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Somogyi R, Smith S, Kark J, Ryu WHA, Yoo J. Age-Based Incidence of Dens Fracture Has Unimodal Distribution Rather Than Commonly Claimed Bimodal Distribution. JB JS Open Access 2024; 9:e23.00059. [PMID: 38214006 PMCID: PMC10773694 DOI: 10.2106/jbjs.oa.23.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background Type-II dens fractures have long been described in the literature as occurring in a bimodal distribution, peaking in young adulthood as well as in older adulthood; however, the origin of this claim is unclear. The primary goal of this study was to examine the incidence of type-II dens fractures and assess for bimodality. Methods This is a retrospective cross-sectional review of the National Trauma Data Bank (NTDB) records on traumatic type-II dens fractures between October 2015 and December 2016. Rates were obtained from the NTDB, and the incidence per 100,000 was ascertained by utilizing U.S. Census data from 2016. Subgroupings by gender and Black or White race were also examined. Results Dens fractures occur unimodally, peaking around 89 years of age overall, skewed left by high rates in older White adults. The Black subgroup demonstrated trimodality, with the fracture incidence peaking at 25, 62, and 82 years of age. Rates among Black and White patients were similar until age 65, after which dens fractures occurred disproportionately in White patients. Fractures prior to age 75 occurred predominantly in men. Conclusions The evidence derived in this study challenges the common belief that type-II dens fractures occur bimodally across the entire population. However, there remains utility in considering younger and older patients as distinct groups for the purposes of management.
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Affiliation(s)
- Rita Somogyi
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jonathan Kark
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Won Hyung A. Ryu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Jo WR, Lee CY, Kwon SM, Kim CH, Kwon MY, Kim JH, Ko YS. Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review. Korean J Neurotrauma 2023; 19:409-421. [PMID: 38222835 PMCID: PMC10782099 DOI: 10.13004/kjnt.2023.19.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Odontoid fractures are treated surgically through the anterior or posterior approach. Each surgical approach has its advantages and disadvantages, so the preferred approach remains debatable. There are few meta-analyses or systemic reviews on the mechanical complications of surgical treatment for odontoid fractures. This meta-analysis aimed to compare the operation-related morbidity, including mechanical complications, and mortality of patients with odontoid fractures, treated via the anterior or posterior approach. Methods A systematic search was performed on PubMed/Medline, Embase, and the Cochrane Library for the studies up to October 2023 on the complication rate of the surgical treatment of odontoid fractures, related to the surgical approach. The risk ratios (RR) with the 95% confidence intervals (CIs) were pooled to assess the mechanical complication rates, other complications, revision surgery, and mortality, depending on the surgical approach. Results A total of 1,519 studies were retrieved using the search strategy, and 782 patients from 15 articles were included in this meta-analysis. Mechanical complications were significantly more frequent in the anterior surgical group with low heterogeneity. The incidences of fracture nonunion and revision surgery were also higher in the anterior surgery group. However, there was no significant difference in systemic complications and mortality rates between the two groups. Conclusion The posterior approach was more advantageous than the anterior approach in terms of mechanical complications, fusion rates, and incidence of revision surgery. However, further studies, should be performed to strengthen these results.
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Affiliation(s)
- Woong Rae Jo
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
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Sakellariou E, Benetos IS, Evangelopoulos DS, Galanis A, Alevrogianni F, Vavourakis M, Marougklianis V, Tsalimas G, Pneumaticos S. Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review. Medicine (Baltimore) 2023; 102:e34653. [PMID: 37713867 PMCID: PMC10508423 DOI: 10.1097/md.0000000000034653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023] Open
Abstract
Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.
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Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Ioannis S. Benetos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Vasilios Marougklianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Georgios Tsalimas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
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Bao X, Chen Y, Guo C, Xu S. Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review. Front Surg 2023; 10:1125665. [PMID: 37377671 PMCID: PMC10291183 DOI: 10.3389/fsurg.2023.1125665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background Odontoid fractures account for 15%-20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures. Methods The relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3. Results Twelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA. Conclusion AA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.
