Minimally invasive monosegmental C1 screw fixation for Jefferson fractures: A Case Series and Technical Note

Objective . To demonstrate the feasibility of a minimally invasive technique for monosegmental C1 screw fixation (MSF) and to evaluate short- and long-term clinical and radiological outcomes in a case series. Materials and Methods . This study included a consecutive series of patients with type II or III fractures of the C1 vertebra according to the Landells classification. The surgical technique is described in detail, along with short- and long-term outcomes. Owing to the absence of comparison groups, only descriptive statistical methods were used. Results . This case series included 8 patients who underwent MSF (5 men and 3 women; mean age, 50.8 ± 20.0 years). All patients were neurologically intact at presentation. Most patients had concomitant transverse atlantal ligament injury or associated unstable spinal trauma. The mean operative time was 216.3 ± 100.3 minutes, and the mean intraoperative blood loss was 125.0 ± 71.5 mL. Seven patients were discharged with clinical improvement, whereas 1 patient died on postoperative day 11 due to severe pneumonia and concomitant injury. Six patients were available for final assessment. The mean follow-up duration was 39.7 ± 31.2 months. The mean VAS score was 2.2 ± 1.1, and the mean NDI score was 6.8 ± 3.0. Solid fusion was achieved in all patients. No implant-related complications were observed. In five patients, no degenerative changes were detected in the C1–C2 lateral joints, whereas one patient showed grade 2 degenerative changes. Conclusion . Our initial clinical experience suggests that minimally invasive posterior monosegmental C1 screw fixation is a feasible and safe procedure, providing consistently favorable clinical outcomes in this case series. The MIS-MSF technique allowed optimal screw trajectories to be achieved without additional tissue trauma or widening of the surgical exposure. Application of MSF enabled preservation of C1–C2 segmental mobility in all patients included in this series.