title: Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise: A case report and literature review.
abstract: BACKGROUND
  Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture.
  
  
  METHODS
  We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up.
  
  
  CONCLUSIONS
  Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis.
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Deting
authors.initials: D
authors.lastname: Xue
authors.forename: Qixin
authors.initials: Q
authors.lastname: Chen
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Wenhai
authors.initials: W
authors.lastname: Zhuo
authors.forename: Fangcai
authors.initials: F
authors.lastname: Li
mesh_terms: D000328:Adult; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries; D001863:Bone Screws; D020210:Central Cord Syndrome / Q000209:etiology / Q000601:surgery; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013168:Spondylolisthesis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome