1
|
Johnstone T, Shah V, Schonfeld E, Sadeghzadeh S, Haider G, Marianayagam NJ, Stienen M, Veeravagu A. Type II odontoid fractures in the elderly presenting to the emergency department: an assessment of factors affecting in-hospital mortality and discharge to skilled nursing facilities. Spine J 2024; 24:682-691. [PMID: 38101547 DOI: 10.1016/j.spinee.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND CONTEXT Type II odontoid fractures (OF) are among the most common cervical spine injuries in the geriatric population. However, there is a paucity of literature regarding their epidemiology. Additionally, the optimal management of these injuries remains controversial, and no study has evaluated the short-term outcomes of geriatric patients presenting to emergency departments (ED). PURPOSE This study aims to document the epidemiology of geriatric patients presenting to EDs with type II OFs and determine whether surgical management was associated with early adverse outcomes such as in-hospital mortality and discharge to skilled nursing facilities (SNF). STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE Data was used from the 2016-2020 Nationwide Emergency Department Sample. Patient encounters corresponding to type II OFs were identified. Patients younger than 65 at the time of presentation to the ED and those with concomitant spinal pathology were excluded. OUTCOME MEASURES The association between the surgical management of geriatric type II OFs and outcomes such as in-hospital mortality and discharge to SNFs. METHODS Patient, fracture, and surgical management characteristics were recorded. A propensity score matched cohort was constructed to reduce differences in age, comorbidities, and injury severity between patients undergoing operative and nonoperative management. Additionally, to develop a positive control for the analysis of geriatric patients with type II OFs and no other concomitant spinal pathology, a cohort of patients that had been excluded due to the presence of a concomitant spinal cord injury (SCI) was also constructed. Multivariate regressions were then performed on both the matched and unmatched cohorts to ascertain the associations between surgical treatment and in-hospital mortality, inpatient length of stay, encounter charges, and discharge to SNFs. RESULTS A total of 11,325 encounters were included. The mean total charge per encounter was $60,221. 634 (5.6%) patients passed away during their encounters. In total, 1,005 (8.9%) patients were managed surgically. Surgical management of type II OFs was associated with a 316% increase in visit charge (95% CI: 291%-341%, p<.001), increased inpatient length of stay (IRR: 2.87, 95% CI: 2.62-3.12, p<.001), and increased likelihood of discharge to SNFs (OR=2.62, 95% CI: 2.26-3.05, p<.001), but decreased in-hospital mortality (OR=0.32, CI: 0.21-0.45, p<.001). The propensity score matched cohort consisted of 2,010 patients, matching each of the 1,005 that underwent surgery to 1,005 that did not. These cohorts were well balanced across age (78.24 vs 77.91 years), Elixhauser Comorbidity Index (3.68 vs 3.71), and Injury Severity Score (30.15 vs 28.93). This matching did not meaningfully alter the associations determined between surgical management and in-hospital mortality (OR=0.34, CI=0.21-0.55, p<.001) or SNF discharge (OR=2.59, CI=2.13-3.16, p<.001). Lastly, the positive control cohort of patients with concurrent SCI had higher rates of SNF discharge (50.0% vs 42.6%, p<.001), surgical management (32.3% vs 9.7%, p<.001), and in-hospital mortality (28.9% vs 5.6%, p<.001). CONCLUSIONS This study lends insight into the epidemiology of geriatric type II OFs and quantifies risk factors influencing adverse outcomes. Patient informed consent should include a discussion of the protective association between definitive surgical management and in-hospital mortality against potential operative morbidity, increased lengths of hospital stay, and increased likelihood of discharge to SNFs. This information may impact patient treatment selection and decision making.
Collapse
Affiliation(s)
- Thomas Johnstone
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA.
| | - Vaibhavi Shah
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Ethan Schonfeld
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Sina Sadeghzadeh
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Ghani Haider
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Martin Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Anand Veeravagu
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| |
Collapse
|
2
|
Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World Neurosurg 2024; 184:112-118. [PMID: 38266989 DOI: 10.1016/j.wneu.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. METHODS We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. RESULTS We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. CONCLUSIONS Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
Collapse
Affiliation(s)
- Alessandro Frati
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Cimatti
- Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Hernán Ileyassoff
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Capobianco
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
3
|
Lim P, Clark AJ, Deviren V, Berven SH, Burch S, Ames CP, Theologis AA. Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center's 11-year experience. Spine Deform 2024; 12:463-471. [PMID: 38157096 PMCID: PMC10866802 DOI: 10.1007/s43390-023-00800-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To define the prevalence, characteristics, and treatment approach for proximal junction failure secondary to odontoid fractures in patients with prior C2-pelvis posterior instrumented fusions (PSF). METHODS A single institution's database was queried for multi-level fusions (6+ levels), including a cervical component. Posterior instrumentation from C2-pelvis and minimum 6-month follow-up was inclusion criteria. Patients who sustained dens fractures were identified; each fracture was subdivided based on Anderson & D'Alonzo and Grauer's classifications. Comparisons between the groups were performed using Chi-square and T tests. RESULTS 80 patients (71.3% female; average age 68.1 ± 8.1 years; 45.0% osteoporosis) were included. Average follow-up was 59.8 ± 42.7 months. Six patients (7.5%) suffered an odontoid fracture post-operatively. Cause of fracture in all patients was a mechanical fall. Average time to fracture was 23 ± 23.1 months. Average follow-up after initiation of fracture management was 5.84 ± 4 years (minimum 1 year). Three patients sustained type IIA fractures one of which had a concomitant unilateral C2 pars fracture. Three patients sustained comminuted type III fractures with concomitant unilateral C2 pars fractures. Initial treatment included operative care in 2 patients, and an attempt at non-operative care in 4. Non-operative care failed in 75% of patients who ultimately required revision with proximal extension. All patients with a concomitant pars fracture had failure of non-operative care. Patients with an intact pars were more stable, but 50% required revision for pain. CONCLUSIONS In this 11-year experience at a single institution, the prevalence of odontoid fractures above a C2-pelvis PSF was 7.5%. Fracture morphology varied, but 50% were complex, comminuted C2 body fractures with concomitant pars fractures. While nonoperative management may be suitable for type II fractures with simple patterns, more complex and unstable fractures likely benefit from upfront surgical intervention to prevent fracture displacement and neural compression. As all fractures occurred secondary to a mechanical fall, inpatient and community measures aimed to minimize risk and prevent mechanical falls would be beneficial in this high-risk group.
