Lag screws for reduction of bilateral lateral mass fractures due to spinal trauma.

Introduction: Bilateral fracture of the C1 lateral mass is a relatively uncommon type of traumatic lesion. Treatment of this kind of fractures is usually conservative, with either external immobilization or traction. Research question: Whether surgical management, with placement of lag screws in lateral mass of C1, could represent a first-line treatment. Material and methods: We describe a case of 67-years old man with bilateral fractures of lateral mass of Atlas due to road accident trauma without ligament lesion but severe gap between bone edges. We performed Computed Tomography and Magnetic Resonance scans for pre-operative imaging, X-Ray and CT scan for follow-up. Medtronic navigation system was used as intraoperative guidance for screw placement. Results: Radiological and clinical results were good, with optimal bone reduction and patient's early return to daily activities. Discussion and conclusion: Surgical management remains debateable for isolated C1 lateral mass fractures. Different surgical approaches have been described for atlas fractures, such as transoral anterior C1-ring plate osteosynthesis, posterior osteosynthesis with a lateral mass screw rod, and posterior C1 to C2 fusion and C0 to C2 fusion. Minimally invasive operative treatment with lag screw and reduction of fracture's edges without occiput-C1 or C1-C2 stabilization could be the optimal treatment with good result and decreasing rate of pseudoarthrosis, allowing to avoid Halo-vest discomfort and complications.