Surgical outcomes of traumatic C2 body fractures: a retrospective analysis

C2 vertebral body fractures are relatively rare fractures with no defined management protocol and outcomes. The aim of the study was to evaluate the clinical and radiological outcomes of C2 body fractures.

The study was conducted at the Department of Neurosurgery, Nizam's Iinstitute of Medical Sciences, Hyderabad, India, following clearance from the Institutional Ethical Committee. The data of all patients with traumatic C2 body fracture who were managed at our Department between January 2008 and January 2019 were retrieved from the database. Functional status of the patients was assessed by Neck Disability Index while pain was assessed by VAS at follow-up after at least 6 months. Fusion and regional kyphotic angles (O-C2 and C2-C7) were assessed for radiological outcome.

There were a total of 16 patients with isolated C2 body fractures in the defined time period. The male (N.=11): female (N.=5) distribution was 2.2:1. Ten patients had road traffic accidents while the remaining 6 had history of fall from height. Only 3 patients presented with neurological deficits. Benzel type 3 fracture pattern distribution was the most common fracture pattern (type 1=1, type 2=5, type 3=9). Of these, 10 were operated and 6 were managed conservatively. The VAS and NDI values improved significantly in all at follow-up when compared to values at presentation (P=0.001). Time to return to work was significantly shorter in those treated with surgical intervention (mean: 2.9±0.87) (P=0.001). Fusion was achieved in all the patients in both groups. Mean O-C2 angle at follow-up was 21.13±10.1. Mean O-C2 angle was significantly decreased in non-surgical group at follow-up (P=0.039) but no significant reduction was observed in surgical group.

The management of C2 body fractures needs to be individualized, reserving surgical management for fractures requiring fragment retrival or restitution of alignment if facets were fractured.