Stéphane Fuentes

Purpose Some cases of isolated unstable Jefferson’s fracture of the Atlas verbebra require surgical fixation. Historical constructs with occipitocervical fixation or C1C2 posterior Harms-Goel fixation remain associated with functional impairment owing to limited postoperative cervical range of motion. Since 2004, motion-preserving C1 ring lateral mass screws with transverse rod (C1 LMF) has emerged as a possible technical alternative. Methods Retrospective multicentric study of patients operated on for isolated unstable Jefferson’s fracture of the Atlas vertebra using C1 LMF in two tertiary referral hospitals from South France. Results Since 2022, 9 patients (mean age 52.2 ± 20.5, male/female 7/2) were operated on by 5 different senior spine surgeon for Jefferson type 3 (6 cases) or type 4 (3 cases), with 8 cases of transverse ligament injury. Seven patients were treated in the acute setting (mean 2.9 ± 1.2 days), two patients were treated for chronic pseudarthrosis (mean 157.5 ± 116.7 days). Mean operative time was 108.7 ± 45.3 min with intraoperative blood loss of 233.3 ± 106.1, guided either by fluoroscopy (6 cases) or spinal navigation (3 cases). One patient had both screws misplaced medially without clinical consequence, requiring revision surgery. After a mean follow-up of 15.7 ± 7.8, self-assessed clinical outcome was excellent (VAS 1.3 ± 1.2, NDI 17.6 ± 8.9) with good cervical motion (rotation 57.8 ± 12.5°) and 66.7% of return-to-work. Bone fusion was achieved in 77.8%, with lateral mass distance reduction from 11.1 ± 3.6 mm down to 6.8 ± 3.3 mm. Conclusion This small patient series suggests the long-term efficacy as well as the operative safety of C1 LMF for isolated unstable Jefferson’s fracture.

Study Design: Observational study.Purpose: The actual sanitary crisis led to a massive mobilization of the sanitary system toward intensive care units and management of coronavirus disease 2019 (COVID-19) patients. However, some patients still require spinal interventions. The present study aimed to assess the impact of the COVID-19 pandemic on spine surgical in a moderate COVID-19 cluster region.Overview of Literature: Previous studies have reported screening and management of patients with spinal conditions during the COVID-19 pandemic. However, to date, knowledge, no observational study on spine surgeries during the pandemic has not been reported.Methods: Between March 17, 2020 and April 17, 2020, information on spine surgical activity was prospectively collected at our institution. This surgical activity related to the first month of confinement in France was compared to the activity during the same period in 2019 to evaluate the impact of the COVID-19 pandemic on surgical activities.Results: In order to reduce the contamination rate of patients and medical staff during hospitalization, the spine department was completely reorganized. Non-urgent elective spine surgeries were cancelled. When considering the global amount of surgeries procedures during the first month of confinement, a decrease of almost 50% was observed in the number of surgical procedures. During the study period, 62 patients were eligible for spine surgery. The numbers of patients managed for tumor and infectious cases were stable, while a considerable reduction was observed in the number of trauma and degenerative cases. During the follow-up period, two patients were tested as COVID+ during the postoperative course, and no cases of medical or paramedical staff contamination were reported using polymerase chain reaction-testing.Conclusions: During the COVID-19 pandemic, it is possible to maintain spine surgical activity. Each surgical procedure must be discussed and organized with all the caregivers involved. Indications for surgery must be in line with the scientific guidelines and adapted to each healthcare facility.