Management of Acute Odontoid Fractures with Single-screw Anterior Fixation

Management of Acute Odontoid Fractures with Single-screw Anterior Fixation AbstractOBJECTIVEAccepted management strategies for odontoid fractures include external immobilization and surgical stabilization using anterior or posterior approaches. Displaced Type II fractures and rostral Type III fractures are at high risk for nonunion. Anterior fixation of odontoid fractures with a single cortical lag screw is a relatively new technique that combines rigid internal stabilization with preservation of intrinsic C1-C2 motion. We retrospectively reviewed our series of 26 consecutive patients who underwent odontoid screw fixation, to further define the safety and efficacy of the technique.METHODSDuring a 5-year period, 26 patients presented with acute traumatic Type II odontoid fractures. Ten patients were female and 16 were male, with a mean age of 35 years. All patients underwent anterior odontoid screw fixation by the senior surgeon (RWH), within a mean of 3 days after injury. All patients were postopera tively maintained in external orthoses, for a mean of 7.2 weeks, and were monitored with serial clinical and radiographic examinations.RESULTSWith a mean follow-up period of 30 months, radiographic fusion was documented for 25 of 26 patients (96%). No complications related to the surgical approach were identified, and all patients remained in neuro- logically stable condition. Two complications (8%) were related to the instrumentation; one patient required external immobilization because of suhoptimal screw placement, and one patient required posterior atlantoaxial arthrodesis because of inadequate fracture reduction.CONCLUSIONSingle-screw anterior odontoid fixation was associated with a relatively low complication rate and a high fusion rate in this study. We think that this should be the preferred treatment method for acute Type II odontoid fractures. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Management of Acute Odontoid Fractures with Single-screw Anterior Fixation

Management of Acute Odontoid Fractures with Single-screw Anterior Fixation

Management of Acute Odontoid Fractures with Single-screw Anterior Fixation Brian R. Subach, M.D., Michael A. Morone, M.D., PhD., Regis W . Haid, Jr., M.D., Mark R. McLaughlin, M.D., Gerald R. Rodts, M.D., Christopher H. Comey, M.D. Department of Neurological Surgery (BRS, MRM), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Department of Neurological Surgery (MAM, RWH, GRR, CHC), Emory University School of Medicine and the Emory Clinic, Atlanta, Georgia O B JE C T IV E : Accepted management strategies for odontoid fractures include external im m obilization and surgical stabilization using anterior or posterior approaches. Displaced Type II fractures and rostral Type III fractures are at high risk for nonunion. Anterior fixation of odontoid fractures w ith a single cortical lag screw is a relatively new technique that combines rigid internal stabilization w ith preservation of intrinsic C1-C2 motion. W e retrospec­ tively reviewed our series of 26 consecutive patients who underwent odontoid screw fixation, to further define the safety and efficacy of the technique. M E T H O D S : During a 5-year period, 2 6 patients presented w ith acute traum atic Type II odontoid fractures. Ten patients w ere female and 16 w ere male, with a mean age of 35 years. All patients underwent anterior odontoid screw fixation by the senior surgeon (R W H ), within a mean of 3 days after injury. All patients w ere postopera tively maintained in external orthoses, for a mean of 7 . 2 weeks, and w ere monitored w ith serial clinical and radiographic examinations. RESULTS: W ith a mean follow-up period of 30 months, radiographic fusion was documented for 25 of 26 patients (9 6 % ). No complications related to the surgical approach w ere identified, and all patients remained in neuro- logically stable condition. Two complications ( 8 % ) w ere related to the instrumentation; one patient required external immobilization because of suhoptimal screw placement,...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199910000-00015
Publisher site
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Abstract

AbstractOBJECTIVEAccepted management strategies for odontoid fractures include external immobilization and surgical stabilization using anterior or posterior approaches. Displaced Type II fractures and rostral Type III fractures are at high risk for nonunion. Anterior fixation of odontoid fractures with a single cortical lag screw is a relatively new technique that combines rigid internal stabilization with preservation of intrinsic C1-C2 motion. We retrospectively reviewed our series of 26 consecutive patients who underwent odontoid screw fixation, to further define the safety and efficacy of the technique.METHODSDuring a 5-year period, 26 patients presented with acute traumatic Type II odontoid fractures. Ten patients were female and 16 were male, with a mean age of 35 years. All patients underwent anterior odontoid screw fixation by the senior surgeon (RWH), within a mean of 3 days after injury. All patients were postopera tively maintained in external orthoses, for a mean of 7.2 weeks, and were monitored with serial clinical and radiographic examinations.RESULTSWith a mean follow-up period of 30 months, radiographic fusion was documented for 25 of 26 patients (96%). No complications related to the surgical approach were identified, and all patients remained in neuro- logically stable condition. Two complications (8%) were related to the instrumentation; one patient required external immobilization because of suhoptimal screw placement, and one patient required posterior atlantoaxial arthrodesis because of inadequate fracture reduction.CONCLUSIONSingle-screw anterior odontoid fixation was associated with a relatively low complication rate and a high fusion rate in this study. We think that this should be the preferred treatment method for acute Type II odontoid fractures.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1999

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