Direct fixation of C1 jefferson fracture using C1 lateral mass screws: A case report

Abstract

Background: Jefferson fractures are classically described as burst fractures of C1. Traditional surgical treatment of these unstable fractures is either occipito-cervical or posterior C1-C2 fusion, resulting in a significant loss of range of cervical neck movement. This case report discusses the fixation of a Jefferson fracture using C1 lateral mass screws to achieve surgical stabilization while preserving the range of movement. We aim to add to the body of evidence supporting this fixation method. Methods: A 39-year-old male presented to our emergency department with an unstable Jefferson fracture caused by trauma. The various treatment options, such as cervical collar, HALO immobilization, occipito-cervical fusion, and atlanto-axial fusion and direct fixation of C1, were evaluated and discussed with the patient. Informed consent was obtained from the patient prior to writing this case report. Results: At 3 months postoperation, the patient demonstrated near full range of movement in his neck. He had also resumed driving. By 6 months, the patient returned to work, and at 12 months, imaging confirmed union. Conclusions: This case report adds to the body of evidence supporting the technique of C1 lateral mass screws for direct stable fixation of Jefferson fractures. This fixation method preserves the cervical spine range of motion with minimal functional restriction.