The Journal of Bone and Joint Surgery, Vol 73, Issue 5 680-691, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Fractures of the atlas
AM Levine and CC Edwards
Section of Spinal Surgery, University of Maryland, Baltimore.
Thirty-four patients who had fractures of the atlas (the first cervical
vertebra) were reviewed at an average follow-up of 4.5 years. Seventeen
patients had bilateral fracture of the posterior arch of the first cervical
vertebra. Eight were treated with immobilization in a cervical orthosis,
with no long-term problems secondary to the injury. Nine of these patients
had additional fractures in the first and second cervical vertebral
complex, complicating the management of the fractures of the posterior
arch. Two of the nine patients died, and the treatment of the other seven
was dependent on the additional fractures. A second group of six patients
had a fracture in the area of the lateral mass, with one fracture just
anterior to or within the anterior portion of the lateral mass of the first
cervical vertebra and a second fracture posterior to the lateral mass of
the first cervical vertebra on the same side; resultant asymmetrical
displacement of the lateral masses was seen on the open-mouth roentgenogram
that was made for each patient. A third group of eleven patients sustained
a Jefferson, or burst, fracture of the first cervical vertebra. These
patients had either four fractures (two in the anterior arch and two in the
posterior arch) or three fractures (one in the anterior arch and two in the
posterior arch). Spreading of the lateral masses was relatively symmetrical
on the open-mouth roentgenogram. Patients who had fractures with
displacement of two to seven millimeters were treated with immobilization
in a halo vest. Patients who had fractures with severe spreading of the
lateral masses (more than seven millimeters) were treated with reduction of
the lateral masses by axial traction until healing of the arch had
occurred. No atlanto-axial instability was evident in any patient at
follow-up.
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