Direct C2 Pedicle Screw Fixation for Axis Body Fracture.
BACKGROUND
Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cervical motion. We describe direct surgical C2 pedicle screw fixation as an option for managing acute complex C2 vertebral body fracture.


METHODS
Three patients were treated with direct pedicle screw fixation of acute traumatic complex C2 vertebral body fractures. All fractures were coronally oriented Benzel type 1. None of the patients sustained neurological injury. Stereotactic navigation with intraoperative computed tomography scanning was used for each procedure. Surgery provided immediate internal orthosis and stability, as judged by intraoperative dynamic fluoroscopy. Rigid cervical collar bracing was used for 1 month after surgery when the patients were out of bed. Initial radiographs showed acceptable screw placement and fracture alignment. Dynamic radiographs at 3 months showed structural stability at the fracture site and adjacent levels, and complete bony union was confirmed with late computed tomography scanning (>1 year) in each case. Each patient reported resolution of trauma-related and postsurgical pain at 30-day follow-up. Postoperative Neck Disability Index questionnaires for each patient suggested no significant disability at 1 year.


CONCLUSIONS
Direct pedicle screw fixation of acute complex C2 vertebral body fracture appeared to be safe and effective in our 3 patients. It may provide a more-efficient and less-morbid treatment than halo brace or cervical collar immobilization in some patients.
Intermountain Medical Center, Murray, Utah, USA.
Jennifer A
JA
Reynolds
Intermountain Medical Center, Murray, Utah, USA; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
Joel D
JD
MacDonald
D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001915:Braces; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011474:Prosthesis Design; D020127:Recovery of Function; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome
C2; Cervical pedicle screw; Fixation; Vertebral body fracture