Clinical study of three internal fixation systems via transoral approach for motor function preservation in atlas...

This study aimed to compare the clinical outcomes of three distinct fixation systems- Jefferson Fracture Reduction Plate (JeRP), laminoplasty plates, and mini-reconstruction titanium plates-for treating atlas fractures via the transoral anterior approach.

A total of 76 patients who underwent single-segment transoral anterior fixation between January 2008 and June 2023 were retrospectively analyzed. Patients were stratified into three groups based on the fixation system used. Baseline characteristics, including fracture patterns, transverse ligament integrity, American Spinal Injury Association (ASIA) scores, and preoperative comorbidities, demonstrated no significant intergroup differences (P > 0.05), ensuring comparability. Outcomes evaluated included operative time, intraoperative blood loss, hospitalization duration, Visual Analog Scale (VAS) scores, Neck Disability Index (NDI), lateral mass displacement (LMD), and complications.

All procedures were successfully completed. No wound dehiscence or surgical site infection was observed. At 1-year follow-up, all patients achieved bony union, near-complete pain resolution, and preserved cervical mobility. The JeRP plate group exhibited significantly longer operative duration and higher blood loss compared to the laminoplasty and mini-reconstruction titanium plate groups. Hospitalization durations were comparable across groups. Postoperative LMD, VAS and NDI reductions were significant in all groups (P < 0.05), with no intergroup differences. Complications included screw loosening and accidental screw placement into the occipitoatlantal joint (JeRP group, n = 2) and transient pharyngeal discomfort (mini-reconstruction titanium plate group, n = 1). Four patients with Dickman Type Ⅰ transverse ligament injuries exhibited asymptomatic atlantoaxial instability but required no intervention (JeRP group, n = 2; mini-reconstruction titanium plate group, n = 1; the laminoplasty plate group, n = 1) .

Transoral anterior single-segment fixation effectively stabilizes atlas fractures while preserving occipital-atlas and atlantoaxial mobility. While all three systems achieved comparable clinical outcomes, laminoplasty and mini-reconstruction titanium plates demonstrated superior operative efficiency. Surgeons should prioritize low-profile implants to optimize visualization and simplify placement. Strict patient selection-particularly excluding Dickman Type I ligament injuries-is critical to ensuring long-term stability.