Journal of Craniovertebral Junction and Spine

REVIEW ARTICLE
Year
: 2022  |  Volume : 13  |  Issue : 3  |  Page : 233--244

Diagnosis and management of isolated C1 fractures: A systematic review


Kyle Samuel Chan, Nathan A Shlobin, Nader S Dahdaleh 
 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Correspondence Address:
Nader S Dahdaleh
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2210, Chicago, IL 60611
USA

Objective: Atlas fractures are a common craniocervical injury, often resulting from trauma. However, diagnosis and management of atlas fractures continues to be the subject of controversy. We aimed to characterize the factors related to diagnosis of atlas fractures, delineate important considerations in selecting the optimal management for a patient with an atlas fracture, and compare outcomes of surgical and conservative management. Methods: We performed a systematic review using PubMed, Embase, and Scopus to identify articles that analyzed diagnosis and management of isolated atlas fractures published between 2013 and 2020. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. Results: Of 305 resultant articles, 13 were included. C1:C2 ratio and lateral mass displacement (LMD) were used to predict transverse atlantal ligament (TAL) injury. Surgery promoted high fusion rates overall. Stable atlas fractures achieved high fusion rates with conservative management, while spinal fusion promoted greater fusion rates than halo vest immobilization management for unstable fractures. Visual Analog Scale scores, range of motion, and/or LMD improved after surgery. LMD increased for unilateral sagittal split fractures with TAL injury after conservative treatment. Conclusion: Stable atlas fractures can be sufficiently treated conservatively. Unstable atlas fractures can be managed both conservatively and surgically, while surgery is associated with favorable outcomes for unstable isolated atlas fractures. Future studies are necessary to further guide risk stratification and treatment approaches in management of the patients with isolated atlas fractures.


How to cite this article:
Chan KS, Shlobin NA, Dahdaleh NS. Diagnosis and management of isolated C1 fractures: A systematic review.J Craniovert Jun Spine 2022;13:233-244


How to cite this URL:
Chan KS, Shlobin NA, Dahdaleh NS. Diagnosis and management of isolated C1 fractures: A systematic review. J Craniovert Jun Spine [serial online] 2022 [cited 2022 Oct 1 ];13:233-244
Available from: https://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=233;epage=244;aulast=Chan;type=0