• Jonathan Garst, Elsa Olson, Max Kahn, and Daniel Fassett.
• Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA. Electronic address: jonathangarst@gmail.com.
• World Neurosurg. 2022 Aug 1; 164: e718-e723.

ObjectiveTo describe open reduction internal fixation (ORIF) with posterior C1-C2 instrumentation without fusion to treat displaced atlantoaxial fractures with later instrumentation removal.MethodsA retrospective review identified 14 patients (mean age 44 years) with displaced atlantoaxial fractures treated with ORIF without fusion. Patient demographics, fracture morphology, trauma etiology, instrumentation levels, timing of hardware removal, and complications were collected. Patients were maintained in a cervical collar, and healing was confirmed via imaging before instrumentation removal.ResultsFractures included type III odontoid, C2 pars, C1 ring, and complex C1 or C2 fractures. All cases used C1 lateral mass screws and C2 pars or pedicle screws with a C1 cross-link. Two patients had C3 lateral mass screws. All patients showed fracture healing on imaging within 4 months after ORIF. Instrumentation removal was performed in 13 patients. No complications were noted.ConclusionsDisplaced atlantoaxial fractures have been traditionally managed with halo-vest immobilization closed reduction or ORIF with fusion. ORIF without fusion and subsequent hardware removal is an alternative approach. This strategy preserves mobility at C1-C2, avoids halo-vest immobilization, and appears to be a safe option for treatment of atlantoaxial fractures.Copyright © 2022 Elsevier Inc. All rights reserved.

23 keywords...

hide…