Technical note
Management of acute odontoid fractures with single anterior screw fixation

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Summary

The use of anterior odontoid screw fixation has grown in popularity for the management of acute, unstable Anderson and d’Alonzo Type II and rostral Type III odontoid fractures. This study critically reviews our clinical experience of 48 patients with single odontoid screw fixation for the treatment of Type II and Type III odontoid fractures between 1997 and 2001. This series had a complication rate of 10% (malposition rate 6% and non-union rate 4%), with a satisfactory overall fusion rate of 96%. Odontoid screw fixation is technically demanding and requires strict patient selection, thorough preoperative planning and careful surgical technique. In our experience, advanced age should not be considered a contraindication to anterior odontoid screw fixation, as satisfactory results can be obtained in some of these patients. This study also emphasises that sagittally oblique type II fractures are associated with a high rate of fusion failure when treated by anterior odontoid screw fixation, and should be treated with other instrumentation methods, such as posterior atlantoaxial arthrodesis.

Section snippets

INTRODUCTION

Type II odontoid fractures, based on the classification of Anderson and d’Alonzo,1 are mechanically unstable injuries. When these fractures (both displaced and nondisplaced) are treated non-operatively, rates of non-union and pseudoarthrosis are high.[2], [3], [4], [5], [6], [7] The high rate of non-union following non-surgical management has resulted in a gradual shift towards surgical treatment.[8], [9], [10], [11], [12], [13] Presently, external immobilisation alone is generally reserved for

MATERIALS AND METHODS

Forty-eight patients were identified with acute type II and rostral type III odontoid fractures who were treated in the neurosurgical department of Chang Gung Memorial Hospital, Taoyuan, Taiwan, with single odontoid screw fixation from 1997 to 2001. Patients more than 30 days between trauma and the day of surgery were excluded. Patient records were reviewed for clinical presentation, neurological examination, imaging studies, diagnosis, treatment and outcomes.

During admission, all patients

RESULTS

Patients ranged in age from 16 to 78 years (mean 37.2 years). Fig. 2 summarises the basic clinical data. There were 37 males and 11 females. Surgery was performed between two and 30 days after trauma (mean 10.6 days). Thirty-nine patients had type II odontoid fractures, while nine patients had rostral type III. The length of the screws used in this series ranged from 36 to 42 mm. Pre-operatively, one patient presented not breathing with complete quadriplegia and four presented with incomplete

DISCUSSION

Anterior odontoid screw fixation is an effective surgical approach for acute type II and rostral type III odontoid fractures. This method has several advantages over posterior C1–2 arthrodesis, providing immediate stabilization, causing less post-operative pain, requiring no bone graft and preserving normal atlantoaxial rotational motion. However, this method is nonetheless associated with some risks, including technical error, screw failure and non-union. In a literature review of 19 series

CONCLUSION

This study shows that single anterior odontoid screw fixation was associated with a relatively high fusion rate and low complication rate for management of acute type II and rostral type III odontoid fractures. Anterior odontoid screw fixation is technically demanding, and requires thorough pre-operative planning and meticulous surgical technique. Advanced age should not be considered a contraindication for the use of anterior odontoid screw fixation as satisfactory results can be obtained in

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  • Cited by (19)

    • Analysis of Computed Tomography Scan After Anterior Odontoid Screw Fixation with the Herbert Screw: Is It Effective to Reduce Fracture Gap?

      2018, World Neurosurgery
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      To our knowledge, no study has analyzed the change in fracture displacement and fracture gap after anterior odontoid screw fixation. Several kinds of screws, including cannulated lag screws and headless compression screws, usually are used for anterior odontoid screw fixation.17-21 Among these, the Herbert screw fixation of type II odontoid fracture was first described by Chang et al.17 The Herbert screw is a headless compression screw, so it can be inserted through articular cartilage and buried below the bone surface, and it has other unique design features, such as being double threaded with a different pitch on the leading and trailing thread for interfragmentary compression.22

    • Anterior surgery for odontoid fractures

      2014, Seminars in Spine Surgery
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      Only a few studies reported patients presenting with neurologic deficits, and there have been no reports of progressive neurologic deficit after anterior screw fixation was performed. In fact, there are few case reports of neurologic decline following non-operative or surgical treatment of odontoid fractures.13,21 Overall morbidity and mortality rates for anterior screw fixation vary widely.

    • Treatment of odontoid fractures with single anterior screw fixation

      2007, Journal of Clinical Neuroscience
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      The atlantal transverse ligament integrity can be assessed with radiologic or open-mouth images, or with CT scan, and more clearly with MRI, although specificity is relatively low. There have been reports of atlantal transverse ligament damage with odontoid process fractures, but this is infrequent.16 In this study, there was no delayed atlanto-axial instability due to ruptured atlantal transverse ligament.

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