Evidence map›Paper›PMID 32050311›Full record

ArticleAsian spine journal2020

Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures.

Shanmuganathan Rajasekaran, Dilip Chand Raja Soundararajan, Ajoy Prasad Shetty, Rishi Mugesh Kanna

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Asian spine journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Implantation choices, fusion preferences and implant removal after fixation in C1-C2 fractures: An AO Spine Knowledge Forum expert survey.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Article
  3. Article
  4. Motion preserving C1 ring lateral mass screw fixation with transverse rod for isolated unstable Jefferson fracture of atlas vertebra: a multicentric study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
    Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Shanmuganathan RajasekaranDepartment of Spine Surgery, Ganga Hospital, Coimbatore, India.
Dilip Chand Raja SoundararajanDepartment of Spine Surgery, Ganga Hospital, Coimbatore, India.
Ajoy Prasad ShettyDepartment of Spine Surgery, Ganga Hospital, Coimbatore, India.
Rishi Mugesh KannaDepartment of Spine Surgery, Ganga Hospital, Coimbatore, India.
Ganga Hospital · IN

Funding

Ganga Orthopaedic Research and Education Foundation GOREF-01-2015
6 · The paper itself

Abstract

STUDY

designProspective observational study. PURPOSE: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation. OVERVIEW OF LITERATURE: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes.

methodsThe patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0-C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years.

resultsA total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (p <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months.

conclusionsSuccessful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.

Indexed as

Atlanto-axial fusionAtlasInjuryInternal fixationMinimally invasive surgical procedures

Identifiers

PMID32050311
PMCPMC7435319
OpenAlexW3006231708

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.