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Affiliation(s)
- Xianguo Bao
- Spinal Surgery, Nanjing Lishui People’s Hospital, Nanjing, China
| | - Yingjun Chen
- Spinal Surgery, Nanjing Lishui People’s Hospital, Nanjing, China
| | - Chen Guo
- Spinal Surgery, Peking University People’s Hospital, Beijing, China
| | - Shuai Xu
- Spinal Surgery, Peking University People’s Hospital, Beijing, China
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Odontoid fracture complicating ankylosing spondylitis presenting with cervical canal stenosis and quadriparesis: A case report with 5-year follow-up and review of the literature. Int J Surg Case Rep 2022; 94:107067. [PMID: 35421726 PMCID: PMC9019263 DOI: 10.1016/j.ijscr.2022.107067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance Spinal fractures, especially cervical fractures, are more common in patients with ankylosing spondylitis in comparison with unaffected patients. However, odontoid fractures are relatively rare in these patients. Also, neurological symptoms are not common in odontoid fractures due to the larger diameter of the spinal canal at this level. Case presentation Here, we presented a 41 year-old man known case of ankylosing spondylitis who develop odontoid fracture and severe cervical stenosis after falling trauma. Quadriparesis and positive Hoffman sign as well as significant thoracolumbar kyphosis were diagnosed in further investigation. Laminectomy and posterior fixation were executed primary and pedicular subtraction osteotomy was performed two years later to manage the kyphosis and sagittal imbalance. On the follow-up period of five years the patient was fully functional. Clinical discussion There are a few cases of odontoid fractures complicating ankylosing spondylitis in the literature. Neurological symptoms are relatively uncommon in odontoid fractures; however, cases with AS can present with neck pain, weakness, and hyperreflexia when having unstable fractures. Conclusion Although there is not any gold standard for the treatment of the odontoid fracture in AS, surgical intervention is preferred. The occurrence of the odontoid fracture is rare in patients with AS. Neurological deficits are more common in posterior subluxation of the odontoid process compared to anterior subluxation. The optimal treatment approach for odontoid fracture in cases with AS is unknown; however, surgical management is preferred.
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Patkar S. Unstable odontoid fractures: technical appraisal of anterior extrapharyangeal open reduction internal fixation for irreducible unstable odontoid fractures. Patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21501. [PMID: 36061093 PMCID: PMC9435568 DOI: 10.3171/case21501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Displaced odontoid fractures that are irreducible with traction and have cervicomedullary compression by the displaced distal fracture fragment or deformity caused by facetal malalignment require early realignment and stabilization. Realignment with ultimate solid fracture fusion and atlantoaxial joint fusion, in some situations, are the aims of surgery. Fifteen such patients were treated with direct anterior extrapharyngeal open reduction and realignment of displaced fracture fragments with realignment of the atlantoaxial facets, followed by a variable screw placement (VSP) plate in compression mode across the fracture or anterior atlantoaxial fixation (transarticular screws or atlantoaxial plate screw construct) or both. OBSERVATIONS Anatomical realignment with rigid fixation was achieved in all patients. Fracture fusion without implant failure was observed in 100% of the patients at 6 months, with 1 unrelated mortality. Minimum follow-up has been 6 months in 14 patients and a maximum of 3 years in 4 patients, with 1 unrelated mortality. LESSONS Most irreducible unstable odontoid fractures can be anatomically realigned by anterior extrapharyngeal approach by facet joint manipulation. Plate (VSP) and screws permit rigid fixation in compression mode with 100% fusion. Any associated atlantoaxial instability can be treated from the same exposure.
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Affiliation(s)
- Sushil Patkar
- Department of Neurosurgery, Poona Hospital & Research Centre, Maharashtra, India
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Risk Factors Associated with 90-day Readmissions Following Odontoid Fractures: A Nationwide Readmissions Database Study. Spine (Phila Pa 1976) 2021; 46:1039-1047. [PMID: 33625117 DOI: 10.1097/brs.0000000000004010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Nationwide Readmissions Database Study. OBJECTIVE The aim of this study was to investigate readmission rates and factors related to readmission after surgical and nonsurgical management of odontoid fractures. SUMMARY OF BACKGROUND DATA Management of odontoid fractures, which are the most common isolated spine fracture in the elderly, continues to be debated. The choice between surgical or nonsurgical treatment has been reported to impact mortality and might influence readmission rates. Hospital readmissions represent a large financial burden upon our healthcare system. Factors surrounding hospital readmissions would benefit from a better understanding of their associated causes to lower health care costs. METHODS A retrospective study was performed using the 2016 Healthcare Utilization Project (HCUP) Nationwide Readmission Database (NRD). Demographic information and factors associated with readmission were collected. Readmission rates, complications, length of hospital stay were collected. Patients treated operatively, nonoperatively, and patients who were readmitted or not readmitted were compared. Statistical analysis was performed using open source software SciPy (Python v1.3.0) for all analyses. RESULTS We identified 2921 patients who presented with Type II dens fractures from January 1, 2016 to September 30, 2016, 555 of which underwent surgical intervention. The readmission rate in patients who underwent surgery was 16.4% (91/555) and 29.4% (696/2366) in the nonoperative group. Hospital costs for readmitted and nonreadmitted patients were $353,704 and $174,922, and $197,099 and $80,715 for nonoperatively managed patients, respectively. Medicaid and Medicare patients had the highest readmission rate in both groups. Charlson and Elixhauser comorbidity indices were significantly higher in patients who were readmitted (P < 0.0001). CONCLUSION We report an overall 90-day readmission rate of 16.4% and 29.4%, in operative and nonoperative management of type II odontoid fractures, respectively. In the face of a rising incidence of this fracture in the elderly population, an understanding of the comorbidities and age-related demographics associated with 90-day readmissions following both surgical and nonsurgical treatment are critical.Level of Evidence: 3.