Collapse
Affiliation(s)
- Perry Lim
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA
| | - Shane Burch
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA
| | | | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA.
| |
Collapse
|
4
|
Foote CW, Salottolo K, Doan XL, Vanier C, Betancourt AJ, Bar-Or D, Palacio CH. Operative Management Improves Near-term Survival of Patients With Odontoid Type II Fractures: A Propensity-matched National Registry Analysis. Clin Spine Surg 2024; 37:15-22. [PMID: 37651564 PMCID: PMC10810352 DOI: 10.1097/bsd.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN National Trauma Data Bank (NTDB) review and propensity-matched analysis. OBJECTIVE To evaluate differences in clinical outcomes by operative management. SUMMARY OF BACKGROUND DATA Odontoid type II fractures are the most prevalent cervical fracture. Operative intervention on these fractures is frequently debated; surgical risks are compounded by clinical severity, patient age, and comorbidities. METHODS This registry review included index admissions for odontoid type II fractures [International Classification of Diseases (ICD)-10 codes beginning with S12.11] from 1/1/2017 to 1/1/2020; patients who died in the emergency department (ED) were excluded. Propensity score techniques were used to match patients 1:1 by surgical management, using a caliper distance of 0.05, after matching on the following covariates that differed significantly between surgical and nonsurgical patients: age, sex, race, cause of injury, transfer status, injury severity score, ED Glasgow coma score, ED systolic blood pressure, presence of transverse ligamentous injury, cervical dislocation, and 8 comorbidities. The following outcomes were analyzed with McNemar tests and Wilcoxon signed-rank tests: near-term survival (discharged from the hospital to locations other than morgue or hospice), intensive care unit (ICU) admission, hospital complications, median hospital length of stay (LOS), and median ICU LOS. RESULTS There were 16,607 patients, 2916 (17.6%) were operatively managed and 13,691 were nonoperatively managed. Before matching, survival was greater for patients managed operatively compared with nonoperatively (95.0% vs. 88.2%). The matched population consisted of 5334 patients: 2667 patients in the operative group (91.5% of this population) and 2667 well-matched patients in the nonoperative group. After matching, there was a survival benefit for patients who were operatively managed compared with nonoperative management (94.8% vs. 91.4% P <0.001). However, operative management was associated with greater development of complications, ICU admission, and longer hospital and ICU LOS. CONCLUSION Compared with nonoperative management, operative management demonstrated a significant near-term survival benefit for patients with odontoid type II fractures in select patients. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Christopher W. Foote
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
- Valley Health System General Surgery Residency Program, Las Vegas, NV
| | | | - Xuan-Lan Doan
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
- Valley Health System General Surgery Residency Program, Las Vegas, NV
| | - Cheryl Vanier
- Touro University Nevada College of Osteopathic Medicine, Henderson, NV
| | | | - David Bar-Or
- Trauma Research Department, McAllen Medical Center, McAllen, TX
| | - Carlos H. Palacio
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
| |
Collapse
|
5
|
Goh BC, Issa TZ, Lee Y, Vaccaro AR, Sebastian AS. Evidence and Controversies in Geriatric Odontoid Fracture Management. J Am Acad Orthop Surg 2024; 32:e84-e94. [PMID: 37793151 DOI: 10.5435/jaaos-d-23-00389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/26/2023] [Indexed: 10/06/2023] Open
Abstract
Geriatric odontoid fractures are some of the most common spine injuries in our aging population, and their prevalence is only continuing to increase. Despite several investigational studies, treatment remains controversial and there is limited conclusive evidence regarding the management of odontoid fractures. These injuries typically occur in medically complex and frail geriatric patients with poor bone quality, making their treatment particularly challenging. In this article, we review the evidence for conservative management as well as surgical intervention and discuss various treatment strategies. Given the high morbidity and mortality associated with odontoid fractures in the elderly, thoughtful consideration and an emphasis on patient-centered goals of treatment are critical to maximize function in this vulnerable population.
