{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:04:38Z","timestamp":1784203478627,"version":"3.55.0"},"reference-count":52,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The treatment of unstable atlas fractures remains a controversial topic. The study aims at assessing the prognosis and efficacy of osteosynthesis for unstable atlas fractures through a review of the current literature and additionally aims to compare outcomes between the transoral and posterior approaches.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A systematic review of databases including PubMed, EMBASE, Cochrane, Web of Science, CNKI, and Wanfang was conducted. Titles and abstracts were screened by two reviewers to identify studies meeting pre-defined inclusion criteria for comprehensive analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The systematic review included 28 articles, 19 employing the posterior approach and 9 utilizing the transoral approach. It covered osteosynthesis in 297 patients with unstable atlas fractures, comprising 169 treated via the posterior approach and 128 via the transoral approach. Analysis revealed high healing rates and clinical improvement in both approaches, evidenced by improvements in the visual analog scale, range of motion, atlantodens interval, and lateral displacement distance post-surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Osteosynthesis offers effective treatment for unstable atlas fractures. Both transoral and posterior approaches can achieve good clinical outcomes for fracture, and biomechanical studies have confirmed that osteosynthesis can maintain the stability of the occipitocervical region, preserve the motor function of the atlantoaxial and occipito-atlantoaxial joints, and greatly improve the quality of life of patients. However, variations exist in the indications and surgical risks associated with each method, necessitating their selection based on a thorough clinical evaluation of the patient's condition.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-024-04571-9","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T05:02:29Z","timestamp":1707368549000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Direct osteosynthesis in the treatment of atlas burst fractures: a systematic review"],"prefix":"10.1186","volume":"19","author":[{"given":"He-Gang","family":"Niu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Jing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Zhu","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin-Shun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"issue":"11","key":"4571_CR1","doi-asserted-by":"publisher","first-page":"2332","DOI":"10.1016\/j.spinee.2015.06.052","volume":"15","author":"C Matthiessen","year":"2015","unstructured":"Matthiessen C, Robinson Y. Epidemiology of atlas fractures\u2013a national registry-based cohort study of 1,537 cases. Spine J. 2015;15(11):2332\u20137.","journal-title":"Spine J"},{"issue":"7","key":"4571_CR2","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1097\/BSD.0000000000000631","volume":"31","author":"RM Smith","year":"2018","unstructured":"Smith RM, Bhandutia AK, Jauregui JJ, Shasti M, Ludwig SC. Atlas fractures: diagnosis, current treatment recommendations, and implications for elderly patients. Clin Spine Surg. 2018;31(7):278\u201384.","journal-title":"Clin Spine Surg"},{"key":"4571_CR3","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/j.wneu.2017.12.053","volume":"111","author":"HS Kim","year":"2018","unstructured":"Kim HS, Cloney MB, Koski TR, Smith ZA, Dahdaleh NS. Management of isolated atlas fractures: a retrospective study of 65 patients. World Neurosurg. 2018;111:e316\u201322.","journal-title":"World Neurosurg"},{"issue":"3","key":"4571_CR4","first-page":"158","volume":"17","author":"X Li","year":"2019","unstructured":"Li X, Ji J, Nong J, Yang Y. Treatment of unstable atlas fracture with reconstruction plate single-segmental internal fixation via oropharyngeal approach. J Spinal Surg. 2019;17(3):158\u201362.","journal-title":"J Spinal Surg"},{"issue":"Suppl 2","key":"4571_CR5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1227\/NEU.0b013e318276ee2a","volume":"72","author":"TC Ryken","year":"2013","unstructured":"Ryken TC, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Management of isolated fractures of the atlas in adults. Neurosurgery. 