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Sawarkar DP, Singh PK, Agrawal D, Gupta DK, Satyarthee GD, Doddamani R, Verma S, Meena R, Tandon V, Gurjar HK, Jagdevan A, Kumar R, Chandra PS, Kale SS. Anterior Odontoid Screw Fixation for Pediatric and Adolescent Odontoid Fractures: Single-Center Experience Over a Decade. World Neurosurg 2021; 153:e153-e167. [PMID: 34166831 DOI: 10.1016/j.wneu.2021.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Management of pediatric odontoid fractures is tricky and controversial. This study will enrich world literature with intricacies of anterior odontoid screw (OS) fixation in the pediatric population learned over the last decade. METHODS In this retrospective study, all patients with pediatric odontoid fracture who underwent anterior odontoid screw fixation from January 2010 to December 2019 were included and evaluated for surgical outcome. RESULTS Thirteen patients were included in this study (mean age, 15 years; range, 6-18 years; male/female, 11:2; type II, 10; type IIA, 1; type III, 2). Common causes of injury were motor vehicle accidents (61.5%) followed by fall from height (38.5%) and all were acute fractures (2-30 days). Five patients had neurologic deficits. Accurate placement of screw was achieved in 92.3% of patients, including all 9 patients who used intraoperative O-arm. K wire migration during bicortical drilling resulted in neurovascular injury, with 1 mortality (7.7%). The remaining 12 patients were available for follow-up (mean, 36 months; range, 20-72 months) and all had preservation of neck movements. Successful OS fixation was achieved in 84.6% of patients, including 1 patient (7.7%) who had a fibrous union. One patient (8.3%) had nonunion because of migration of the screw head in the C2 body. CONCLUSIONS Anterior odontoid screw fixation in the pediatric population provides good functional outcomes with instant fixation by direct osteosynthesis. However, the surgeon should be meticulous in the surgical approach and should achieve a lag effect. The surgeon should stop after engaging the outer cortex of the odontoid peg with K wire to avoid cranial migration. Intraoperative O-arm guidance is useful.
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Affiliation(s)
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Kumar Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Fazzolari B, Jannelli G, Conti E, Delitala A, Tessitore E, Brunori A. Clinical and radiological outcome after minimally invasive surgical approach for type II unstable odontoid fractures. Neurochirurgie 2020; 67:350-357. [PMID: 33338497 DOI: 10.1016/j.neuchi.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anterior odontoid screw fixation is a valid surgical option for unstable odontoid fractures, as type II Anderson D'Alonzo fractures. Grauer further divided type II fractures in subtypes according to the fracture line, providing recommendations for implementation of screw fixation techniques. OBJECTIVE Primary endpoint of our study is to evaluate the postoperative results of minimally invasive odontoid screw insertion in terms of outcome, fusion rate and stability of cranio-cervical junction. Secondary endpoint was to investigate the influence of age or fractures' features on outcome and fusion rate. MATERIALS AND METHODS We report the clinical and radiological features of 32 patients harbouring unstable type II fractures operated by a minimally invasive odontoid screw insertion technique. All patients underwent a high resolution multiplanar CT in order to assess fracture features according to Grauer's classification; the integrity of ligaments was investigated by MRI. In addition, a preoperative neurological performance (modified Rankin Scale, mRS) was evaluated for patients either directly or interviewing their families. Follow-up at one, three and six months and 1 year have been performed (averaging 13.5 months) by cervical CT (fusion rate and stability) and mRS update. In order to investigate the influence of age on postoperative neurological performance, two groups (≤50 yrs, 9 pts/>50 yrs, 23 pts) were separately considered and analysed. Overall, we observed no surgery related complications. We also analysed the fusion rate and its correlation with patient age and Grauer's subtype of fracture. RESULTS At last available clinical follow-up, the preoperative performance was preserved (mRS 0/1: 24, 75%; mRS 2-4: 9, 15%) although with slight reduction of intact patients (mRS 0: 22 vs. 19; 71.8 vs. 59.3%). Younger patients (≤50 yrs) fared significantly better than older ones, achieving a good clinical outcome (mRS 0/1) in 100% vs. 69.5% (9/9 vs. 16/23 pts). Statistical analysis showed a fair correlation between age and outcome. Other factors such as sex and Grauer's type did not influence significantly the clinical outcome. Nine patients did not complete a full radiological follow-up and were therefore excluded from analysis of radiological outcome. Among the remaining 23 patients, only 25% of those who were followed three months or less showed fusion; conversely, all patients who have been examined from 6 to 48 months fused. Among the non-union patients, two underwent a second surgery by posterior approach. CONCLUSIONS In our recent experience, the minimally invasive AOSF proved safe and effective in treating odontoid peg fractures. Selection based on Grauer's type is mandatory to achieve best results. While in the elderly, an anterior approach is well accepted as the first choice treatment, we recommend that this option should be offered as a suitable alternative to Halo or orthosis also in younger patients since it provides prompt, excellent clinical outcome and high fusion rate especially in this age group.
