Comparison of clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures

Abstract

The aim of this study was to compare clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures, and hope to provide references in decision making and surgical planning for both spinal surgeons and surgically treated patients.This is a retrospective study. By retrieving the medical records from January 2005 to July 2015 in our hospital, 53 Type II odontoid fracture patients were reviewed. According to the instrumentation type, patients were divided into 2 groups: Wiring group and Screw group. Three categorized factors were analyzed statistically: patient characteristics: age, body mass index, preoperative neurological status, duration, complicated injuries; surgical variables: surgery time, blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, pain at the bone donor area, instrumentation failure, revision rate; and radiographic parameters: preoperative and final follow-up data of C0–2 curvature, C2–7 curvature, C2-C7 sagittal vertical axis, C7 slope, fracture classification, separation, and displacement of odontoid fracture, fusion rate. An additional comparison of surgical outcomes was done, including patient satisfaction, visual analog scale score for neck pain, neck stiffness, medical expense.There was no statistically significant difference between the 2 groups in patient characteristics of age, sex, body mass index, preoperative neurological status, duration, and complicated injuries. No statistically significant difference was noted in surgical variables of blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, bone harvested zone pain, instrumentation failure, revision rate. The surgery time was shorter in Wiring group than that in Screw group, with a statistically significant difference. We noted no significant difference between the 2 groups when comparing radiographic parameters of preoperative and final follow-up data of C0–2 curvature, C2-C7 sagittal vertical axis, fracture classification, the separation and displacement of odontoid fracture, and fusion rate. Although we noted no significant difference in preoperative C2–7 curvature and C7 slope, the final follow-up data showed that C2–7 curvature and C7 slope were smaller in Wiring group than that in Screw group. We noted no significant difference in visual analog scale score, neck stiffness, and neurological status at final follow-up. The medical expense was less in Wiring group; the patient satisfaction was lower in the Wiring group than that in the Screw group.The modified Gallie graft fusion-wiring technique provided solid fusion and stabilization for patients with Type II odontoid fractures, Gallie graft fusion-wiring resulted in less surgery time, less medical expense, but lower patient satisfaction when compared with the posterior cervical screw constructs.

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

“…According to our results, both groups presented with mild symptoms after fixation of their upper cervical spine. In summary, and according to other studies [28,39,47,48], OCF and AAF enable a sufficient improvement of pain with a reasonable level of activities in daily life.…”

Regional variations in C1–C2 bone density on quantitated computed tomography and clinical implications

“…By considering posterior C1–C2 wiring/cable constructs which use the C1 posterior arch and C2 spinous process/posterior arch to allow for incorporation of bone with higher BMD and better bone quality to be integrated into the surgical construct this offers a stronger construct in the elderly population. Depending on the surgeon's comfort with placing sublaminar wires or cables and the patient's anatomy, the use of various C1–C2 wiring/cable techniques [35] , [36] , [37] should still be considered particularly in the elderly. If the posterior elements of C1 and C2 are fractured or the patient is younger, surgeons need to recognize the regional variations in BMD to optimize the surgical approach and screw length to obtain a secure construct.…”