ArticleNeurospine2022
Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study.
Article in Neurospine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Perioperative outcomes and technical and patient-reported success of rigid occipitocervical fusions in adults: a systematic review and meta-analysis.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 · 2025Pooled it
- C1-ring osteosynthesis for Jefferson fracture: a multi-institutional retrospective case series.Journal of trauma and injury · 2026Article
- Clinical study of three internal fixation systems via transoral approach for motor function preservation in atlas fractures.Journal of orthopaedic surgery and research · 2026Article
- 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 · 2026Article
- Craniocervical traumatic ligamentous injuries - AO spine type B injuries - Anatomy, biomechanics and clinical perspectives.Journal of clinical orthopaedics and trauma · 2025Article
- More postoperative complications and revision surgery after occipitocervical fusion than after atlantoaxial fusion: a retrospective multicenter cohort study.Asian spine journal · 2025Article
- Article
- Design of a novel lateral mass screw-plate system for the treatment of unstable atlas fractures: a finite element analysis.Journal of orthopaedic surgery and research · 2024Article
- Commentary on "Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study".Neurospine · 2022Article
Corrections and comments
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Authors and funding
9 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures.
methodsWe retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).
resultsThirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman's classification of transverse atlantal ligament injuries.
conclusionSurgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.
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Registered trials
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.