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Affiliation(s)
- B Fazzolari
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
| | - G Jannelli
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - E Conti
- United Nations High Commissioner for Refugees, Rome, Italy.
| | - A Delitala
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
| | - E Tessitore
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - A Brunori
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
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Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type II odontoid fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:498-506. [DOI: 10.1007/s00586-020-06644-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
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11
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The impact of odontoid screw fixation techniques on screw-related complications and fusion rates: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:475-497. [DOI: 10.1007/s00586-020-06501-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
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Buchmann N, Schweizer C, Kirschke JS, Rienmüller A, Gempt J, Ringel F, Meyer B, Ryang YM. C1–C2 posterior screw fixation in atlantoaxial fractures revisited: technical update based on 127 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1036-1042. [DOI: 10.1007/s00586-019-06244-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/13/2019] [Accepted: 11/28/2019] [Indexed: 11/28/2022]
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13
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Zitouna K, Riahi H, Lassoued NB, Selmene MA, Barsaoui M, Drissi G. Traumatic Atlantoaxial Dislocation with an Odontoid Fracture: A Rare and Potentially Fatal Injury. Asian J Neurosurg 2019; 14:1249-1252. [PMID: 31903373 PMCID: PMC6896646 DOI: 10.4103/ajns.ajns_214_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Traumatic dislocation of the atlanto-axial joint in combination with an odontoid fracture remains a rare entity. Beaucause of its instability, it's alsoo a seriuous injury. A fatal outcome is feared especially in elderly. We report a case of 74-year-old man who presented with neck pain Confusion and spastic tetraparesia after a low energy trauma. Radiographs and computed tomography demonstrated a C1C2 dislocation with odontoid fracture. After an unsuccessful attempt at closed reduction with halo traction, a surgical stabilisation was performed using a posterior approach. Death was occured in early postoperative due to respiratory distress.
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Affiliation(s)
- Khaled Zitouna
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Hend Riahi
- Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia.,Department of Radiology, Kassab Institute, Tunis, Tunisia
| | - Nabil Ben Lassoued
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Mohamed Amine Selmene
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Maher Barsaoui
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
| | - Ghassen Drissi
- Department of Orthopedics and Traumatology, La Rabta Hospital, Tunis Medical School, Tunis, Tunisia.,Department of Orthopedics and Traumatology, Faculté De Médecine De Tunis, Tunis Medical School, Tunis, Tunisia
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Type II Odontoid Fracture: a case series highlighting the treatment strategies. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:317-324. [PMID: 30610340 DOI: 10.1007/978-3-319-62515-7_46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A type II odontoid fracture, if unstable, can cause spinal cord damage. In this case, it is essential to choose the correct treatment-but the issues of what the correct treatment is and which of the different surgical options is best are quite controversial. In this paper we present strategies for treatment of type II odontoid fracture. MATERIALS AND METHODS Thirty consecutive cases of type II odontoid fracture were treated at the Division of Neurosurgery at Villa Sofia Hospital in Palermo (23 cases) and at the Neurosurgical Clinic, University Hospital of Palermo (seven cases), from January 2011 to August 2016. Four patients were treated with external immobilization. Twenty-six patients underwent a surgical procedure. RESULTS There was no mortality related to the surgical procedure. One patient had a pre- and postoperative neurological deficit, and remained tetraparetic. Follow-up radiological studies in the surgically treated group showed bone union in 21 patients and stable fibrous union in one. CONCLUSION In our and other authors' experience, when the direction of the fracture line is down and forward, external immobilization can be sufficient for healing. Anterior odontoid screw fixation can be considered the treatment of choice for unstable odontoid fractures (with a horizontal, down and back, or comminuted fracture line) without dislocation or with dislocation less than 7 mm.When the odontoid fracture is associated with a Jefferson fracture or dislocation greater than 7 mm, stabilization of C1-C2 may be necessary. In this case, placement of screws in the dens and in the joints through a single approach represents the most valid technique.In the case of an inveterate fracture of the dens with severe C1-C2 dislocation, the surgical operation that offers the best prospects is posterior stabilization, utilizing the Guo technique.
