Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

Jun Jae Shin, Kwang Ryeol Kim, Joongkyum Shin, Jiin Kang, Ho Jin Lee, Tae Woo Kim, Jae Taek Hong, Sang Woo Kim, Yoon Ha

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objective: This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures. Methods: We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental inter-val (AADI). Results: Thirty-two patients underwent surgical fixation and 21 received HVI (mean fol-low-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman’s classification of transverse atlantal ligament injuries. Conclusion: Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inade-quate maintenance and a lower probability of reducing fractured lateral masses. Stabiliza-tion by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.

Original languageEnglish
Pages (from-to)1013-1025
Number of pages13
Issue number4
Publication statusPublished - 2022 Dec

Bibliographical note

Funding Information:
The authors would like to thank Joong-kyum Shin for their contributions in drafting and revising the manuscript for important intellectual content. The authors also wish to thank all the subjects who participated in the study, as well as the support staff and the research coordinator.

Publisher Copyright:
© 2022 by the Korean Spinal Neurosurgery Society.

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology


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