C1 Arch Reconstruction: A Novel Alternative to Fusion in Maintaining Mobility of the Atlanto-Axial Joint

Abstract

First decribed by Sir Goeffrey Jefferson in London in 1924, the term Jefferson’s fracture has become an eponym for all fractures of the Atlas. Complex Jefferson fractures and unstable Jefferson fractures require surgical fusion to maintain stability of the spinal axis. This however results in debilitating loss of movement at the crucial C1C2 joint, the most versatile of spinal joints where stability and mobility are intricately balanced into a complex yet supremely agile structure. The desire to attempt in some way to preserve a degree of movement and to spare the patient the crippling loss of movement at this joint has led to many attempts at innovation, both surgical and technological. This has led to the discovery of C1 osteosynthesis. This revolutionary technique enables the anatomical fixation of the defect thus allowing motion preservation without compromising on stability, which is a major advantage given the extreme importance of both to the proper functioning of the C1C2 and C1C0 joints. We present a case report of a 54 year old man with an isolated Jefferson’s fracture which was treated successfully by this technique. We also present an overview of the biomechanics of C1 injury and the relevant review of literature regarding options for management of complex C1C2 injuries.