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Gonschorek O, Vordemvenne T, Blattert T, Katscher S, Schnake KJ. Treatment of Odontoid Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:12S-17S. [PMID: 30210956 PMCID: PMC6130105 DOI: 10.1177/2192568218768227] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To establish recommendations for the treatment of odontoid fractures based on current literature and the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). METHODS Narrative review of the literature. Analyzing treatment algorithms of German trauma and spine centers as members of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). RESULTS There are many influencing factors leading to appropriate treatment of odontoid fractures such as age, bone quality, arthrosis, classification, and type of the fracture. Conservative nonoperative treatment is appropriate for stable undislocated displaced odontoid fractures. Anterior osteosynthesis with 1 or 2 screws leads to good results in the classical unstable type II odontoid fracture in patients with good bone quality. However, modifiers have been identified by the working group leading to higher complication and failure rates. For these cases, more stable constructs and/or posterior approaches are indicated. CONCLUSIONS Operation seems to be standard treatment for odontoid fractures. However, in the aged population, conservative treatment should be considered as morbidity and mortality rise significantly in the group of >75 years. Conservative treatment may also be started within stable nondislocated fractures, but then regular controls have to be performed. If operation is indicated, many influencing factors have to be considered for appropriate approach and technique. The classification of Anderson and D'Alonzo is still standard. To create an adequate treatment algorithm, dislocation displacement and instability have to be identified. Stable odontoid fractures are treated conservatively non-operatively, but if so regular controls have to be performed. Unstable and/or dislocated displaced odontoid fractures are treated by anterior osteosynthesis with 1 or 2 screws. The technique is demanding and leads to elevated complication and failure rates if modifiers are apparent. In these cases, posterior instrumentation or fusion of C1 and C2 is favorable. In the aged population (>80 years), operative therapy is critical as postoperative morbidity complication and mortality rates rise significantly. As there is still some bias in the treatment algorithms, the working group recommends establishment of a prospective study to result in more objective statements.
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Affiliation(s)
- Oliver Gonschorek
- BGU Trauma Center, Murnau, Germany,Oliver Gonschorek, Department of Spine Surgery, BGU Trauma Center, 82418 Murnau, Germany.
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Aquila F, Tacconi L, Baldo S. Type II Fractures in Older Adults: Can They Be Treated Conservatively?: A Single-Center Experience and Review of the Literature. World Neurosurg 2018; 118:e938-e945. [PMID: 30036717 DOI: 10.1016/j.wneu.2018.07.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Odontoid fractures are the most common acute cervical spinal fractures in the geriatric population. Their rate is increasing along with the rising age of the elderly population. Whereas conservative management with external immobilization is reported as the treatment of choice for type I and III odontoid fractures, there are no clear indications concerning the best treatment for type II fractures. In younger patients surgical management is considered the best choice, but in older adults the rate of good outcomes worsens and operative risk because of comorbidities increases. METHODS We report our retrospective single-center experience with conservative treatment of type II odontoid fractures in an elderly population, focusing on both radiologic and functional outcomes to compare our results with the recent literature. RESULTS Among the 21 selected subjects with a minimum follow-up of 18 months, 19 (90.5%) showed a satisfactory clinical outcome, with an adequate bony healing in 10 cases and nonsymptomatic pseudarthrosis in 9 patients. All these patients were satisfied with the conservative results and could stop use of the collar. Two patients (9.5%) did not show any improvement and had to keep the collar indefinitely. CONCLUSIONS Our study was limited because it was a retrospective review, with a limited number of patients. Nevertheless, the clinical and radiologic outcomes of our patients differ from the results of other studies, suggesting that conservative management of these fractures in this population does not necessarily lead to a bad clinical outcome or delayed surgery.
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Affiliation(s)
- Filippo Aquila
- Division of Neurological Surgery, Azienda Universitaria Integrata di Trieste, Trieste, Trieste, Italy
| | - Leonello Tacconi
- Division of Neurological Surgery, Azienda Universitaria Integrata di Trieste, Trieste, Trieste, Italy.
