Anatomical basis for a new method of atlas osteosynthesis in unstable C1 vertebra fractures
Журнал: Вопросы нейрохирургии имени Н.Н. Бурденко. 2026;90(2):37-43.
DOI: 10.17116/neiro20269002137
Read: 1726 раз
Abstract
BACKGROUND
Surgical treatment for unstable atlas fractures is still controversial. Harm’s atlantoaxial fusion or more extensive occipitospondylodesis reduces quality of life and functional status. Biomechanical rationales for anterior and posterior C1 osteosynthesis are based on small sample, and the role of ligamentous complex in C1-C2 segment remains understudied.
OBJECTIVE
To evaluate the effectiveness of a new method of surgical treatment for unstable fractures of the first cervical vertebra.
MATERIAL AND METHODS
Biomechanical analysis enrolled 10 anatomical specimens. Various injuries of the atlas ring and ligament complex were simulated. The role of apical and cruciate ligaments as additional stabilizers of craniovertebral junction was assessed. Morphometric parameters and anatomical relationships were presented using new surgical method for unstable C1 vertebral fractures and Harm’s atlantoaxial fusion as a comparative treatment model.
RESULTS
Instability was observed in all cases of ligamentous complex injury. Rotation angle in atlantoaxial segment remained stable. New surgical method for C1 vertebral injury reduces anterior atlantodental interval to 2.37±0.27 mm, distance between articular surfaces of C1-C2 vertebrae to 3.51±0.46 mm and Redlund-Johnell index to 36.61±1.22 mm without block rotation in atlantoaxial joint.
CONCLUSION
Original surgical method for unstable C1 fractures is effective when patient selection principles are followed. Preoperative planning and assessment of integrity of craniovertebral ligaments are essential to avoid tactical errors when choosing surgical intervention.
Keywords
- unstable Jefferson fracture
- atlas osteosynthesis
- atlantoaxial instability
- transverse ligament of the atlas
Дата поступления: 26.10.2025
Дата принятия в печать: 26.11.2025
Дата публикации: 03.04.2026
- Kim D, Viswanathan VK, Munakomi S, Menger RP. C1 Fractures. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
- Jefferson G. Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. British Journal of Surgery. 1919;7(27):407-422. https://doi.org/10.1002/bjs.1800072713
- Oda T, Panjabi MM, Crisco JJ 3rd, Oxland TR, Katz L, Nolte LP. Experimental study of atlas injuries. II. Relevance to clinical diagnosis and treatment. Spine. 1991;16(10):S466-473. https://doi.org/10.1097/00007632-199110001-00002
- Shin JJ, Kim KR, Shin J, Kang J, Lee HJ, Kim TW, Hong JT, Kim SW, Ha Y. Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study. Neurospine. 2022;19(4):1013-1025. https://doi.org/10.14245/ns.2244352.176
- Domenicucci M, Dugoni DE, Mancarella C, D’Elia A, Missori P. Vincenzo Quercioli (1876—1939), researcher and pioneer of the atlas fracture. Journal of Neurosurgery: Spine. 2015;22(3):253-258. https://doi.org/10.3171/2014.11.SPINE14483
- Koller H, Resch H, Tauber M, Zenner J, Augat P, Penzkofer R, Acosta F, Kolb K, Kathrein A, Hitzl W. A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. European Spine Journal. 2010;19(8):1288-1298. https://doi.org/10.1007/s00586-010-1380-3
- Arena JD, Ghenbot Y, Tomlinson SB, Wathen CA, Schneider ALC, Chen HI, Ali ZS, Schuster JM, Petrov D. Navigated Osteosynthesis for Unstable Atlas Fractures: Technical Note and Case Series. World Neurosurgery. 2025;194:123524. https://doi.org/10.1016/j.wneu.2024.11.107
- Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM. Fractures of the atlas vertebra. Skeletal Radiology. 1976;1:97-102. https://doi.org/10.1007/BF00347414
- Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44-50. https://doi.org/10.1097/00006123-199601000-00012
- Harms J, Melcher RP. Posterior C1—C2 fusion with polyaxial screw and rod fixation. Spine. 2001;26(22):2467-2471. https://doi.org/10.1097/00007632-200111150-00014
- Spence KF Jr, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. The Journal of Bone & Joint Surgery. 1970;52(3):543-549.
