Temporary Posterior C1-C2 Instrumentation without Fusion for Treatment of Displaced Atlantoaxial Fractures

To describe open reduction internal fixation (ORIF) with posterior C1-C2 instrumentation without fusion to treat displaced atlantoaxial fractures with later instrumentation removal. A retrospective review identified 14 patients (mean age 44 years) with displaced atlantoaxial fractures treated with ORIF without fusion. Patient demographics, fracture morphology, trauma etiology, instrumentation levels, timing of hardware removal, and complications were collected. Patients were maintained in a cervical collar, and healing was confirmed via imaging before instrumentation removal. Fractures included type III odontoid, C2 pars, C1 ring, and complex C1 or C2 fractures. All cases used C1 lateral mass screws and C2 pars or pedicle screws with a C1 cross-link. Two patients had C3 lateral mass screws. All patients showed fracture healing on imaging within 4 months after ORIF. Instrumentation removal was performed in 13 patients. No complications were noted. Displaced atlantoaxial fractures have been traditionally managed with halo-vest immobilization closed reduction or ORIF with fusion. ORIF without fusion and subsequent hardware removal is an alternative approach. This strategy preserves mobility at C1-C2, avoids halo-vest immobilization, and appears to be a safe option for treatment of atlantoaxial fractures.