| | - Sara Baldo
- Division of Neurological Surgery, Azienda Universitaria Integrata di Trieste, Trieste, Trieste, Italy
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Zhu C, Wang L, Liu H, Song Y, Liu L, Li T, Gong Q. Treatment of type II odontoid fracture with a novel technique: Titanium cable-dragged reduction and cantilever-beam internal fixation. Medicine (Baltimore) 2017; 96:e8521. [PMID: 29095313 PMCID: PMC5682832 DOI: 10.1097/md.0000000000008521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Surgical methods for type II odontoid fracture can be classified into 2 main groups: anterior or posterior approach. A more effective way to achieve bone fusion with the lowest possible surgical risk is needed. Therefore, the aim of our study was to describe and evaluate a novel technique, cable-dragged reduction/cantilever beam internal fixation for the treatment of type II odontoid fracture.This was a retrospective study enrolled 34 patients underwent posterior cable-dragged reduction/cantilever-beam internal fixation surgery. Medical records, rates of reduction, the location of the instrumentation and fracture healing during follow-up were analyzed. Once fracture healing was obtained, instrumentation was removed. Neck pain (scored using a visual analog scale [VAS]), neck stiffness, patient satisfaction, and neck disability index (NDI) were recorded before and after removing the instrumentation during follow-up.The mean duration of follow up was 22.8 ± 5.3 months. There was no iatrogenic damage to nerves or blood vessels. Radiographic evaluation showed complete reduction in the 20 patients with fracture displacement and satisfactory fracture healing in all 34 cases. Titanium cable breakage was observed in 4 patients after fracture healing. After removal of instrumentation, significant improvements were seen in neck-pain VAS score, neck stiffness, patient satisfaction, and NDI (all P < .01).Posterior cable-dragged reduction/cantilever-beam internal fixation was an optimal salvage maneuver to conventional surgical methods such as anterior screw fixation and C1-C2 screw-rod system. The operative difficulty and incidence of nerve and vascular injury were reduced. Its major disadvantage is the exposure and screw-setting at C3, which is left intact in traditional surgery, and it is suitable only for patients with intact C1 posterior arches.
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Cao L, Yang E, Xu J, Lian X, Cai B, Liu X, Zhang G. "Direct vision" operation of posterior atlantoaxial transpedicular screw fixation for unstable atlantoaxial fractures: A retrospective study. Medicine (Baltimore) 2017; 96:e7054. [PMID: 28640081 PMCID: PMC5484189 DOI: 10.1097/md.0000000000007054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The posterior screw fixation in atlas via posterior arch and lateral mass, also called C1 "pedicle" screw, combined with C2 pedicle screw fixiation has shown better biomechanical stability in unstable atlantoaxial fractures. However, its popularization has to fulfill the limitation imposed by anatomical characteristics. The aim of this study was to explore the manipulation, effect, and safety of the atlantoaxial transpedicular screw fixation under "direct vision" for the treatment of unstable atlantoaxial fracture. METHODS All the patients diagnosed with unstable atlantoaxial fracture, who received surgery treatment of C1,C2 internal fixation from January 2012 to December 2014 were reviewed. Only these patients that were diagnosed with atlantoaxial unstability secondary to trauma and were treated with atlantoaxial transpedicular screw fixation under "direct vision" and iliac autograft were included. The safety of transpedicular screw placement, postoperative outcome, atlantoaxial stability, autograft fusion, and complications was observed and analyzed retrospectively. The pain visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) score were used as surgical curative effect evaluation standards. RESULTS We reviewed a total of 92 patients diagnosed with unstable atlantoaxial fracture, who received surgery treatment of C1,C2 internal fixation from January 2012 to December 2014, and 87 patients were treated with atlantoaxial transpedicular screw fixation under "direct vision" and were included this analysis. A total of 306 transpedicular screws in atlas and axis were placed successfully. All cases were followed-up >12 months. The overall breach rate was 11.36%. None of the breaches resulted in new-onset neurological sequela. The neurological status in cases with bilateral upper extremities numbness and lower extremities weakness had improved after surgery. At the latest follow-up, the neck VAS and JOA scores were significantly improved (P < .01) than those preoperatively. No cases demonstrated implantation failure and bone graft absorption on the postoperative x-ray films and CT scans. CONCLUSION Atlantoaxial transpedicular screw fixation under "direct vision" and iliac autograft for the treatment of unstable atlantoaxial fracture has shown simple manipulation and efficient performance. Thus, the technique of C1-C2 fixation is feasible in treating unstable atlantoaxial fracture.
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Affiliation(s)
- Liangliang Cao
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Erzhu Yang
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Jianguang Xu
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Xiaofeng Lian
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Bin Cai
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Xiaokang Liu
- Department of Orthopedics, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Guowang Zhang
- Spine Subdivision, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
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Patkar S. Anterior retropharyngeal plate screw fixation with bilateral anterior transarticular screws for odontoid fractures ... a new comprehensive technique. Neurol Res 2017; 39:581-586. [PMID: 28403693 DOI: 10.1080/01616412.2017.1315881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A certain group of odontoid fractures (Anderson and D' Alonzo Type-2) are usually offered surgical treatment. Common surgical option is an anterior odontoid screw. Some of the fractures are not suitable for anterior odontoid screw (anterior oblique, displaced distal fragments and those with atlantoaxial instability) and these are usually offered posterior transarticular screws (Magerl's) or posterior atlantoaxial screw rod/plate fixation (Goel-Harms technique). Posterior surgery involves atlantoaxial fixation with an indirect attempt to reduce and fuse the fracture . Posterior surgery has a risk of injury to the vertebral arteries, hemorrhage from the paravertebral venous plexus and the C2 root ganglion. METHODS A direct anterior submandibular retropharyangeal approach with open reduction and fixation (ORIF) using a customized variable screw placement (VSP) plate was used to realign and fix the fracture fragments in compression mode under direct vision. Twenty patients of type-II odontoid fractures (unsuitable for anterior odontoid screw) underwent an anterior retropharyngeal approach with anterior variable screw position (VSP) plate and screw fixation and eight amongst them, who had associated atlantoaxial instability underwent additional bilateral anterior transarticular screws. RESULTS All patients treated by this technique had 100% fracture site bone union without any implant failure. Longest follow-up has been for 3 years. CONCLUSION Anterior retropharyangeal approach allows direct fracture fragment realignment under vision with an opportunity to fix in compression mode using the VSP plate, which ensures early fusion across the type-II odontoid fracture. Any associated instability can be treated by additional bilateral anterior transarticular screws. The approach is simple and safe without any risk to the vertebral arteries and biomechanically appealing.