- Mohile NV, Kuczmarski AS, Minaie A, Syros A, Geller JS, Maaieh MA. Management of combined atlas and axis fractures: a systematic review. North American Spine Society Journal. 2023;14:100224. https://doi.org/10.1016/j.xnsj.2023.100224
- Denton H, McDonnell JM, Curran J, Wilson K, Temperley H, Cunniffe G, Morris S, Darwish S, Butler JS. Isolated C1 arch fractures: C1-2 fusion vs. C1 osteosynthesis — surgical strategies for potentially unstable injuries. European Spine Journal. 2024;33(10):3904-3914. https://doi.org/10.1007/s00586-024-08460-x
- Dong WX, Chu ZT, Hu Y. Treatment of unstable C1 semi-ring fractures with direct C1 pedicle screw fixation using a navigational template: A case report and literature review. Medicine. 2023;102(20):e33800. https://doi.org/10.1097/MD.0000000000033800
- Yan L, Du J, Yang J, He B, Hao D, Zheng B, Yang X, Hui H, Liu T, Wang X, Guo H, Chen J, Wang S, Ma S, Dong S. C1-ring osteosynthesis versus C1-2 fixation fusion in the treatment of unstable atlas fractures: a multicenter, prospective, randomized controlled study with 5-year follow-up. Journal of Neurosurgery: Spine. 2022;37(2):157-165. https://doi.org/10.3171/2021.12.SPINE211063
- Zou X, Yang H, Deng C, Chen J, Ma R, Ma X, Xia H. Management of Unstable C1 Fractures Involving the Lateral Mass: Posterior C1—C2 Screw-Rod Fixation and Fusion. Medical Science Monitor. 2023;29:e938600. https://doi.org/10.12659/MSM.938600
- Eun J, Oh Y. Traumatic lateral atlantoaxial dislocation combined with a type II odontoid fracture in a patient with ankylosing spondylitis: A case report. Medicine. 2022;101(40):e30912. https://doi.org/10.1097/MD.0000000000030912
- Yang K, Niu HG, Tao H, Liu C, Cao Y, Li W, Zhang JJ, Shen CL, Zhang YS. Posterior osteosynthesis with a new self-designed lateral mass screw-plate system for unstable atlas burst fractures. BMC Musculoskeletal Disorders. 2023;24(1):108. https://doi.org/10.1186/s12891-023-06209-z
- Lisitsky IYu, Rashidov VN, Lychagin AV, Zarov AYu, Korkunov AL, Cherepanov VG, Vyazankin IA, Tselishcheva EYu. Original surgical technique of unstable atlas fracture osteosynthesis: case series analysis. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2025;22(1):53-61. (In Russ.). https://doi.org/10.14531/ss2025.1.53-61
- Ruf M, Melcher R, Harms J. Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures. Spine. 2004;29(7):823-827. https://doi.org/10.1097/01.brs.0000116984.42466.7e
- Niu HG, Zhao CK, Yang K, Tao H, Liu C, Zhang JJ, Shen CL, Zhang YS. Monoaxial Screws Versus Polyaxial Screws Osteosynthesis for Unstable Atlas Fractures: A Retrospective, Comparative Study With a Minimum Follow-Up of 3 years. Global Spine Journal. 2025;15(1):31-40. https://doi.org/10.1177/21925682241247489
- Montemurro N, Carnesecchi S, Morganti R, De Carlo A, Cocciaro A. Surgical Outcomes of Craniocervical Junction Fractures in Elderly Patients: A Retrospective Single-Center Series. Journal of Personalized Medicine. 2025;15(10):485. https://doi.org/10.3390/jpm15100485
- Ishihama Y, Ikeda T, Iemura S, Toriumi K, Goto K. Spontaneous Anterior Arch Fracture of the Atlas Following C1 Laminectomy in a Patient With Osteopetrosis: A Case With Five Years of Follow-Up. Cureus. 2025;17(2):e79471. https://doi.org/10.7759/cureus.79471