Collapse
|
6
|
Müller JU, Nowak S, Matthes M, Pillich DT, Schroeder HWS, Müller J. Biomechanical comparison of two different compression screws for the treatment of odontoid fractures in human dens axis specimen. Clin Biomech (Bristol, Avon) 2024; 111:106162. [PMID: 38159327 DOI: 10.1016/j.clinbiomech.2023.106162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Lag screw osteosynthesis for odontoid fractures has a high rate of pseudoarthrosis, especially in elderly patients. Besides biomechanical properties of the different screw types, insufficient fragment compression or unnoticed screw stripping may be the main causing factors for this adverse event. The aim of the study was to compare two screws in clinical use with different design principles in terms of compression force and stability against screw stripping. METHODS Twelve human cadaveric C2 vertebral bodies were considered. Bone density was determined. The specimens were matched according to bone density and randomly assigned to two experimental groups. An odontoid fracture was induced, which were fixed either with a 3.5 mm standard compression screw or with a 5 mm sleeve nut screw. Both screws are certified for the treatment of odontoid fractures. The bone samples were fixed in a measuring device. The screwdriver was driven mechanically. The tests were analyzed for peak interfragmentary compression and screw-in torque with a frequency of 20 Hz. FINDINGS The maximum fragment compression was significantly higher with screw with sleeve nut at 346.13(SD ±72.35) N compared with classic compression screw at 162.68(SD ±114.13) N (p = 0.025). Screw stripping occurred significantly earlier in classic compression screw at 255.5(SD ±192.0)° rotation after reaching maximum compression than in screw with sleeve nut at 1005.2(SD ±341.1)° (p = 0.0039). INTERPRETATION Screw with sleeve nut achieves greater fragment compression and is more robust to screw stripping compared to classic compression screw. Whether the better biomechanical properties lead to a reduction of pseudoarthrosis has to be proven in clinical studies.
Collapse
Affiliation(s)
- Jan-Uwe Müller
- Department of Neurosurgery, University Medicine, Greifswald, Germany.
| | - Stephan Nowak
- Department of Neurosurgery, University Medicine, Greifswald, Germany
| | - Marc Matthes
- Department of Neurosurgery, University Medicine, Greifswald, Germany
| | | | | | - Jonas Müller
- Department of Neurosurgery, University Medicine, Greifswald, Germany
| |
Collapse
|
7
|
Ammanuel SG, Page PS, Brooks NP, Resnick DK. Development of a Predictive Model for Persistent Instability Following Conservative Management of Type II Odontoid Fractures. World Neurosurg 2024; 181:e422-e426. [PMID: 37863424 DOI: 10.1016/j.wneu.2023.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Odontoid fractures are common cervical spine fractures; however, significant controversy exists regarding their treatment. Risk factors for failure of conservative therapy have been identified, although no predictive risk score has been developed to aid in decision-making. METHODS A retrospective review was conducted of all patients evaluated at a level 1 trauma center. Patients identified with type II odontoid fractures as classified by the D'Alonzo Classification system who were treated with external orthosis were included in analysis. Patients were considered to have failed conservative therapy if they were offered surgical intervention. A machine learning method (Risk-SLIM) was then utilized to create a risk stratification score based on risk factors to identify patients at high risk for requiring surgical intervention due to persistent instability. RESULTS A total of 138 patients were identified as presenting with type II odontoid fractures that were treated conservatively; 38 patients were offered surgery for persistent instability. The Odontoid Fracture Predictive Model (OFPM) was created using a machine learning algorithm with a 5-fold cross validation area under the curve of 0.7389 (95% CI: 0.671 to 0.808). Predictive factors were found to include fracture displacement, displacement greater than 5 mm, comminution at the fracture base, and history of smoking. The probability of persistent instability was <5% with a score of 0 and 88% with a score of 5. CONCLUSIONS The OFPM model is a unique, quick, and accurate tool to assist in clinical decision-making in patients with type II odontoid fractures. External validation is necessary to evaluate the validity of these findings.
Collapse
Affiliation(s)
- Simon G Ammanuel
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.
| | - Paul S Page
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Nathaniel P Brooks
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Daniel K Resnick
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| |
Collapse
|
8
|
Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis: Corrigendum. Neurosurgery 2023; 93:e177. [PMID: 37782108 DOI: 10.1227/neu.0000000000002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
|
9
|
Diaz S, Zenkhri S, Omoumi P, Maeder B, Penet N, Rothenfluh D, Barges-Coll J. C2 Odontoid Fracture Associated with C1-C2 Rotatory Dislocation: A Retrospective Analysis of 2 Surgical Techniques. World Neurosurg 2023; 180:e460-e467. [PMID: 37777174 DOI: 10.1016/j.wneu.2023.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Odontoid fractures in association with a C1-C2 rotatory luxation reports are seldom found in the literature. The fusion between the lateral mass of C1 and C2 could be of interest to ensure adequate treatment in these particular cases. We report 23 cases where there was coexistence of an odontoid fracture and rotatory subluxation, which were treated surgically using cages between C1 and C2 or just traditional Goel-Harms technique. We evaluated the radiologic fusion rate, reoperation rate, and complications. METHODS This was a single-center, retrospective, cohort study of patients with C2 fractures (mixed type and C1-C2 rotatory luxation according to the Fielding classification) who were treated surgically. Radiologic computed tomography scans were used to assess fusion (presence of bridging trabecular bone end plate or pseudoarthrosis) between 6 months and 1.5 years after the surgery. RESULTS Twenty-three patients were diagnosed with C2 fractures and C1-C2 rotatory luxation that were treated surgically and were suitable for the analysis; 11 patients underwent C1-C2 fusion with intra-articular cages, and 12 underwent a classical Goel-Harms technique. The fusion rate at the C1-C2 joint was higher in the cages group. Only 12 patients exhibited fusion at the level of the odontoid fracture. CONCLUSIONS C2 fractures associated with C1-C2 rotatory dislocation are rare. The fusion rate at the level of the odontoid in these patients appears to be lower than that reported in patients without rotatory dislocation. It may be of special interest to obtain a clear fusion at the C1-C2 joint, where this type of implant seems to offer an advantage.