2013;72(Suppl 2):127\u201331.","journal-title":"Neurosurgery"},{"issue":"4","key":"4571_CR6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.3171\/spi.2005.2.4.0411","volume":"2","author":"MF Dvorak","year":"2005","unstructured":"Dvorak MF, Johnson MG, Boyd M, Johnson G, Kwon BK, Fisher CG. Long-term health-related quality of life outcomes following Jefferson-type burst fractures of the atlas. J Neurosurg Spine. 2005;2(4):411\u20137.","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"4571_CR7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.spinee.2017.06.029","volume":"18","author":"Y Zhang","year":"2018","unstructured":"Zhang Y, Zhang J, Yang Q, Li W, Tao H, Shen C. Posterior osteosynthesis with monoaxial lateral mass screw-rod system for unstable C1 burst fractures. Spine J. 2018;18(1):107\u201314.","journal-title":"Spine J"},{"issue":"9","key":"4571_CR8","first-page":"987","volume":"30","author":"H Yamamoto","year":"2002","unstructured":"Yamamoto H, Kurimoto M, Hayashi N, Ohmori T, Hirashima Y, Endo S. Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment\u2013report of two cases. No Shinkei Geka. 2002;30(9):987\u201391.","journal-title":"No Shinkei Geka"},{"issue":"23","key":"4571_CR9","doi-asserted-by":"publisher","first-page":"2505","DOI":"10.1097\/BRS.0b013e3181b4009a","volume":"34","author":"J Tan","year":"2009","unstructured":"Tan J, Li L, Sun G, Qian L, Yang M, Zeng C, et al. C1 lateral mass-C2 pedicle screws and crosslink compression fixation for unstable atlas fracture. Spine. 2009;34(23):2505\u20139.","journal-title":"Spine"},{"key":"4571_CR10","first-page":"E100","volume":"63","author":"E Tessitore","year":"2008","unstructured":"Tessitore E, Momjian A, Payer M. Posterior reduction and fixation of an unstable Jefferson fracture with C1 lateral mass screws, C2 isthmus screws, and crosslink fixation: technical case report. Neurosurgery. 2008;63:E100\u20131.","journal-title":"Neurosurgery"},{"issue":"1","key":"4571_CR11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/00006123-199601000-00012","volume":"38","author":"CA Dickman","year":"1996","unstructured":"Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44\u201350.","journal-title":"Neurosurgery"},{"issue":"8","key":"4571_CR12","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1007\/s00586-009-0901-4","volume":"18","author":"H Koller","year":"2009","unstructured":"Koller H, Acosta F, Forstner R, Zenner J, Resch H, Tauber M, et al. C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Eur Spine J. 2009;18(8):1135\u201353.","journal-title":"Eur Spine J"},{"issue":"3","key":"4571_CR13","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.spinee.2015.11.041","volume":"16","author":"J Shatsky","year":"2016","unstructured":"Shatsky J, Bellabarba C, Nguyen Q, Bransford RJ. A retrospective review of fixation of C1 ring fractures: Does the transverse atlantal ligament (TAL) really matter? Spine J. 2016;16(3):372\u20139.","journal-title":"Spine J"},{"issue":"12","key":"4571_CR14","doi-asserted-by":"publisher","first-page":"2892","DOI":"10.1016\/j.spinee.2014.04.020","volume":"14","author":"B He","year":"2014","unstructured":"He B, Yan L, Zhao Q, Chang Z, Hao D. Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture. Spine J. 2014;14(12):2892\u20136.","journal-title":"Spine J"},{"issue":"2","key":"4571_CR15","doi-asserted-by":"publisher","first-page":"145","DOI":"10.4103\/0019-5413.128750","volume":"48","author":"Y Hu","year":"2014","unstructured":"Hu Y, Albert TJ, Kepler CK, Ma WH, Yuan ZS, Dong WX. Unstable Jefferson fractures: results of transoral osteosynthesis. Indian J Orthop. 2014;48(2):145\u201351.","journal-title":"Indian J Orthop"},{"issue":"10","key":"4571_CR16","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1007\/s00586-013-2870-x","volume":"22","author":"W Ma","year":"2013","unstructured":"Ma W, Xu N, Hu Y, Li G, Zhao L, Sun S, et al. Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach. Eur Spine J. 2013;22(10):2232\u20139.","journal-title":"Eur Spine J"},{"key":"4571_CR17","first-page":"68","volume":"24","author":"Y Han","year":"2014","unstructured":"Han Y, Yang M, Pan J. Biomechanical analysis of direct posterior C1 screws compression reduction in the selective treatment of unstable atlas fractures. Chin J Spine Spinal Cord. 2014;24:68\u201373.","journal-title":"Chin J Spine Spinal Cord"},{"issue":"7","key":"4571_CR18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7): e1000097.","journal-title":"Plos Med"},{"issue":"6","key":"4571_CR19","doi-asserted-by":"publisher","first-page":"E219","DOI":"10.1097\/BSD.0b013e31829a36c5","volume":"27","author":"Y Hu","year":"2014","unstructured":"Hu Y, Xu RM, Albert TJ, Vaccoro AR, Zhao HY, Ma WH, et al. Function-preserving reduction and fixation of unstable jefferson fractures using a C1 posterior limited construct. J Spinal Disord Tech. 2014;27(6):E219\u201325.","journal-title":"J Spinal Disord Tech"},{"issue":"20","key":"4571_CR20","doi-asserted-by":"publisher","first-page":"E1360","DOI":"10.1097\/BRS.0b013e318206cf63","volume":"36","author":"L Abeloos","year":"2011","unstructured":"Abeloos L, De Witte O, Walsdorff M, Delpierre I, Bruneau M. Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures. Spine. 2011;36(20):E1360\u20133.","journal-title":"Spine"},{"issue":"15","key":"4571_CR21","doi-asserted-by":"publisher","first-page":"E1046","DOI":"10.1097\/BRS.0b013e3181fef78c","volume":"36","author":"L Li","year":"2011","unstructured":"Li L, Teng H, Pan J, Qian L, Zeng C, Sun G, et al. Direct posterior C1 lateral mass screws compression reduction and osteosynthesis in the treatment of unstable Jefferson fractures. Spine. 2011;36(15):E1046\u201351.","journal-title":"Spine"},{"issue":"9","key":"4571_CR22","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1007\/s00402-017-2737-4","volume":"137","author":"R Gumpert","year":"2017","unstructured":"Gumpert R, Poglitsch T, Krassnig R, Pranzl R, Puchwein P. Reduction and ring fixation of instable C1 fractures with monoaxial pedicle screws. Arch Orthop Trauma Surg. 2017;137(9):1253\u20139.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"4571_CR23","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12891-023-06209-z","volume":"24","author":"K Yang","year":"2023","unstructured":"Yang K, Niu HG, Tao H, Liu C, Cao Y, Li W, et al. Posterior osteosynthesis with a new self-designed lateral mass screw-plate system for unstable atlas burst fractures. BMC Musculoskelet Disord. 2023;24(1):108.","journal-title":"BMC Musculoskelet Disord"},{"issue":"7","key":"4571_CR24","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1097\/01.BRS.0000116984.42466.7E","volume":"29","author":"M Ruf","year":"2004","unstructured":"Ruf M, Melcher R, Harms J. Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures. Spine. 2004;29(7):823\u20137.","journal-title":"Spine"},{"issue":"1","key":"4571_CR25","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1186\/s12891-020-03575-w","volume":"21","author":"X Zou","year":"2020","unstructured":"Zou X, Ouyang B, Wang B, Yang H, Ge S, Chen Y, et al. Motion-preserving treatment of unstable atlas fracture: transoral anterior. BMC Musculoskelet Disord. 2020;21(1):538.","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"4571_CR26","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1186\/s12891-021-04628-4","volume":"22","author":"Q Tu","year":"2021","unstructured":"Tu Q, Chen H, Li Z, Chen Y, Xu A, Zhu C, et al. Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures. BMC Musculoskelet Disord. 2021;22(1):745.","journal-title":"BMC Musculoskelet Disord"},{"issue":"11","key":"4571_CR27","doi-asserted-by":"publisher","first-page":"E418","DOI":"10.1097\/BRS.0b013e3181a0ff2f","volume":"34","author":"Y Hu","year":"2009","unstructured":"Hu Y, Ma W, Xu R. Transoral osteosynthesis C1 as a function-preserving option in the treatment of bipartite atlas deformity. Spine. 2009;34(11):E418\u201321.","journal-title":"Spine"},{"issue":"12","key":"4571_CR28","doi-asserted-by":"publisher","first-page":"2451","DOI":"10.1007\/s00701-018-3710-x","volume":"160","author":"N Gelinas-Phaneuf","year":"2018","unstructured":"Gelinas-Phaneuf N, Stienen MN, Park J. Posterior open reduction and internal fixation of C1 fractures: the C-clamp. Acta Neurochir. 2018;160(12):2451\u20137.","journal-title":"Acta Neurochir"},{"issue":"3","key":"4571_CR29","doi-asserted-by":"publisher","first-page":"265","DOI":"10.3349\/ymj.2022.63.3.265","volume":"63","author":"J Shin","year":"2022","unstructured":"Shin J, Suk K, Kim H, Yang J, Kwon J, Lee H, et al. Direct internal fixation for unstable atlas fractures. Yonsei Med J. 2022;63(3):265\u201371.","journal-title":"Yonsei Med J"},{"issue":"5","key":"4571_CR30","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.jocn.2010.08.033","volume":"18","author":"K Jo","year":"2011","unstructured":"Jo K, Park I, Hong JT. Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct. J Clin Neurosci. 