Classification and surgical management for the axis fracture complicated with adjacent segment instability

This study was to classify the axis fracture complicated with adjacent segment instability and to explore its significance to surgical management. 42 patients (25 males and 17 females) with axis fractures with an average age of 44.14 years (range, 23 to 65) who received surgery between January 2006 and June 2012 were analyzed retrospectively. Results suggest that all patients underwent surgery safely without spinal cord injury, cerebrospinal fluid leakage or vertebral artery injury. The average follow up was 18 months (12-48 months). There was significant difference (t = 2.339, P = 0.011) in JOA score between pre-operation (13.10 ± 4.51) and post-operation time points (15.24 ± 3.86). 1-2 degree improvement of neurofunction was achieved in all except 1 Frankel B. After operation, all patients were immobilized in a hard collar for 3 months. Fusion was achieved in all cases (mean 4.5 months). X-ray showed no malposition of the screws. No instrument failure was noted during follow up. Thus, axis fracture complicated with adjacent segment instability should be treated individually based on the fracture type and adjacent segment instability. Our classification can be used to guide the surgical management.