Collapse
Affiliation(s)
- Simon Diaz
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland; Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Salim Zenkhri
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Benoit Maeder
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Penet
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Dominique Rothenfluh
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Juan Barges-Coll
- Spine Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| |
Collapse
|
10
|
Ai Y, Alemayehu DG, Mao G, Liang Y, Cao R, Hu J, Yang Y, Ren Z. Feasibility of Two-Screw Anterior Fixation for Odontoid Fractures in a Chinese Population: A Morphometric Study Based on Computed Tomography. Clin Orthop Surg 2023; 15:983-988. [PMID: 38045572 PMCID: PMC10689213 DOI: 10.4055/cios23094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 12/05/2023] Open
Abstract
Background To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new measurement strategy to guide screw insertion in treating these fractures. Methods A retrospective review of cervical computed tomographic scans of 128 patients (aged 18-76 years; men, 55 [43.0%]) was performed. The minimum external transverse diameter (METD), minimum external anteroposterior diameter (MEAD), maximum screw length (MSL), and screw projection back angle (SPBA) of the odontoid process were measured on coronal and sagittal CT images. Results The mean values of METD and MEAD were 10.0 ± 1.1 mm and 12.0 ± 1.0 mm, respectively, in men and 9.2 ± 1.0 mm and 11.0 ± 1.0 mm, respectively, in women. Both measurements were significantly higher in men (p < 0.001). In total, 87 individuals (68%) had METD > 9.0 mm that could accommodate two 3.5-mm cortical screws. The mean MSL value and SPBA range were 34.4 ± 2.9 mm and 13.5°-24.2°, respectively, with no statistically significant difference between men and women. Conclusions The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fractures in 87 patients (68%) in our study, and there was a statistically significant difference between men and women.
Collapse
Affiliation(s)
- Yixiang Ai
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dereje Gobena Alemayehu
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Genwen Mao
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | | | - Ran Cao
- Xi’an Jiaotong University, Xi’an, China
| | - Jiale Hu
- Xi’an Jiaotong University, Xi’an, China
| | - Yimin Yang
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhiwei Ren
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
11
|
Jung MK, Hörnig L, Raisch P, Grützner PA, Kreinest M. Odontoid fracture in geriatric patients - analysis of complications and outcome following conservative treatment vs. ventral and dorsal surgery. BMC Geriatr 2023; 23:748. [PMID: 37968595 PMCID: PMC10652439 DOI: 10.1186/s12877-023-04472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Different treatment options are discussed for geriatric odontoid fracture. The aim of this study was to compare the treatment options for geriatric odontoid fractures. METHODS Included were patients with the following criteria: age ≥ 65 years, identification of seniors at risk (ISAR score ≥ 2), and odontoid fracture type A/B according to Eysel and Roosen. Three groups were compared: conservative treatment, surgical therapy with ventral screw osteosynthesis or dorsal instrumentation. At a follow-up examination, the range of motion and the trabecular bone fracture healing rate were evaluated. Furthermore, demographic patient data, neurological status, length of stay at the hospital and at the intensive care unit (ICU) as well as the duration of surgery and occurring complications were analyzed. RESULTS A total of 72 patients were included and 43 patients could be re-examined (range: 2.7 ± 2.1 months). Patients with dorsal instrumentation had a better rotation. Other directions of motion were not significantly different. The trabecular bone fracture healing rate was 78.6%. The patients with dorsal instrumentation were hospitalized significantly longer; however, their duration at the ICU was shortest. There was no significant difference in complications. CONCLUSION Geriatric patients with odontoid fracture require individual treatment planning. Dorsal instrumentation may offer some advantages.
Collapse
Affiliation(s)
- Matthias K Jung
- Department of Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen, Germany.
