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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

 Jun Jae Shin  ;  Kwang-Ryeol Kim  ;  Joongkyum Shin  ;  Jiin Kang  ;  Ho Jin Lee  ;  Tae Woo Kim  ;  Jae Taek Hong  ;  Sang-Woo Kim  ;  Yoon Ha 
 NEUROSPINE, Vol.19(4) : 1013-1025, 2022-12 
Journal Title
Issue Date
Atlas fracture ; Cervical trauma ; Halo-vest ; Jefferson fracture ; Surgery ; Unstable fracture
Objective: This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures.

Methods: We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).

Results: Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman's classification of transverse atlantal ligament injuries.

Conclusion: Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Jiin(강지인)
Shin, Jun Jae(신준재) ORCID logo https://orcid.org/0000-0002-1503-6343
Ha, Yoon(하윤)
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