Screw fixation of odontoid fractures: Preliminary report

Pentelényi, T; Szarvas, I; Bodrogi, L

doi:10.1016/0020-1383(88)90001-0

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…There was one death (1%) related to surgery (in the recent group surgically treated fewer than 6 months postinjury). The complication rate in this and other smaller series 1,8,9,[18][19][20][21]25,26,28,[31][32][33]40 in which direct screw fixation for odontoid fractures was used is similar to that associated with posterior fixation techniques. 3,10,15,38 The most common hardware-related failure was screw pullout of the body of C-2 (five cases).…”

Section: Operative Outcome Analysismentioning

confidence: 77%

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Direct anterior screw fixation for recent and remote odontoid fractures

Apfelbaum¹,

Lonser²,

Veres³

et al. 2000

Journal of Neurosurgery: Spine

140

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Object. The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1–2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. Methods. One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for recent (≤ 6 months postinjury [129 patients]) or remote (≥ 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow up 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p ≤ 0.05) higher in fractures oriented in the horizontal and posterior oblique direction (compared with anterior oblique), but this finding was independent (p ≥ 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and those unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Conclusions. Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures (< 6 months postinjury). It confers immediate stability, preserves C1–2 rotatory motion, and achieves a fusion rate that compares favorably with alternative treatment methods. In contradistinction, in patients with remote fractures (≥ 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.

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Section: Operative Outcome Analysismentioning

confidence: 77%

“…Despite sporadic reports from a number of surgeons, 1,5,[26][27][28]31,33 it was not until advances in the quality of intraoperative fluoroscopy and improvements in surgical instrumentation were made that this procedure gained wider acceptance.…”

Section: Treatment Of Odontoid Fracturesmentioning

confidence: 99%

Direct anterior screw fixation for recent and remote odontoid fractures

Apfelbaum¹,

Lonser²,

Veres³

et al. 2000

Journal of Neurosurgery: Spine

140

View full text Add to dashboard Cite

show abstract

“…Direct anterior screw fixation was originally advocated by Nakanishi 32 in 1980 and later by Bohler 8 who, in 1982, independently reported his experience dating back to 1968. Despite sporadic reports from a number of surgeons, 1,5,[26][27][28]31,33 it was not until advances in the quality of intraoperative fluoroscopy and improvements in surgical instrumentation were made that this procedure gained wider acceptance.…”

Section: Treatment Of Odontoid Fracturesmentioning

confidence: 99%

Direct anterior screw fixation for recent and remote odontoid fractures

Apfelbaum¹,

Lonser²,

Veres³

et al. 2000

FOC

109

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Object The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1–2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. Methods One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for a recent fracture (< 6 months postinjury [129 patients]) or remote (≥ 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow-up period 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p ≤ 0.05) higher in fractures oriented in the horizontal and posterior oblique direction (as compared with anterior oblique), but this finding was independent (p ≥ 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Conclusions Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures (< 6 months postinjury). It confers immediate stability, preserves C1–2 rotatory motion, and achieves a fusion rate that compares favorably with alternative treatment methods. In contradistinction, in patients with remote fractures (≥ 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.

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“…Apresentaram 6,6% de complicações, sendo a complicação mais comum a saída do parafuso em 2,6%, seguida da quebra do parafuso em 1,2%, parafuso mal posicionado em média 1% nestas séries [3][4][5][6][7][8][9]11,[13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30] . Tabela Na série em estudo não houve quebra nem saída do parafuso.…”

Section: Discussionunclassified

“…Admite-se que os maus resultados da fixação anterior nesta faixa etária estejam relacionados à osteoporose e à rigidez cervical que dificulta um bom posicionamento do parafuso. Na nossa sé-rie, não houve influência entre idade e resultado clíni-co, fato encontrado também em outras séries 8,9,15,28 .…”

Section: Discussionunclassified

Tratamento cirúrgico das fraturas do odontóide tipo II com parafuso anterior: análise de 15 casos

Dantas

Prandini

Caires

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -Apresentamos estudo retrospectivo dos resultados de 15 pacientes consecutivos, com fratura do odontóide tipo II P (fratura com traço oblíquo e deslocamento posterior) e II N (fratura com traço horizontal na base do odontóide), segundo a classificação de Roy-Camille , que foram submetidos a fixação anterior direta do odontóide com parafuso. A série é composta por 13 homens e 2 mulheres, com idade variando entre 14 a 74 anos e período de acompanhamento de 6 a 36 meses (média 20 meses). Tivemos apenas uma complicação relacionada com a técnica cirúrgica: um parafuso mal posicionado necessitando de uma reoperação para ser reposicionado. Não houve óbito. Não houve saída nem quebra de parafuso. Obteve-se 94% de fusão óssea. Propomos que seja utilizada a classificação de Roy-Camille na seleção dos casos cirúrgicos de fraturas do odontóide, pois ela fornece uma abordagem cirúrgica específica para cada tipo de fratura.PALAVRAS-CHAVE: fraturas do odontóide, fixação com parafuso, fusão cervical. Management of odontoid fractures using anterior screw fixation: analysis of 15 casesABSTRACT -A retrospective analysis of the results of 15 patients with odontoid fractures type II P and II N, according to Roy-Camille's classification is presented. They were operated on by an anterior approach and direct fixation of the odontoid process through a screw. There were 13 men and 2 women, the age ranging from 14 to 74 years. The follow up period was from 6 to 36 months (mean 20 months). There was only one complication related to the surgical technique: one screw was misplaced and it was necessary another surgery to replace it. There were no deaths in this series. There were no screw breakdown and the fusion rate was 94%. We propose, based on this study, that the classification of Roy-Camille for odontoid fractures should be always used, since it proposes one surgical approach for each type of fracture. The results of this series show that this technique is useful and has advantages over another modalities of treatment. The correct diagnosis of the type of fracture and an appropriate selection of patients are the main elements to achieve good results.KEY WORDS: odontoid fractures, screw fixation, cervical fusion. Fraturas do processo odontóide têm sido tratadas por meio de diversas formas terapêuticas, que vão desde métodos conservadores a várias técnicas cirúrgicas, com taxas variáveis de sucesso [1][2][3][4][5][6][7] . As fraturas do odontóide representam cerca de 10 a 15 % das fraturas do áxis e 2% das fraturas da coluna vertebral desenvolveram uma classificação levando em consideração apenas a altura do traço de fratura, dividindo as fraturas em três tipos: Tipo I são fraturas da ponta do odontóide, geralmente oblíquas, acima do ligamento transverso-atlanta; são fraturas estáveis. Tipo II são fraturas da base do odontóide, correspondendo a cerca de 40% das fraturas do odontóide. As fraturas Tipo III são as que envolvem o corpo do áxis.

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Screw fixation of odontoid fractures: Preliminary report

Cited by 5 publications

References 10 publications

Direct anterior screw fixation for recent and remote odontoid fractures

Direct anterior screw fixation for recent and remote odontoid fractures

Direct anterior screw fixation for recent and remote odontoid fractures

Tratamento cirúrgico das fraturas do odontóide tipo II com parafuso anterior: análise de 15 casos

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