| | - Lukas Hörnig
- Department of Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| | - Philipp Raisch
- Department of Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| | - Paul A Grützner
- Department of Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| | - Michael Kreinest
- Department of Trauma and Orthopaedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| |
Collapse
|
12
|
Sowa D, Guzik G, Daniel P, Bronisz M, Merkiel D. Outcomes of Odontoid Process Fracture Surgery. Ortop Traumatol Rehabil 2023; 25:249-257. [PMID: 38088099 DOI: 10.5604/01.3001.0053.9673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Odontoid fractures are found in two age groups. In younger patients, they occur following traffic accidents, falls from a height and during sports. In older patients with poor bone quality, they are usually caused by falls from one's own height. Most fractures are stable and do not require surgical treatment. Unstable, severely displaced fractures with neurological deficits require surgical treatment. The aim of the study was to evaluate the surgical and functional outcomes of treatment of odontoid fractures with a cannulated screw. MATERIALS AND METHODS The study enrolled 20 patients that underwent surgery in the years 2020-2022. The patients were divided into two groups: below 60 (group A) and over 60 years of age (group B). Patients were assessed at one day pre-op, one day post-op, 6 weeks following surgery and 3 months following surgery. Imaging studies were performed to assess the angulation and degree of displacement of bone fragments. After the fracture was surgically fixed with a cannulated screw, bone union and the stability of fracture fixation were assessed. Preoperative and postoperative pain intensity as per a VAS, functional status assessed with the NDI questionnaire, quality of life (EQ-VAS) and neurological status (ASIA scale) were compared. RESULTS Good functional and surgical results were obtained in both groups of patients. Performance and quality of life improved, while pain intensity decreased in all patients. In 3 patients with post-traumatic paresis, the dysfunctions gradually subsided. No general medical or perioperative complications were observed. Bone union of the fracture was achieved in 40% of patients in group B and in 80% in group A. Achieving union did not determine the functional status of patients. On functional radiographs, all places of fixation were stable. CONCLUSIONS 1. Odontoid fracture fixation with a single cannulated screw is a safe method of treatment. It provided a high union rate and good stability of the fracture. 2. Fracture non-union was noted more often in the group of older patients, but it did not negatively impact quality of life and performance.
Collapse
Affiliation(s)
- Dariusz Sowa
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Grzegorz Guzik
- Odział Ortopedii Onkologicznej Szpitala Specjalistycznego w Brzozowie - Podkarpacki Ośrodek Onkologiczny, Rzeszów, Polska / Orthopaedic Oncology Department, Subcarpathian Oncology Centre in Brzozów, Rzeszów University of Technology, Rzeszów, Poland
| | - Pyrka Daniel
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Michał Bronisz
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Dawid Merkiel
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| |
Collapse
|
13
|
Huybregts JGJ, Barot KA, Recio C, Doucette J, Mekary RA, Vleggeert-Lankamp CLA. The optimal treatment of type II and III odontoid fractures in the elderly: an updated meta-analysis. Eur Spine J 2023; 32:3434-3449. [PMID: 37439865 DOI: 10.1007/s00586-023-07779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Odontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the outcome of surgical and conservative treatments in elderly (≥ 65 years), by updating a systematic review published by the authors in 2013. METHODS A comprehensive search was conducted in seven databases. Clinical outcome was the primary outcome. Fracture union- and stability were secondary outcomes. Pooled point estimates and their respective 95% confidence intervals (CIs) were derived using the random-effects model. A random-effects multivariable meta-regression model was used to correct for baseline co-variates when sufficiently reported. RESULTS Forty-one studies met the inclusion criteria, of which forty were case series and one a cohort study. No clinical differences in outcomes including the Neck Disability Index (NDI, 700 patients), Visual Analogue Scale pain (VAS, 180 patients), and Smiley-Webster Scale (SWS, 231 patients) scores were identified between surgical and conservative treatments. However, fracture union was higher in surgically treated patients (pooled incidence 72.7%, 95% CI 66.1%, 78.5%, 31 studies, 988 patients) than in conservatively treated patients (40.2%, 95% CI 32.0%, 49.0%, 22 studies, 912 patients). This difference remained after correcting for age and fracture type. Fracture stability (41 studies, 1917 patients), although numerically favoring surgery, did not appear to differ between treatment groups. CONCLUSION While surgically treated patients showed higher union rates than conservatively treated patients, no clinically relevant differences were observed in NDI, VAS pain, and SWS scores and stability rates. These results need to be further confirmed in well-designed comparative studies with proper adjustment for confounding, such as age, fracture characteristics, and osteoporosis degree.
Collapse
Affiliation(s)
- Jeroen G J Huybregts
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland, The Hague, The Netherlands.
| | | | - Camila Recio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rania A Mekary
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- School of Pharmacy, MCPHS University, Boston, MA, USA
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurosurgery, Spaarne Hospital Haarlem/Hoofddorp, Hoofddorp, The Netherlands
| |
Collapse
|
14
|
Cloney M, Thirunavu V, Roumeliotis A, Azad H, Shlobin NA, Swong K, El Tecle N, Dahdaleh NS. Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis. Neurosurgery 2023; 93:546-554. [PMID: 37306435 PMCID: PMC10400064 DOI: 10.1227/neu.0000000000002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Existing literature suggests that surgical intervention for odontoid fractures is beneficial but often does not control for known confounding factors. OBJECTIVE To examine the effect of surgical fixation on myelopathy, fracture nonunion, and mortality after traumatic odontoid fractures. METHODS We analyzed all traumatic odontoid fractures managed at our institution between 2010 and 2020. Ordinal multivariable logistic regression was used to identify factors associated with myelopathy severity at follow-up. Propensity score analysis was used to test the treatment effect of surgery on nonunion and mortality. RESULTS Three hundred and three patients with traumatic odontoid fracture were identified, of whom 21.6% underwent surgical stabilization. After propensity score matching, populations were well balanced across all analyses (Rubin's B < 25.0, 0.5 < Rubin's R < 2.0). Controlling for age and fracture angulation, type, comminution, and displacement, the overall rate of nonunion was lower in the surgical group (39.7% vs 57.3%, average treatment effect [ATE] = -0.153 [-0.279, -0.028], P = .017). Controlling for age, sex, Nurick score, Charlson Comorbidity Index, Injury Severity Score, and selection for intensive care unit admission, the mortality rate was lower for the surgical group at 30 days (1.7% vs 13.8%, ATE = -0.101 [-0.172, -0.030], P = .005) and at 1 year was 7.0% vs 23.7%, ATE = -0.099 [-0.181, -0.017], P = .018. Cox proportional hazards analysis also demonstrated a mortality benefit for surgery (hazard ratio = 0.587 [0.426, 0.799], P = .0009). Patients who underwent surgery were less likely to have worse myelopathy scores at follow-up (odds ratio = 0.48 [0.25, 0.93], P = .029). CONCLUSION Surgical stabilization is associated with better myelopathy scores at follow-up and causes lower rates of fracture nonunion, 30-day mortality, and 1-year mortality.
