A Comparative Study of Fixation Techniques for Type II Fractures of the Odontoid Process

Graziano, Gregory P.; Jaggers, C.; Lee, M.; Lynch, Wesley C.

doi:10.1097/00007632-199312000-00003

Cited by 74 publications

(34 citation statements)

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“…41 Clinically, similar fusion rates have been described when a single screw has been used for Type II odontoid fractures. 16,24,31,38,42,61,63 However, Platzer et al 55 achieved high success rates using 2 screws, and we noted a significantly higher success rate (p ≤ 0.05) in our patients undergoing instrumentation with 2 screws (96 vs 56%). The validity of this conclusion can be questioned, because the patients were not randomized, and those receiving 2 screws may have had a broader dens over which to fuse.…”

Section: Discussionmentioning

confidence: 47%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

111

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Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

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Section: Discussionmentioning

confidence: 47%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

111

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“…Of 31 patients, 15 underwent HVI for odontoid fracture healing (10 type II fractures, 5 type III fractures). Sixteen patients underwent surgical treatment including anterior screw fixation (6 cases), posterior C1-2 screw fixation (8), and transarticular screw fixation (2) for odontoid fractures (11 type II fractures, 5 type III fractures) ( Table 3). The study groups did not differ significantly in patients' characteristics, including gender and initial fracture degree.…”

Section: Resultsmentioning

confidence: 99%

“…Posterior fixation of C1-2 achieves higher fusion rates compared to conservative treatment, but is a challenging surgical technique and results in limitations in the cervical range of motion after surgery 5,17,18,22) . Anterior fixation techniques such as direct anterior odontoid screw fixation preserve rotatory motion of the cervical spine, with immediate stabilization of the spine 8,12,24,25) . In this study, we retrospectively analyzed preoperative and postoperative clinical and radiographic findings of patients with odontoid fractures who were treated with either nonsurgical management (HVI) or surgical fixation using the anterior or posterior approach.…”

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confidence: 99%

Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures

Kim

Shin

Kim

et al. 2011

J Korean Neurosurg Soc

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or HVI may provide adequate support in type II fracture or type III stable fractures. Posterior fixation of C1-2 achieves higher fusion rates compared to conservative treatment, but is a challenging surgical technique and results in limitations in the cervical range of motion after surgery 5,17,18,22) . Anterior fixation techniques such as direct anterior odontoid screw fixation preserve rotatory motion of the cervical spine, with immediate stabilization of the spine 8,12,24,25) . In this study, we retrospectively analyzed preoperative and postoperative clinical and radiographic findings of patients with odontoid fractures who were treated with either nonsurgical management (HVI) or surgical fixation using the anterior or posterior approach. Efficacy and comparative treatment outcomes of these methods for odontoid type II and III fractures are also discussed. MATERIALS AND METHODSAfter we received approval from our Institutional Review Board, we retrospectively reviewed all patients with high cervical fractures treated between April 1997 and December 2008. We treated 60 patients with high cervical fractures. This study INTRODUCTIONMore than 60% of spinal injuries involve the cervical spine, and about 25% of all cervical spinal injuries affect the axis 6,7) . The most common axis injury is odontoid fracture, of which the majority are type II or type III dens fractures 3,6) . Treatment strategies for odontoid fractures are based on fracture type, the degree of initial dens displacement, the angulation of the dens with respect to the body of C2, and the age of the patient. The nonunion rate for odontoid fractures is between 4% and 64% depending on the fracture site and method of treatment 16,21,26) . Therapeutic options range from conservative treatment, including soft neck collars, rigid cervical orthosis and halo-vest immobilization (HVI), to surgical treatments including anterior screw fixation, posterior C1-2 screw fixation, or transarticular screw fixation. Non-surgical treatment with cervical collar Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, KoreaObjective : In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation. Methods : From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation.Results : There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 typ...

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“…In contrast to an open procedure, where the surrounding anatomy is directly visualized, insertion of the second screw is associated with more additional risks in a percutaneous procedure. Moreover, several studies have demonstrated no biomechanical or clinical outcome difference in patients stabilized with one versus two odontoid screws [9,11,21]. Anterior odontoid screw fixation can potentially result in any of the complications related to the surgical approach, including postoperative hematomas, dysphagia, hoarseness, or vascular or neural structure injuries.…”

Section: Discussionmentioning

confidence: 99%

Management of odontoid fractures with percutaneous anterior odontoid screw fixation

Chi

Wang

et al. 2007

Eur Spine J

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Minimally invasive techniques have revolutionized the management of a variety of spinal disorders. The authors of this study describe a new instrument and a percutaneous technique for anterior odontoid screw fixation, and evaluate its safety and efficacy in the treatment of patients with odontoid fractures. Ten patients (6 males and 4 females) with odontoid fractures were treated by percutaneous anterior odontoid screw fixation under fluoroscopic guidance from March 2000 to May 2002. Their mean age at presentation was 37.2 years (with a range from 21 to 55 years). Six cases were Type II and four were Type III classified by the Anderson and D'Alonzo system. The operation was successfully completed without technical difficulties, and without any soft tissue complications such as esophageal injury. No neurological deterioration occurred. Satisfactory results were achieved in all patients and all of the screws were in good placement. After a mean follow-up of 15.7 months (range 10-25 months), radiographic fusion was documented for 9 of 10 patients (90%). Neither clinical symptoms nor screw loosening or breakage occurred. Our preliminary clinical results suggest that the percutaneous anterior odontoid screw fixation procedure using a new instrument and fluoroscopy is technically feasible, safe, useful, and minimally invasive.

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A Comparative Study of Fixation Techniques for Type II Fractures of the Odontoid Process

Cited by 74 publications

References 0 publications

Anterior fixation of odontoid fractures in an elderly population

Anterior fixation of odontoid fractures in an elderly population

Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures

Management of odontoid fractures with percutaneous anterior odontoid screw fixation

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