A Jefferson fracture is defined as a fracture of the atlas with combined fractures of the posterior and anterior arches of the atlas (C1 arches) at four points. It is a complete burst fracture of the atlas ring.
Historical background
The eponymous designation Jefferson fracture is based on the description by Jefferson G. in 19201.
Symptoms
Neurological deficits are rare in an isolated Jefferson fracture because of the large diameter of the spinal canal at this level. In addition, the fracture fragments tend to displace outward, away from the spinal cord. Possible and documented clinical symptoms include2:
- Neck pain with guarding against movement
- Prevertebral swelling with compression of the esophagus and associated dysphagia.
- Pain in the distribution of the greater occipital nerve in cases involving the C2 nerve root.
- Associated dissection of the vertebral artery.
- Deficits of the lower cranial nerves (IX–XII) have been described in the literature.
Figure
Classification
- According to the Gehweiler classification of atlas fractures, a Jefferson fracture is classified as a type III Gehweiler fracture.
- According to the Landells classification, Jefferson fractures are classified as type II fractures.
Stability
Jefferson fractures in which the transverse ligament is intact are generally considered stable. In the event of disruption of the transverse ligament, a Jefferson fracture is generally considered unstable3. The atlantodental interval and the Rule of Spence may be used to help determine the integrity of the transverse ligament.
References
Jefferson G. Fractures of the atlas vertebra: report of four cases and a review of those previously reported. Br J Surg 1920;7:407–422 ↩ ↩
Kakarla UK, Chang SW, Theodore N, et al. Atlas fractures. Neurosurgery. 2010;66:60-67. ↩ ↩
Handbook of Neurosurgery. Greenberg M, ed. 9th Edition. New York: Thieme; 2019. ↩ ↩