Collapse
Affiliation(s)
- Michael Cloney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anastasios Roumeliotis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hooman Azad
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Swong
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
15
|
Dantas FLR, Dantas F, Cariri GA, Caires ACV, Reis MTDSE, Botelho RV. Type II Odontoid Fractures: Is the Anterior Screw a Good Solution for all Patients? A Case Series of 60 Consecutive Patients. World Neurosurg 2023; 176:e535-e542. [PMID: 37268191 DOI: 10.1016/j.wneu.2023.05.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Type II odontoid fracture is the most common fracture type, and its treatment remains challenging. The objective of this study was to evaluate the results of anterior screw fixation for type II odontoid fractures in patients aged over and below 60 years. METHODS A retrospective analysis of consecutive patients diagnosed with type II odontoid fractures who were surgically treated using the anterior approach by a single surgeon was conducted. Demographic characteristics, including age, sex, type of fracture, time from trauma to surgery, length of stay (LoS), fusion rate, complications, and reoperation, were evaluated. Surgical outcomes were compared between patients over and below 60 years of age. RESULTS Sixty consecutive patients underwent odontoid anterior fixation during the analysis period. The mean age of patients was 49.58 ± 23.22 years. Twenty-three (38.3%) patients were aged over 60 years, and the minimum follow-up period was two years. Of the patients, 93.3% developed bone fusion, which was observed in 86.9% of patients over 60 years. Complications related to hardware failure occurred in six (10%) patients. Transient dysphagia was observed in 10% of the cases. Three (5%) patients required reoperation. Patients over 60 years had a significantly increased risk of dysphagia compared with those below 60 years (P = 0.0248). There was no significant difference between the groups regarding nonfusion rate, reoperation rate, or LoS. CONCLUSIONS Anterior fixation of the odontoid showed high fusion rates with a low rate of complications. It is a technique to be considered for treating type II odontoid fractures in selected cases.
Collapse
Affiliation(s)
- Fernando Luiz Rolemberg Dantas
- Department of Neurosurgery, Biocor Instituto/Rede D'Or, Minas Gerais, Brazil; Graduation in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Minas Gerais, Brazil.
| | - François Dantas
- Department of Neurosurgery, Biocor Instituto/Rede D'Or, Minas Gerais, Brazil; Graduation in Health Sciences, IAMSPE, São Paulo, Brazil
| | - Gustavo Agra Cariri
- Department of Neurosurgery, Biocor Instituto/Rede D'Or, Minas Gerais, Brazil
| | | | | | | |
Collapse
|
16
|
Eun J, Oh Y. Traumatic lateral atlantoaxial dislocation combined with a type II odontoid fracture in a patient with ankylosing spondylitis: A case report. Medicine (Baltimore) 2022; 101:e30912. [PMID: 36221340 PMCID: PMC9542739 DOI: 10.1097/md.0000000000030912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RATIONALE Traumatic lateral atlantoaxial dislocation (AAD) combined with an odontoid fracture is extremely rare. The standards applicable to management of the traumatic lateral AAD are still in flux due to the infrequency of this injury. PATIENT CONCERNS We present a unique case of traumatic lateral AAD combined with a type II odontoid fracture in a patient with ankylosing spondylitis (AS). DIAGNOSIS Spinal computed tomography showed ankylosis of the entire spine from the sacroiliac joint to the cervical spine. On the cervical X-ray the head was rotated to the right with anterior subluxation of the C1 and odontoid tip relative to C2. The coronal computed tomography (CT) scan also revealed left lateral dislocation of C1 on C2 with a horizontal translation of the odontoid tip. On the axial and sagittal CT scan, the left C1 lateral mass was displaced anteriorly and locked by C2 body. INTERVENTIONS We performed occipito-cervical fusion (OCF) after successful manual reduction under general anesthesia. OUTCOMES The patient's recovery from surgery was uneventful and without complication. At the 3 year follow-up the patient was asymptomatic and reportedly satisfied with the surgery. LESSONS Traumatic AAD with an odontoid fracture is an exceedingly uncommon cervical spine injury. A lateral subluxation with a type II odontoid fracture in a patient with AS is rarer still, so much so that this type of subluxation was not classifiable using any of the previously developed classification systems. In this patient with AS, posterior OCF with internal fixation was necessary to avoid hardware failure, particularly in light of the intensive stress caused by AS.