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Affiliation(s)
- Sushil Patkar
- a Department of Neurosurgery , Poona Hospital & Research Center, Bhartividyapeeth Medical College & Hospital , Pune , India
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Fam MD, Zeineddine HA, Nassir RM, Bhatt P, Kamel MH. Patient-reported outcome following nonsurgical management of type II odontoid process fractures in adults. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:64-69. [PMID: 28250639 PMCID: PMC5324363 DOI: 10.4103/0974-8237.199871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Transverse (type II) odontoid process fracture is among the most commonly encountered cervical spine fractures. Nonsurgical management through external immobilization is occasionally preferred to surgical management but is criticized for its higher rates of failure and lower patient satisfaction. Our aim is to analyze patient-reported outcomes in patients who underwent nonsurgical treatment for type II odontoid fractures. Methods: We identified patients >18-year-old who underwent external immobilization as a treatment for isolated type II odontoid fracture between 2007 and 2012. We collected demographic parameters, clinical presentation, mode of injury, imaging studies and modality and duration of treatment (soft collar, halo-vest, or both). Patients were contacted by telephone to participate in a 15-min survey addressing their recovery including their subjective rate of return to preinjury level of functioning. Results: Fifteen patients met the inclusion/exclusion criteria and participated in our survey. Patients were followed up for an average of 19 months after injury. Overall mean age was 61 years. Injury followed a mechanical fall or a road traffic accident in 11 and 4 cases, respectively. External immobilization was achieved by halo vest only in nine patients, soft collar only in two patients (13%), and through a sequential combination in the remaining 4 (27%). This was deployed for a mean of 7.8 months. Radiological studies at the last follow-up showed bony healing (27%), fibrous nonunion (60%), and persistent instability (13%). Patients reported gradual recovery of function throughout the 1st year after injury with levels above 70% of preinjury functioning achieved by 13% of patients at 6 months, 33% at 9 months, and 47% at 12 months. Overall satisfaction with nonsurgical management was 68%. Conclusion: In selected patients with type II odontoid fractures, external immobilization represents a good option with acceptable course of recovery.
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Affiliation(s)
- Maged D Fam
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa, USA
| | - Hussein A Zeineddine
- Department of Surgery, Section of Neurosurgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | | | - Pragnesh Bhatt
- Department of Neurosurgery, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, Scotland, UK
| | - Mahmoud H Kamel
- Department of Neurosurgery, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, Scotland, UK
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Schroeder GD, Kepler CK, Kurd MF, Paul JT, Rubenstein RN, Harrop JS, Brodke DS, Chapman JR, Vaccaro AR. A Systematic Review of the Treatment of Geriatric Type II Odontoid Fractures. Neurosurgery 2016; 77 Suppl 4:S6-14. [PMID: 26378359 DOI: 10.1227/neu.0000000000000942] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is controversial. OBJECTIVE To compare the short-term (<3 months) mortality, long-term (≥12 months) mortality, and complication rates of patients >60 years of age with a type II odontoid fracture managed either operatively or nonoperatively. METHODS We performed a systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed. RESULTS A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30-0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34-0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63-1.63). Surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with hard collar or a halo orthosis immobilization. CONCLUSION The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications.
