Direct repair of displaced anterior arch fracture of the atlas under microendoscopy: Experience with seven patients

Abstract

Introduction In general, bony injuries heal well with immobilization when the fractured segments are well apposed in the cases of stable atlas fracture. Osseous nonunion of the displaced anterior arch fracture of the atlas has been reported in the literature. However, there have been no reports published on the treatment of nonunion of the atlas fractures. Objective The objective of this study is to describe a new technique for direct repair of the displaced anterior arch fracture of the atlas in a minimally invasive manner. Methods Seven patients with the atlas fracture were treated by a minimally invasive approach. Reduction of anterior arch fractures was not performed by skull traction and the displacement of fractures was more than 5 mm. Direct autograft was performed under microendoscope to improve union of the anterior arch fractures. Radiographic and CT evaluation of the atlas fractures were performed at 3, 6 and 12 months postoperatively. Results Seven cases of the atlas fractures (one old and six new fractures) underwent the surgical procedure smoothly without major complications. Total average displacement of the anterior arch fracture was 5.7 mm (range 5-8 mm) before surgery. Of the seven patients, bony union of the fracture developed in six. At latest follow-up, two patients had neck pain associated with movement and limited range of rotational motion. Conclusion Direct repair under microendoscope is a new technique that improves bony union of displaced anterior arch of the atlas fractures. © 2011 Springer-Verlag.