TREATMENT OF BIPEDICULATED C2 FRACTURES: RETROSPECTIVE COMPARISON OF TWO SERIES USING IDENTICAL INDICATIONS AND SURGICAL METHODS: 57 CASES

Abstract

Purpose: The purpose of this work was to determine the role of orthopaedic treatment as a function of initial criteria of instability and potential risk of secondary restabilisation after healing of the common anterior vertebal ligament in patients with bipediculated C2 fractures and to compare the results of surgical treatment using CE pediatric fixation of C1-C3 fractures associated with C1-C3 graft to those with C2-C3 arthrodesis using posterior screw plate fixation with a pedicular screw in C2.

Material and methods: This was a retrospective analysis conducted in patients treated over a ten year period. There were 57 patients treated by two different orthopaedic surgery teams. There were 33 women and 24 mean, mean age 37 years with a maximum follow-up of 12 months. Clinical and radiographic findings were the same before treatment and at last follow-up. The surgical indication was for rupture of the common posterior vertebral ligament as assessed differently by two different surgical teams.

Results: Orthopaedic treatment was given to 65% of the patients (72% and 62% for the two teams). Clinical outcome in these patients was good or excellent in 69% and 79% resepectively for the two teams. Surgical treatment was given in 35% of the cases. Cervical CD fixation produced 100% fair clinical results and 40% very good and good radiographic results with the other 60% being acceptable. For the C2-C3 plate with a pedicular screw in C2, the clinical outcome was good or very good in 53% with 34% fair and poor results and 73% good and very good and 27% poor radiographic results.

Discusssion: This work demonstrated that indications or orthopaedic treatment can be extended, following the work by Roy-Cammille on the instability of these lesions introducting thus the notion of spontaneous anterior restabilisation due to healing of the common anterior vertebral ligament. For the choice of the technique, arthrodesis by cervical CD fixation remains a safe and sure technique despite the logical loss of C2-C3 rotation. Plate screw fixation with a C2 pedicular screw is more attractive but remains technically difficult.