Safety and Efficacy of Anterior Odontoid Screw for the Management of Odontoid Fractures. A Series of 22 Patients.

Abstract

Background Data: Several methods of treatment of odontoid fractures have been used. These have ranged from rigid immobilization to atlantoaxial fusion. Odontoid screw osteosynthesis is gaining popularity. Purpose: To define the efficacy and safety of odontoid screw fixation in the management of odontoid fractures and to report the clinical and radiological results. Study Design: A prospective cohort study of odontoid fractures treated with odontoid screw osteosynthesis. The study was conducted in Cairo university hospital, Egypt and AOA Neuro-spinal Centre, Libya in the period from January 2007 to October 2010. Patients and Methods: Over the period from January 2007 to October 2010, twenty two patients, 17 males and 5 females, with a mean age of 32.5 years were included in this study. These were 19 odontoid type-II and 3 shallow type-III fractures. All patients underwent odontoid screw fixation using a single screw. Results: Mean operative time was 80 minutes and mean blood loss 150 ml Patients were followed for a mean period of 20.6 months. Nineteen patients (87%) obtained a good or excellent result on the Smiley Webster scale. Fourteen patients (64%) obtained a bony union, 7 (32%) a stable fibrous union and one patient (4%) developed a pseudoarthrosis. One patient had a misplaced screw that was successfully revised and another patient had displacement of the screw with re-displacement of the fracture at three months follow up. He had removal of the screw and underwent atlanto-axial fusion. Conclusion: This study has proven the efficacy and safety of odontoid screw osteosynthesis in selected types of odontoid type II and shallow type III fractures. (2012ESJ024) Keywords: Odontoid fracture, upper cervical spine, odontoid screw fixation, anterior odontoid fixation, osteosynthesis of odontoid.