation: Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Abeloos
authors.forename: Olivier
authors.initials: O
authors.lastname: De Witte
authors.forename: Michel
authors.initials: M
authors.lastname: Walsdorff
authors.forename: Isabelle
authors.initials: I
authors.lastname: Delpierre
authors.forename: Michaël
authors.initials: M
authors.lastname: Bruneau
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery; D001269:Atlanto-Occipital Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery; D001270:Cervical Atlas / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*