Morphological Features and Clinical Results of C2 Vertebral Body Fractures

Abstract

Type of study: Retrospective study. Objectives: To classify and analyze the morphological patterns of vertebral body fractures and report the clinical results. Summary of literature review: There have not been many reports on the classification of vertebral body fractures and treatment results, and it remains a matter of debate. Materials and methods: Among 107 patients diagnosed with an axis fracture from 2005 to 2019, 53 patients with fracture involving the vertebral body were selected. After the exclusion of 9 patients with a history of cervical spine surgery or who were lost to follow-up, 44 consecutive patients were enrolled in this retrospective study. Patients were classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the main fracture line. The demographic data, injury mechanism, discoligamentous injury, combined injury, neurological symptoms, and clinical treatment results were analyzed. Results: Patients’ average age was 61.7 years (range, 25–81 years). 24 patients were male and 20 were female. The average follow-up period was 14.2 months (range, 7–33 months). The coronal, sagittal, transverse, avulsion, and complex groups contained 5, 5,8, 7, and 19 patients, respectively. Six patients were injured by slip-down accidents, 12 patients by falling height, and 26 patients by traffic accidents. Eighteen patients were presented with a discoligamentous injury. Twenty-five patients showed a combination of fractures of cervical vertebrae and bones. Thirteen patients presented neurological symptoms. 16 patients were treated with a neck collar and 28 patients were treated with a halo-vest. Two patients eventually required surgical fusion because union was not achieved with conservative management. In the final follow-up, all neurological symptoms were resolved; however, 4 patients still complained of a mild tingling sensation in the upper extremity. Pin site infection occurred in 3 patients who were treated with a halo-vest, but it was controlled after antibiotic administration. Conclusion: Vertebral body fractures accounted for almost 50% of axis fractures in this study. Vertebral body fractures can be classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the morphological pattern. Non-operative management can be a reasonable treatment option with good clinical results and bone union.