To evaluate the efficacy of pedicle screw fixation combined with bucking bar technique in treatment of C₂ pedicle fractures.

A retrospective case series study was conducted for 26 cases of C₂ pedicle fractures undergone posterior pedicle screw fixation after putting the bucking bar on the anterior surface of C₂ via oral cavity from April 2004 to April 2014. There were 19 males and 7 females, with a mean age of 42 years (range, 27-71 years). Bilateral C₂ pedicle screw placement status, operation time and intraoperative blood loss were recorded. American Spinal Injury Association (ASIA) impairment scale and Visual Analogue Scale (VAS) were used for outcome evaluation. Fracture reduction and symptoms such as sore throat, expectoration, hoarse voice, dysphagia and condition of posterior pharyngeal wall were detected after operation.

Pedicle fixation of C₂ pedicle fractures was completed successfully in 21 cases, repeat C₂ pedicle fixation took place in three, and C_1-3 fixation was conducted for two. Operation time was (83.2±16.6)min and blood loss was (171.2±115.5)ml. One of the cases experiencing repeat manipulation for screw insertion had transient body balance disorder caused by cerebellar ischemia and recovered within 2 days. X-ray and CT showed complete reduction in 17 cases and incomplete reduction in nine cases. Bony fusion was obtained 6 months after operation. Twenty cases were followed up for 3-46 months (mean, 26 months). Final follow-up showed anatomical reduction and bony healing in 19 cases, while malunion in other three cases. ASIA grade improved from C to D in one case, whereas the rest showed a complete neurological recovery (ASIA grade E). VAS improved from preoperative 3-8 points[(5.2±2.5)points] to 0-4 points[(1.6±1.5)points] at the final follow-up (P<0.05). Mild swollen sore throat occurred in four cases after operation. Laryngoscopy showed injury to the posterior pharyngeal wall mucosa (Grade Ⅰ in six cases and Grade Ⅱ in two cases), which were healed within 5-7 days after operation.

For C₂ pedicle fractures, pedicle screw fixation combined with bucking bar technique via oral cavity benefits fracture reduction and stability without apparent impairment to the soft tissue of pharyngeal mucosa.

Cervical vertebrae; Spinal fractures; Joint instability