Collapse
Affiliation(s)
- Jongpil Eun
- Department of Neurosurgery, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Youngmin Oh
- Department of Neurosurgery, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- * Correspondence: Youngmin Oh, Department of Neurosurgery, Jeonbuk National University Medical School/Hospital, Geonjiro 20, Deokjingu, Jeonju, 54907, South Korea (e-mail: )
| |
Collapse
|
17
|
Sawarkar DP, Singh PK, Agrawal D, Satyarthee GD, Gupta DK, Tandon V, Gurjar HK, Borkar S, Jagdevan A, Mishra S, Kedia S, Sharma R, Doddamani R, Verma S, Meena R, Kumar R, Chandra PS, Kale SS. O-Arm Assisted Anterior Odontoid Screw Fixation in Type II and Rostral Type III Odontoid Fractures: Single Center Surgical Series of 50 Patients. Neurol India 2022; 70:S135-S143. [PMID: 36412360 DOI: 10.4103/0028-3886.360924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Accuracy of screw placement is one of the important factors necessary for adequate union in odontoid fractures with malposition rates as high as 27.2% with standard techniques. OBJECTIVE To evaluate efficacy of intraoperative O-arm assistance in improving accuracy of anterior odontoid screw placement and clinco-radiological outcome in type II and III odontoid fractures. MATERIAL AND METHODS In this retrospective study, surgery consisted of anterior odontoid screw fixation under intraoperative O-arm assistance over 5 years. Demographical, clinical, radiological, operative details and postoperative events were retrieved from hospital database and evaluated for fusion and surgical outcome. RESULTS 50 patients (Mean age 34.6 years, SD 14.10, range: 7-70 years; 44 males and 6 females) with Type II and Type III odontoid fracture underwent O-arm assisted anterior screw placement. The mean interval between injury and surgery was 12 days (range 1-65 days). Mean operating time was 132.2 min ± SD 33.56 with average blood loss of 93 ml. ±SD 61.46. With our technique, accurate screw placement was achieved in 100% patients. At the mean follow-up of 26.4 month (SD13.75), overall acceptable fusion rate was 97.8% with non-union in 2.2% patients. Morbidity occurred in two patients; one patient developed fixation failure while other patient had nonunion which was managed with posterior C1-C2 arthrodesis. We had surgical mortality in one patient due to SAH. So overall our procedure was successful in 94% patients and among patients whose follow-up was available, acceptable fusion rates of 97.8% were achieved. CONCLUSION We conclude that use of intraoperative three-dimensional imaging using O-arm for anterior odontoid screw fixation improves accuracy and leads to improved radiological and clinical outcomes. It further enables us to extend the indications of odontoid screw fixation to selected complex Type II and rostral Type III odontoid fractures.
Collapse
Affiliation(s)
| | - Pankaj Kumar Singh
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Kumar Gupta
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Kumar Gurjar
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Borkar
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Jagdevan
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Kedia
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Sharma
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Kumar
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
18
|
Woodfield J, Edlmann E, Black PL, Boyd J, Copley PC, Cranswick G, Eborall H, Keerie C, Khan S, Lawton J, Lowe DJ, Norrie J, Niven A, Reed MJ, Shenkin SD, Statham P, Stoddart A, Tomlinson J, Brennan PM. Duration of External Neck Stabilisation (DENS) following odontoid fracture in older or frail adults: protocol for a randomised controlled trial of collar versus no collar. BMJ Open 2022; 12:e057753. [PMID: 35840308 PMCID: PMC9295672 DOI: 10.1136/bmjopen-2021-057753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Fractures of the odontoid process frequently result from low impact falls in frail or older adults. These are increasing in incidence and importance as the population ages. In the UK, odontoid fractures in older adults are usually managed in hard collars to immobilise the fracture and promote bony healing. However, bony healing does not always occur in older adults, and bony healing is not associated with quality of life, functional, or pain outcomes. Further, hard collars can cause complications such as skin pressure ulcers, swallowing difficulties and difficulties with personal care. We hypothesise that management with no immobilisation may be superior to management in a hard collar for older or frail adults with odontoid fractures. METHODS AND ANALYSES This is the protocol for the Duration of External Neck Stabilisation (DENS) trial-a non-blinded randomised controlled trial comparing management in a hard collar with management without a collar for older (≥65 years) or frail (Rockwood Clinical Frailty Scale ≥5) adults with a new odontoid fracture. 887 neurologically intact participants with any odontoid process fracture type will be randomised to continuing with a hard collar (standard care) or removal of the collar (intervention). The primary outcome is quality of life measured using the EQ-5D-5L at 12 weeks. Secondary outcomes include pain scores, neck disability index, health and social care use and costs, and mortality. ETHICS AND DISSEMINATION Informed consent for participation will be sought from those able to provide it. We will also include those who lack capacity to ensure representativeness of frail and acutely unwell older adults. Results will be disseminated via scientific publication, lay summary, and visual abstract. The DENS trial received a favourable ethical opinion from the Scotland A Research Ethics Committee (21/SS/0036) and the Leeds West Research Ethics Committee (21/YH/0141). TRIAL REGISTRATION NUMBER NCT04895644.
