A simple technique for easier anterior odontoid screw fixation

Khattab, Mohamed Fawzy; Mahmoud, Ahmed Nageeb; Younis, Ahmed Saeed; Elhawary, Youssry

doi:10.1080/02688697.2018.1550191

Cited by 8 publications

(9 citation statements)

References 13 publications

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“…3,10,11,23 This represents a minimally invasive approach through the cervical fascial planes, which requires a mild soft-tissue retraction and preserves the C1-2 range of motion. [9][10][11]24 However, it re-mains an ultra-specialist procedure that requires specific training and is associated with nonnegligible risks for vascular, nervous system, and dural injuries.…”

Section: Discussionmentioning

confidence: 99%

Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study

Ricciardi

Trungu

Scerrati

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEAnderson type II odontoid fractures are severe conditions, mostly affecting elderly people (≥ 70 years old). Surgery can be performed as a primary treatment or in cases of failed conservative management. This study aimed to investigate how duration from injury to surgery, as well as clinical, radiological, and surgical risk factors, may influence the union rate after anterior odontoid screw placement for Anderson type II odontoid fractures.METHODSThe authors conducted a retrospective multicenter study. Demographic, clinical, surgical, and radiological data of patients who underwent anterior odontoid screw placement for Anderson type II fractures were retrieved from institutional databases. Study exclusion criteria were prolonged corticosteroid drug therapy (> 4 weeks), polytraumatic injuries, oncological diagnosis, and prior cervical spine trauma.RESULTSEighty-five patients were included in the present investigation. The union rate was 76.5%, and 73 patients (85.9%) did not report residual instability. Age ≥ 70 years (p < 0.001, OR 6), female gender (p = 0.016, OR 3.61), osteoporosis (p = 0.009, OR 4.02), diabetes (p = 0.056, OR 3.35), fracture diastasis > 1 mm (p < 0.001, OR 8.5), and duration from injury to surgery > 7 days (p = 0.002, OR 48) independently influenced union rate, whereas smoking status (p = 0.677, OR 1.24) and odontoid process angulation > 10° (p = 0.885, OR 0.92) did not.CONCLUSIONSAlthough many factors have been reported as influencing the union rate after anterior odontoid screw placement for Anderson type II fractures, duration from injury to surgery > 7 days appears to be the most relevant, resulting in a 48 times higher risk for nonunion. Early surgery appears to be associated with better radiological outcomes, as reported by orthopedic surgeons in other districts. Prospective comparative clinical trials are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study

Ricciardi

Trungu

Scerrati

et al. 2021

Journal of Neurosurgery: Spine

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“…They were considered relatively unstable and had a high incidence of nonunion [5]. Anterior odontoid screw fixation can achieve a high union rate (86-100%) as found in numerous studies [5,8,15,[19][20][21][22][23]. It has a number of advantages, including immediate stability, less postoperative pain, and direct fracture fixation without bone graft [16].…”

Section: Discussionmentioning

confidence: 99%

A new tool in percutaneous anterior odontoid screw fixation

Wang

Cui

et al. 2021

BMC Musculoskelet Disord

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Background Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation. Methods Twenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery. Results There were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group. Conclusions The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.

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“…However, there has been several other anterior approaches described, all aiming at reducing the tissue dissection while accessing the desired entry point. [ 2 3 4 5 6 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…The challenging learning curve and the potential risk for iatrogenic injury with error in the screw trajectory limit the wide clinical application of percutaneous anterior screw fixation. [ 2 3 4 5 6 ] Utility of minimally invasive approach to increase the safety is the need of the hour. There are few reports which suggest use of endoscope for odontoid screw placement but did not become popular because of lack of reproducibility.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic anterior odontoid screw fixation for the odontoid fracture: A cadaveric pilot study

Kedia¹,

Sawarkar²,

Mansoori³

et al. 2021

Asian J Neurosurg

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Introduction: Anterior odontoid screw fixation technique for specific types of odontoid fracture has been proven to be an effective, yet challenging procedure because of threatened damage to the structures in the vicinity. There are few articles suggesting the role of percutaneous and endoscopic technique as an alternative approach to the standard microscopic way. This is the first cadaveric study using existing “EASY GO” endoscopic system-assisted odontoid screw placement. Study Design: This was a cadaveric study. Objective: The objective of the study is to use the endoscope as a safer minimally invasive approach than the standard microscopic anterior approach to odontoid. Methodology: This is a pilot study on 10 fresh-frozen formalin-fixed adult human cadavers. The cadaver was positioned in a way to simulate reduced odontoid fracture. Tubular dilators were used to dock at C2–3 disk space after identifying the landmarks through the microscopic method. The EASY GO endoscopic system was then introduced, and a handheld drill was used to mark the entry point and pass the K-wire through the planned trajectory. Results: No vascular or adjacent vital structures' injury was observed in any of the cadavers. The initial difficulty in attaining the alignment was overcome by the appropriate positioning of the scope. Conclusions: Endoscopic-assisted technique for odontoid screw fixation shall provide a minimally invasive, safe, and easy surgery.

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A simple technique for easier anterior odontoid screw fixation

Cited by 8 publications

References 13 publications

Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study

Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study

A new tool in percutaneous anterior odontoid screw fixation

Endoscopic anterior odontoid screw fixation for the odontoid fracture: A cadaveric pilot study

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