- Kawasaki T, Takayama M, Maki Y, Nakajima K, Kobayashi T, Saiki M, Ioroi Y. A case of anterior arch fracture of the atlas associated with C1 laminectomy. Surgical Neurology International. 2023;14:136. https://doi.org/10.25259/SNI_254_2023
- Palmieri G, Cofano F, Marengo N, Ajello M, Zenga F, Garbossa D. Posterior arch reconstruction in cervical surgery to restore the global biomechanics of the Atlas: a technical note. British Journal of Neurosurgery. 2023;37(5):1402-1405. https://doi.org/10.1080/02688697.2021.1881042
- Liawrungrueang W, Laohapoonrungsee A, Bunmaprasert T. Acute traumatic lateral atlantoaxial dislocation associated with locked atlas lateral mass and odontoid process fracture: A clinical case study and literature review. North American Spine Society Journal. 2022;12:100169. https://doi.org/10.1016/j.xnsj.2022.100169
- Shin JJ, Kim KR, Shin J, Kang J, Lee HJ, Kim TW, Hong JT, Kim SW, Ha Y. Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study. Neurospine. 2022;19(4):1013-1025. https://doi.org/10.14245/ns.2244352.176
- Shin JW, Suk KS, Kim HS, Yang JH, Kwon JW, Lee HM, Moon SH, Lee BH, Park SJ, Park SR, Kim SK. Direct Internal Fixation for Unstable Atlas Fractures. Yonsei Medical Journal. 2022;63(3):265-271. https://doi.org/10.3349/ymj.2022.63.3.265
- Cai M, Wu Y, Ma R, Chen J, Chen Z, Deng C, Huang X, Ma X, Zou X. Comparison of Transoral Anterior Jefferson-Fracture Reduction Plate and Posterior Screw-Rod Fixation in C1-Ring Osteosynthesis for Unstable Atlas Fractures. Neurospine. 2024;21(2):544-554. https://doi.org/10.14245/ns.2347230.615
- Lisitskiy IYu, Rashidov VN, Lychagin AV. Method for surgical treatment of isolated unstable fractures of the first cervical vertebra. Russian Federation Patent No. 2835893, Mar 5, 2025. Bulletin No. 7. (In Russ.).
Recommended articles:
Contents.Non Nocere. New Therapeutic Journal. 2026;(10):4-5
Editor's Letter.Non Nocere. New Therapeutic Journal. 2026;(10):1-1
Academician Andrei Dmitrievich Kaprin is 60 years old.P.A. Herzen Journal of Oncology. 2026;15(5):97-97
Diagnostic value of biomarkers in the detection of preclinical cervical neoplasia.P.A. Herzen Journal of Oncology. 2026;15(5):92-96
Fluorescence imaging in pancreatic cancer surgery. (A systematic review).P.A. Herzen Journal of Oncology. 2026;15(5):87-91
Adrenal cysts clinically mimicking cancer (three clinical observations and literature review).P.A. Herzen Journal of Oncology. 2026;15(5):82-86
Well-differentiated liposarcoma of the pancreas: morphological features and surgical management in an elderly female patient.P.A. Herzen Journal of Oncology. 2026;15(5):77-81
Synchronous gastrointestinal stromal tumor and locally advanced gastric adenocarcinoma achieving complete pathomorphological response after neoadjuvant therapy.P.A. Herzen Journal of Oncology. 2026;15(5):73-76
A software calculator for assessing cardiovascular risk in breast cancer radiation therapy: development and validation.P.A. Herzen Journal of Oncology. 2026;15(5):67-72
Minimally invasive simultaneous operations on the lungs and abdominal organs for secondary tumor lesions.P.A. Herzen Journal of Oncology. 2026;15(5):60-66