Characterizing Non-Operative Management for Stable Atlas Fractures: Insights from the Jefferson and Gehweiler Classification Scheme
Main Article Content
Abstract
Background: Burst fractures of the C1 vertebra (atlas) have been characterized using both the Jefferson and Gehweiler classification schemes. Management of atlas fractures is largely determined by the integrity of the transverse atlantal ligament. Non-operative therapy is often indicated for stable fractures with an intact ligament. However, strict management guidelines have not been established, and more research is required to better characterize the patient population and complication profile.
Aims: The purpose of this study was to characterize and compare patient characteristics, risk factors, and outcomes of non-operatively managed stable atlas fractures according to classification scheme.
Methods: Patients who sustained isolated, stable C1 fractures and were managed non-operatively were included; patients with concomitant C2 or subaxial cervical fractures were excluded. Medical records were reviewed to collect demographics, management, injury mechanism, fracture pattern, past medical history, and outcome data. Jefferson and Gehweiler Classifications were manually assigned. Variables were analyzed using multinomial regression and analysis of variance where appropriate.
Results: After applying inclusion and exclusion criteria, 173 unique patients (91 males, 82 females) were eligible for analysis. Patients with Jefferson type IV fracture were significantly younger, more often polytrauma cases, and sustained higher-energy injuries. Length of stay, polytrauma percentages, rates of high-energy mechanisms, dependent functional status at 6 months, incidence of complications, age at time of fracture, and Age-Adjusted Charlson Comorbidity Index were significantly different between Gehweiler types. Overweight and obese status modulated odds for both Jefferson and Gehweiler fracture patterns. Complications were significantly lower with Gehweiler types I and III, though overall incidence was low. Only 4 deaths were recorded within 90 days.
Conclusion: This work contributes a large study to a limited body of literature describing outcomes of non-operative management for stable atlas fractures and stratifies outcomes in relation to the Jefferson and Gehweiler Classification schemata. These findings strengthen the existing evidence for safety and efficacy of conservative management and serve as a basis for a direct comparison of outcomes between operatively in the and non-operatively managed cohorts future. Further work is needed to clarify the relationship between fracture pattern, type of conservative management, and occurrence of complications.
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