C1-Ring Osteosynthesis as a Safe and Effective Method for C1 Fractures

Author(s): Maria Goldberg, Felix Bader, Maria Wostrack, Bernhard Meyer, Nicole Lange

Background:

C1 fractures are traditionally treated with C1–2 fixation and fusion because they are thought to provide a better level of stability. However, this surgical treatment is associated with a reduced range of motion. C1 ring osteosynthesis is an alternative technique that provides adequate fracture healing while preserving the range of motion. We aimed to describe the clinical and radiological outcomes of patients with C1 fractures treated with C1 osteosynthesis.

Methods:

This retrospective single-center study included all patients with C1 fractures who underwent C1-ring osteosynthesis surgery during 2007– 2023. Lateral mass displacement (LMD), atlantodental interval (ADI), hospital stay, surgical duration, and surgical complications were analyzed.

Results:

Overall, 38 patients were identified. Thirty patients received C1 ring osteosynthesis alone, and eight patients had associated polytrauma and multiple surgeries including other spondylodesis in the cervical spine (17 female, 21 male; age: 57.3 ± 23.7 years). The mean operative duration was 94 ± 17 minutes. The mean hospital stay was 18.2 ± 7.6 days, however, after excluding polytraumatic patients with long intensive care treatment, the mean hospital stay was 9.8 ± 1.4 days. No postoperative neurological deterioration was observed. All patients reported pain relief shortly after surgery. ADI and bi- and unilateral LMD were significantly reduced after surgery.

Conclusion:

Based on this analysis, C1 ring osteosynthesis is a safe and feasible procedure for treating C1 fractures. Radiographic and clinical parameters were significantly improved, while complication rates were comparable to those of other methods.