Monoaxial Fixation of Jefferson Fractures: A Systematic Review and Meta-Analysis

Introduction: This study investigates the feasibility and efficacy of monoaxial fixation of C1 as a motion-preserving surgical strategy.

Methods: This is PRISMA-compliant study. PubMed, Web of Science, Science Direct, and Cochrane, were searched using structured search algorithms.. Primary outcome measures included: fusion rates, spine stability, motion preservation, and clinical patient outcomes. The Joanna Briggs Institute and Newcastle Ottawa Scales were used to assess the quality of case reports and observational studies, respectively. A meta-analysis of proportions was performed utilizing RStudio. The random-effects model was employed for the analysis, and proportions underwent a logarithmic transformation. Both data and forest plots illustrate post-operative radiologic instability as a fraction of the total cohort.

Results: A total of 27 studies, published between 2004-2022, met the inclusion criteria (n=185 patients; age range 20-68 years old). The quality of the included studies ranged from moderate to good. Reduction and Ring fixation of C1 using pedicle screws and a rod was the most reported construct (96.7%, n=91). This was achieved via a posterior or transoral approach in the majority of cases (77%, n=123, and 38%, n=71, respectively).

Neck pain was the most common presenting symptom (88.1%, n=160), followed by reduced neck mobility (59.5%; n=110). Neurological deficits were infrequent (2%; n=2), with only one patient experiencing brachial plexus injury (0.5%) and another experiencing hyperreflexia (0.5%).

Post-operatively, only 1.6% of patients (n=3) demonstrated radiological signs of instability necessitating fusion. The average follow-up duration was 19.7 months (range: 6 to 77 months). The range of motion was significantly improved at the last follow-up. Preoperative pain scores decreased from 6.9 ± 1.7 to 1.3 ± 1.2 postoperatively (VAS). Radiologic stability was excellent, with a risk ratio of 0.04 [0.00; 0.10], I2 = 0%, and a p-value of 0.48.

Conclusion : Monoaxial fixation of C1 appears to be a promising surgical strategy for Jefferson fracture stabilization, offering motion preservation and improved clinical outcomes with low rates of instability and complications. Further research is needed to validate these findings and optimize patient selection.