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Affiliation(s)
- Gregory D Schroeder
- *Rothman Institute at Thomas Jefferson University, Department of Orthopedic Surgery, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania; §Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah; ¶Swedish Neuroscience Institute, Department of Orthopedic Surgery, Seattle, Washington
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A Novel Anterior Odontoid Screw Plate for C1-C3 Internal Fixation: An In Vitro Biomechanical Study. Spine (Phila Pa 1976) 2016; 41:E64-72. [PMID: 26555834 DOI: 10.1097/brs.0000000000001165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro study was performed using a standardized experimental protocol in a biomechanical spine testing apparatus. OBJECTIVE The aims of this study were to evaluate the biomechanical stability afforded by 4 cervical fixation techniques: anterior cervical plate+odontoid screw+cage (ACP+OS+cage), anterior odontoid screw plate+bone graft (AOSP+bone graft), posterior C2-3 fixation+odontoid screw (C2PS+C3LMS+OS), and posterior C1-3 fixation (C1PS+C2PS+C3LMS). SUMMARY OF BACKGROUND DATA Unstable axis injuries with multiple fracture lines are uncommon injuries, and their management is still challenging for surgeons who aim to achieve primary stability, early mobilization, preserved cervical range of motion (ROM), and favorable outcome. We designed a novel AOSP to assist in this challenging clinical scenario. METHODS Eight fresh-frozen cadaveric spine specimens (C1-C3) were subjected to stepwise destabilization of the C1-3 complex, with serial replication of a type II Hangman fracture, a type II odontoid fracture, and a C2 to C3 disc injury. Intact specimens, destabilized specimens, and destabilized specimens with various stabilization techniques including anterior and posterior techniques, some using our AOSP, were each tested for stability. Each spine was subjected to flexion, and extension testing, left and right lateral bending, and left and right rotation. RESULTS After AOSP+bone graft fixation, the ROMC2-C3 during all loading modes were reduced to values that were significantly less than normal. During all loading modes, AOSP+bone graft fixation significantly outperformed the ACP+OS+cage fixation in limiting ROMC2-C3. During flexion and extension, AOSP+bone graft fixation significantly outperformed the C1PS+C2PS+C3LMS fixation and C2PS+C3LMS+OS fixation in limiting ROMC2-C3. CONCLUSION The AOSP has excellent biomechanical performance when dealing with type I Hangman fractures, type II odontoid fractures, and C2-3 disc injuries. The AOSP+one graft fixation can preserve the function of atlanto-axial joint, which may be a valuable stabilization strategy for these unique injuries.
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Shen Y, Miao J, Li C, Fang L, Cao S, Zhang M, Yan J, Kuang Y. A meta-analysis of the fusion rate from surgical treatment for odontoid factures: anterior odontoid screw versus posterior C1–C2 arthrodesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1649-57. [DOI: 10.1007/s00586-015-3893-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 02/07/2023]
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Tian NF, Hu XQ, Wu LJ, Wu XL, Wu YS, Zhang XL, Wang XY, Chi YL, Mao FM. Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation. PLoS One 2014; 9:e103065. [PMID: 25058011 PMCID: PMC4109995 DOI: 10.1371/journal.pone.0103065] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/25/2014] [Indexed: 02/06/2023] Open
Abstract
Background Anterior odontoid screw fixation (AOSF) has been one of the most popular treatments for odontoid fractures. However, the true efficacy of AOSF remains unclear. In this study, we aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures. Methods We searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and potential sources of heterogeneity were explored by meta-regression analysis. Results Of 972 references initially identified, 63 were eligible for inclusion. 54 studies provided data regarding non-union. The pooled non-union rate was 10% (95% CI: 7%–3%). 48 citations provided re-operation information with a pooled proportion of 5% (95% CI: 3%–7%). Infection was described in 20 studies with an overall rate of 0.2% (95% CI: 0%–1.2%). The main approach related complication is postoperative dysphagia with a pooled rate of 10% (95% CI: 4%–17%). Proportions for the other approach related complications such as postoperative hoarseness (1.2%, 95% CI: 0%–3.7%), esophageal/retropharyngeal injury (0%, 95% CI: 0%–1.1%), wound hematomas (0.2%, 95% CI: 0%–1.8%), and spinal cord injury (0%, 95% CI: 0%–0.2%) were very low. Significant heterogeneities were detected when we combined the rates of non-union, re-operation, and dysphagia. Multivariate meta-regression analysis showed that old age was significantly predictive of non-union. Subgroup comparisons showed significant higher non-union rates in age ≥70 than that in age ≤40 and in age 40 to <50. Meta-regression analysis did not reveal any examined variables influencing the re-operation rate. Meta-regression analysis showed age had a significant effect on the dysphagia rate. Conclusions/Significances This study summarized the rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid factures. Elderly patients were more likely to experience non-union and dysphagia.
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Affiliation(s)
- Nai-Feng Tian
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (NFT); (FMM)
| | - Xu-Qi Hu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li-Jun Wu
- Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin-Lei Wu
- Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao-Sen Wu
- Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao-Lei Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Center for Stem Cells and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiang-Yang Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yong-Long Chi
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang-Min Mao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (NFT); (FMM)
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Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. BIOMED RESEARCH INTERNATIONAL 2014; 2014:231948. [PMID: 24683543 PMCID: PMC3934525 DOI: 10.1155/2014/231948] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/28/2013] [Indexed: 11/18/2022]
Abstract
Odontoid fractures type II according to Anderson and d'Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.
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