C1 isolated posterior arch fracture

Background

• Stable cervical spine fracture
  • Anterior arch and transverse ligament are unaffected
• Also called a Landells Atlas Type I fracture
• Rule out burst fracture

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Clinical Features

• Due to forced neck extension

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Diagnosis

• Vertical fracture line through posterior arch seen on lateral x-ray
• CT test of choice to evaluate for associated fractures
• MRI can evaluate ligamentous injury (transverse ligament is primary AA junction stabilizer)

Management

• Hard collar for 6-12 weeks
  • Neurosurgery may prefer Halo immobilization
• Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization

Disposition

• Usually discharge (if truly isolated) in consultation with neurosurgery

See Also

• Cervical spine injuries
• C-Spine X-Ray
• C1 isolated anterior arch fracture
• Jefferson fracture