Classification and treatment of axis body fractures

We have classified 31 cases of axis body fracture by the type of bony injury depicted in radiographic images into the following four types: avulsion, transverse, burst, and sagittal fractures. The results of treatment in these types were retrospectively analyzed. In all of nine cases of avulsion fracture and two cases of transverse fracture, bone union was obtained by nonoperative treatment. All three cases of burst fracture healed, one by nonoperative treatment, and the remaining two by C2/3 anterior interbody fusion. Bone union was also obtained in all of the 17 cases of sagittal fracture, which included nonoperative treatment in 15 cases, and transoral atlanto-axial fusion in the remaining two cases. because many axis body fractures are inherently stable injuries, the authors normally select nonoperative treatment as initial therapy. However, in sagittal fractures, eight patients had sequelae of nuchal pain caused by osteoarthrosis of the atlanto-axial joint. As a result of these findings, the authors deem it appropriate to utilize atlanto-axial fusion when severe malalignment of the atlanto-axial joint is recognized.