The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures
have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient
with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension
radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment
confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the
clinical relevance of treatment algorithms that rely on the “rules of Spence” to guide treatment of unstable Jefferson fractures
and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally,
it emphasizes a more reliable way of assessing C1–C2 stability in unstable Jefferson fractures is by measuring the presence
and extent of anterior subluxation on lateral flexion and extension views.
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arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his institution has approved the reporting of this case report, that all investigations were conducted
in conformity with ethical principles of research, and that a waiver of informed consent was obtained.