Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2019; 7(7): 898-902
Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.898
Min-invasive surgical treatment for multiple axis fractures: A case report
Xuan-Chen Zhu, Yi-Jie Liu, Xue-Feng Li, Han Yan, Ge Zhang, Wei-Min Jiang, Hou-Yi Sun, Hui-Lin Yang
Xuan-Chen Zhu, Yi-Jie Liu, Xue-Feng Li, Han Yan, Ge Zhang, Wei-Min Jiang, Hou-Yi Sun, Hui-Lin Yang, Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
Author contributions: Zhu XC and Liu YJ joined the surgery and wrote the paper; Li XF, Yan H, Zhang G and Sun HY collect the information and follow up of the patient; Jiang WM and Yang HL revised the paper; Zhu XC and Liu YJ contribute equally to the work.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) was adopted during preparation of this manuscript.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Min Jiang, MD, Chief Doctor, Professor, Department of Orthopedics Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215008, Jiangsu Province, China. jwm610829@vip.sina.com
Telephone: +86-15051586694
Received: December 17, 2018
Peer-review started: December 17, 2018
First decision: January 30, 2019
Revised: February 16, 2019
Accepted: February 18, 2019
Article in press: February 18, 2019
Published online: April 6, 2019
Processing time: 110 Days and 18.4 Hours
Abstract
BACKGROUND

Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.

CASE SUMMARY

We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography (CT) scan revealed an axis injury consisting of an odontoid Type III fracture associated with a Hangman fracture categorized as a Levine-Edwards Type I fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.

CONCLUSION

Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.

Keywords: Axis injury; Odontoid fracture; Hangman fracture; Minimally invasive treatment; Intraoperative O-arm navigation; Percutaneous screw fixation; Case report

Core tip: Multiple axis fracture is one kind of severe upper cervical injuries. Our team tries to find a min-invasive treatment for this kind of patients. We present a case about the surgical outcome of a patient with an odontoid Type III fracture associated with a Hangman fracture categorized as a Levine-Edwards Type I fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous C2 pedicle screw fixation using intraoperative O-arm navigation. The patient recovered quickly and went back to normal life. Follow-up X-ray and computed tomography scan showed satisfactory bone union of C2. The range of cervical motion was well preserved.