2011;18(5):695\u20138.","journal-title":"J Clin Neurosci"},{"issue":"3","key":"4571_CR31","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/BSD.0b013e3181e12419","volume":"24","author":"R Bransford","year":"2011","unstructured":"Bransford R, Chapman JR, Bellabarba C. Primary internal fixation of unilateral C1 lateral mass sagittal split fractures: a series of 3 cases. J Spinal Disord Tech. 2011;24(3):157\u201363.","journal-title":"J Spinal Disord Tech"},{"issue":"8","key":"4571_CR32","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1007\/s00701-017-3241-x","volume":"159","author":"A Ottenbacher","year":"2017","unstructured":"Ottenbacher A, Bettag M. Resolution of traumatic vertebral artery dissection and occlusion after repositioning and posterior C1-ring osteosynthesis of a displaced Jefferson burst fracture. Acta Neurochir. 2017;159(8):1561\u20134.","journal-title":"Acta Neurochir"},{"issue":"4","key":"4571_CR33","doi-asserted-by":"publisher","first-page":"345","DOI":"10.14444\/6047","volume":"13","author":"A Kumar","year":"2019","unstructured":"Kumar A, Onggo J, Fon LH, Oh J. Direct fixation of C1 jefferson fracture using C1 lateral mass screws: a case. Int J Spine Surg. 2019;13(4):345\u20139.","journal-title":"Int J Spine Surg"},{"issue":"6","key":"4571_CR34","first-page":"379","volume":"17","author":"X Li","year":"2019","unstructured":"Li X, Zhao D, Li W, Yang Y. Treatment of atlas fracture with posterior pedicle screw single-segmental internal fixation. J Spinal Surg. 2019;17(6):379\u201382.","journal-title":"J Spinal Surg"},{"issue":"4","key":"4571_CR35","doi-asserted-by":"publisher","first-page":"466","DOI":"10.31616\/asj.2019.0189","volume":"14","author":"S Rajasekaran","year":"2020","unstructured":"Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM. Motion-preserving navigated primary internal fixation of unstable C1 fractures. Asian Spine J. 2020;14(4):466\u201374.","journal-title":"Asian Spine J"},{"issue":"4","key":"4571_CR36","first-page":"302","volume":"31","author":"K Gao","year":"2021","unstructured":"Gao K, Yu Z, Du L, Shao J, Zhang X, Gao Y. Posterior single-segmental osteosynthesis with monoaxial screw system for unstable C1 fractures. Chin J Spine Spinal Cord. 2021;31(4):302\u20138.","journal-title":"Chin J Spine Spinal Cord"},{"key":"4571_CR37","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2022.101668","volume":"2","author":"A Ottenbacher","year":"2022","unstructured":"Ottenbacher A, Rizk AR, Mehlitz M, Bettag M. Unstable jefferson burst fractures (JBF): Intraoperative stability testing after posterior atlas ring osteosynthesis (C1-RO) allows determination of surgical procedure extent. Brain Spine. 2022;2: 101668.","journal-title":"Brain Spine"},{"issue":"4","key":"4571_CR38","first-page":"594","volume":"27","author":"K Bao","year":"2023","unstructured":"Bao K, Song W, Liu C, Liang K, Wang J. Posterior single-segment pedicle screw fixation for unstable atlas fractures. Zhongguo Zuzhi Gongcheng Yanjiu. 2023;27(4):594\u20139.","journal-title":"Zhongguo Zuzhi Gongcheng Yanjiu"},{"issue":"6","key":"4571_CR39","first-page":"405","volume":"4","author":"Z Yin","year":"2012","unstructured":"Yin Z, Xia H, Wu Z, Ma X, Ai F, Zhang K, et al. Transoral reduction and internal fixation in the treatment of unstable Jefferson fractures. Chin Orthop J Clin Basic Res. 2012;4(6):405\u201310.","journal-title":"Chin Orthop J Clin Basic Res"},{"issue":"4","key":"4571_CR40","doi-asserted-by":"publisher","first-page":"364","DOI":"10.4103\/jcvjs.JCVJS_94_17","volume":"8","author":"S Keskil","year":"2017","unstructured":"Keskil S, G\u00f6ksel M, Y\u00fcksel U. Transoral screw and wire fixation for unstable anterior 1\/2 atlas fracture. J Craniovertebral Junction Spine. 2017;8(4):364\u20138.","journal-title":"J Craniovertebral Junction Spine"},{"issue":"27","key":"4571_CR41","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1002\/bjs.1800072713","volume":"7","author":"G Jefferson","year":"1919","unstructured":"Jefferson G. Fracture of the atlas vertebra. Report of four cases, and areview of those previously recorded. Br J Surg. 1919;7(27):407\u201322.","journal-title":"Br J Surg"},{"issue":"5","key":"4571_CR42","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1097\/00007632-198805000-00002","volume":"13","author":"CD Landells","year":"1988","unstructured":"Landells CD, Van Peteghem PK. Fractures of the atlas: classification, treatment and morbidity. Spine. 