[Fracture of the axis--surgical treatment. II. Axial isthmus]

The authors present their own experience with the surgical treatment of fractures of the isthmus axis. They discuss contemporary classifications and give indications for surgical treatment. They consider direct compressive osteosynthesis, as described by Judet, performed by a posterior approach as excessively risky for the patient because of possible damage of the vertebral artery and structures of the spinal cord. They substituted this operation by indirect stabilization on Decaulx' principles. The advantage of this method, using an anterior approach, is also immediate treatment of the damaged disc. The authors describe their own experience with both techniques and similarly as in surgical stabilization of the dens they consider it the method of choice. In all cases of surgically treated isthmic, dislocated fractures a firm osseous connection was established with practically no functional restrictions of the cervical segment.