The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Abstract

Background Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is unclear whether any one technique produces better outcomes than another. Questions/purposes We assessed the quality of the available literature for management of Type II odontoid fractures and surgery-related parameters, including surgical indications, clinical failure rate, and survivorship, postoperative ROM and function, neurologic deficits, complication and death rates, and radiographic healing rates related to either anterior dens screw or posterior C1-C2 fusion.Methods We performed a systematic search in PubMed, Ovid, Cochrane Reviews, and Google Scholar databases. We used the methodology score proposed by Coleman et al. to rate study quality. Postoperative imaging bone union rates were extracted. Postoperative complications and neurologic impairment data were also collected. Results Sixteen retrospective studies of overall low quality (average methodology score, 37.1) reporting a total of 518 patients were included. The methodology score and publication year were positively associated. The bone union rate approximated 83% (range, 33%-100%), with higher nonunion rates among patients older than 65 years. The death rate ranged widely (0%-28.6%) among different centers. Residual cervical pain was documented postoperatively from 10.5% to 26.7%, while survivorship ranged from 72% to 96.6%. No ROM data were reported. Conclusions Current data on patients who had surgery for fracture of the dens did not allow us to establish superiority of one surgical approach over another.

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

“…23 Lastly, there are studies suggesting that halo vests result in worse outcomes when compared with cervical collars in older patients, including a significant mortality rate during hospitalization (up to 28.6%). 8,10,16,26 Halo vest immobilization in older patients is associated with pneumonia and cardiac arrest; 26,36 for this reason, it may be prescribed only as a last resource in this fragile population. Instead, conservative treatment may be best addressed through a rigid cervical collar.…”

“…[6][7][8]21,22 In this paper, we review the potential surgical indications for Type II odontoid fractures with an emphasis on choosing the best surgical approach for treatment (anterior vs posterior approach). Advantages and disadvantages of each approach are discussed in detail.…”

Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture

“…Common surgical procedures for odontoid fractures include internal fixation (odontoid screw fixation) and arthrodesis (posterior fusion); however, superiority of treatments is controversial [5,6].…”

Treatment of Anderson Type II Odontoid Fracture in Elderly Patients by Posterior Pedicle Screw Fixation Combined with Iliac Bone Grafting

“…Elderly odontoid fractures in patients with no surgical treatment, only give conservative treatment (such as strict relax on bed, line Halo-vest external fixation, etc.). The fracture healing rate of odontoid fracture can up to 50% -80% [2], and may be caused by the relevant serious complications due to atlantoaxial instability, so most scholars consider that the vast majority of elderly odontoid fractures need to be given surgical diagnosis and treatment [3]; but for the elderly odontoid fracture, there is still more controversy of the choice of surgical methods [4]. There are many kinds of internal fixation methods, such as posterior lateral mass screw fixation (Magerl operation), posterior lateral mass screw fixation (Apofix operation), Brooks posterior wire fixation, Halifax posterior laminectomy and so on.…”