Minimally invasive direct screw fixation of Jefferson fractures: A case series and technical note

Abstract

Objective

To demonstrate the feasibility of a minimally invasive technique for direct C1 screw fixation and to evaluate short- and long-term clinical and radiological outcomes in a case series.

Materials and methods

This study included a consecutive series of patients with type II or III fractures of the C1 vertebra according to the Landells classification. The surgical technique is described in detail, along with short- and long-term outcomes. Owing to the absence of comparison groups, only descriptive statistical methods were used.

Results

This case series included 8 patients (5 men and 3 women; mean age, 50.8 ± 20.0 years). All patients were neurologically intact at presentation. Most patients had concomitant transverse atlantal ligament injury or associated unstable spinal trauma. The mean operative time was 216.3 ± 100.3 min, and the mean intraoperative blood loss was 125.0 ± 71.5 mL. Seven patients were discharged with clinical improvement, whereas 1 patient died on postoperative day 11 due to severe pneumonia and concomitant injury.

Six patients were available for final assessment. The mean follow-up duration was 39.7 ± 31.2 months. The mean VAS score was 2.2 ± 1.1, and the mean NDI score was 6.8 ± 3.0. Solid fusion was achieved in all patients. No implant-related complications were observed. In five patients, no degenerative changes were detected in the C1-C2 lateral joints, whereas one patient showed grade 2 degenerative changes.

Conclusion

Our initial clinical experience suggests that minimally invasive posterior direct C1 screw fixation is a feasible and safe procedure, providing consistently favourable clinical outcomes in this case series. This technique allowed optimal screw trajectories to be achieved without additional tissue trauma or widening of the surgical exposure. Its application enabled preservation of C1-C2 segmental mobility in all patients included in this series.