1988;13(5):450\u20132.","journal-title":"Spine"},{"issue":"2","key":"4571_CR43","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1055\/s-2008-1056538","volume":"132","author":"G Brecht","year":"1980","unstructured":"Brecht G, Schwinger E, Gebhardt M. Early changes in the microangiogram of the rabbit brain after experimental skull and cerebral trauma. Part 1: methods (author\u2019s transl). Rofo. 1980;132(2):124\u201332.","journal-title":"Rofo"},{"issue":"2","key":"4571_CR44","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3171\/jns.1995.83.2.0248","volume":"83","author":"CA Dickman","year":"1995","unstructured":"Dickman CA, Sonntag VK. Surgical management of atlantoaxial nonunions. J Neurosurg. 1995;83(2):248\u201353.","journal-title":"J Neurosurg"},{"issue":"6","key":"4571_CR45","first-page":"1105","volume":"12","author":"C Lee","year":"1991","unstructured":"Lee C, Woodring JH. Unstable jefferson variant atlas fractures: an unrecognized cervical injury. Ajnr Am J Neuroradiol. 1991;12(6):1105\u201310.","journal-title":"Ajnr Am J Neuroradiol"},{"issue":"11","key":"4571_CR46","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1016\/j.spinee.2015.06.067","volume":"15","author":"D Huang","year":"2015","unstructured":"Huang D, Hao D, Liu T, Zheng Y, Qian L. Atlas fracture with an intact transverse atlantal ligament. Spine J. 2015;15(11):e41\u20132.","journal-title":"Spine J"},{"issue":"5","key":"4571_CR47","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1038\/sc.2014.8","volume":"52","author":"L Li-Jun","year":"2014","unstructured":"Li-Jun L, Ying-Chao H, Ming-Jie Y, Jie P, Jun T, Dong-Sheng Z. Biomechanical analysis of the longitudinal ligament of upper cervical spine in maintaining atlantoaxial stability. Spinal cord. 2014;52(5):342\u20137.","journal-title":"Spinal cord"},{"issue":"9","key":"4571_CR48","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1007\/s00113-006-1081-x","volume":"109","author":"H Bohm","year":"2006","unstructured":"Bohm H, Kayser R, El Saghir H, Heyde CE. Direct osteosynthesis of instable Gehweiler Type III atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function. Unfallchirurg. 2006;109(9):754\u201360.","journal-title":"Unfallchirurg"},{"issue":"8","key":"4571_CR49","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1007\/s00586-010-1380-3","volume":"19","author":"H Koller","year":"2010","unstructured":"Koller H, Resch H, Tauber M, Zenner J, Augat P, Penzkofer R, et al. A biomechanical rationale for C1-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. Eur Spine J. 2010;19(8):1288\u201398.","journal-title":"Eur Spine J"},{"issue":"4","key":"4571_CR50","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.jocn.2009.08.015","volume":"17","author":"WN Al-Holou","year":"2010","unstructured":"Al-Holou WN, Park P, Wang AC, Than KD, Marentette LJ. Modified trans-oral approach with an inferiorly based flap. J Clin Neurosci. 2010;17(4):464\u20138.","journal-title":"J Clin Neurosci"},{"issue":"4","key":"4571_CR51","doi-asserted-by":"publisher","first-page":"E15","DOI":"10.3171\/2014.7.FOCUS14301","volume":"37","author":"JA Ponce-Gomez","year":"2014","unstructured":"Ponce-Gomez JA, Ortega-Porcayo LA, Soriano-Baron HE, Sotomayor-Gonzalez A, Arriada-Mendicoa N, Gomez-Amador JL, et al. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus. 2014;37(4):E15.","journal-title":"Neurosurg Focus"},{"issue":"4","key":"4571_CR52","first-page":"393","volume":"113","author":"TT Kingdom","year":"1995","unstructured":"Kingdom TT, Nockels RP, Kaplan MJ. Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg. 1995;113(4):393\u2013400.","journal-title":"Otolaryngol Head Neck Surg"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04571-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-024-04571-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04571-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T06:05:11Z","timestamp":1707372311000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-024-04571-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,8]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4571"],"URL":"https:\/\/doi.org\/10.1186\/s13018-024-04571-9","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,8]]},"assertion":[{"value":"7 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e., consultancies, stock ownership, equity interest, patent\/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"129"}}