Collapse
Affiliation(s)
- Julie Woodfield
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Ellie Edlmann
- Southwest Neurosurgical Centre, Derriford Hospital, Plymouth, UK
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Polly L Black
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - Gina Cranswick
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Helen Eborall
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Sadaquate Khan
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Julia Lawton
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - David J Lowe
- Department of Emergency, Queen Elizabeth University Hospital Campus, Glasgow, UK
- University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Angela Niven
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Susan Deborah Shenkin
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Advanced Care Research Centre, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Patrick Statham
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Health Services Research Unit, The University Of Edinburgh, Edinburgh, UK
| | - James Tomlinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| |
Collapse
|
19
|
Asada T, Koda M, Teramura S, Sugita S, Matsuoka R, Yamazaki M. Cervical Myelopathy due to Odontoid Fracture Induced by Spinal Involvement of Xanthoma Disseminatum: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00004. [PMID: 35809027 DOI: 10.2106/jbjs.cc.21.00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 47-year-old Japanese woman with a medical history of xanthoma disseminatum (XD) presented with posterior neck pain and abnormal gait without a history of trauma. Imaging studies revealed odontoid process thinning resulting in its fracture due to XD involvement in the atlantoaxial joint and subsequent cervical myelopathy. Posterior C1-C2 fusion surgery improved the patient's symptoms. An XD lesion around the odontoid process was confirmed intraoperatively. CONCLUSION We report cervical myelopathy caused by XD involvement in the C1-C2 joint, showing that early fusion surgery is critical for treating pathological fractures in patients with XD.
Collapse
Affiliation(s)
- Tomoyuki Asada
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shin Teramura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shohei Sugita
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryota Matsuoka
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
20
|
Kotheeranurak V, Pholprajug P, Jitpakdee K, Pruttikul P, Chitragran R, Singhatanadgige W, Limthongkul W, Yingsakmongkol W, Kim J. Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique. Orthop Surg 2022; 14:990-996. [PMID: 35445547 PMCID: PMC9087464 DOI: 10.1111/os.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE First, to propose a novel minimally invasive technique of full-endoscopic anterior odontoid fixation (FEAOF) that aims to reduce the risk of retropharyngeal approach (both open and percutaneous techniques) to anterior odontoid screw fixation. Second, to describe steps of the procedure and, lastly, to report the initial outcomes in patients treated with this novel technique. METHODS Four non-consecutive patients who were diagnosed with a displaced odontoid fracture (Anderson-D'Alonzo classification type II and Grauer subclassification type A or B) from 2019 to 2020 underwent surgical fixation by our novel technique for anterior odontoid screw fixation. A detailed technical approach of FEAOF for the surgical treatment of type II odontoid fractures was described, and the patients' outcomes based on postoperative radiographic results including computed tomography (CT), clinical outcome parameters including visual analogue scale (VAS) for neck pain both preoperatively and at postoperative follow-up, and range of neck motion at the final follow-up were reported. RESULTS The mean age was 33.5 years (24-41), three patients were male. The mean operative time was 93.75 min, and the mean blood loss was 7.5 ml. An immediate post-operative thin-sliced CT showed that all patients achieved satisfactory reduction and proper screw position. No screw malposition or penetration was found. At a 6-month follow-up, a thin-sliced CT demonstrated solid bony union in every case. The mean VAS for neck pain was reduced from 6.5 to 0.6 at the 6-months follow-up. At the final follow-up, all patients showed improvement in ranges of motion without any complications; however, one patient was lost to follow-up. CONCLUSIONS FEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.
Collapse
Affiliation(s)
- Vit Kotheeranurak
- Department of OrthopaedicsQueen Savang Vadhana Memorial HospitalSrirachaThailand
| | | | - Khanathip Jitpakdee
- Department of OrthopaedicsQueen Savang Vadhana Memorial HospitalSrirachaThailand
| | | | - Roongrath Chitragran
- Department of OrthopaedicsPhramongkutklao hospital and college of medicineBangkokThailand
| | - Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Center of Excellence in Biomechanics and Innovative Spine SurgeryChulalongkorn UniversityBangkokThailand
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Center of Excellence in Biomechanics and Innovative Spine SurgeryChulalongkorn UniversityBangkokThailand
| | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Center of Excellence in Biomechanics and Innovative Spine SurgeryChulalongkorn UniversityBangkokThailand
| | - Jin‐Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, Spine CenterCollege of medicineSeoulSouth Korea
| |
Collapse
|
21
|
Watts A, Athanassacopoulos M, Breakwell L, Chiverton N, Cole A, Ivanov M, Tomlinson J. Management of C2 odontoid peg fragility fractures - A UK survey of spinal surgeons. Injury 2022; 53:1057-1061. [PMID: 34635337 DOI: 10.1016/j.injury.2021.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/23/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients sustaining fragility fractures of the C2 odontoid peg have 30-day mortality rates as high as 10% rising up to 34.1% at 1 year. Substantial controversy exists regarding optimal management of these fractures and there is a lack of national guidance to inform best practice. The aim of this study was to determine current practice in the management of these fractures throughout the United Kingdom. METHODS A UK wide, cross sectional survey was conducted, asking 10 questions regarding the initial management, imaging and follow-up of an elderly patient with a type 2 fragility odontoid peg fracture. This was publicised through the British Orthopaedic Association website and sent to all members of the Society of British Neurological Surgeons (SBNS) via email. RESULTS 107 Responses were received. 56% from orthopaedic consultants, 29% from neurosurgical consultants and 15% from senior spine fellows. 86% (92) of respondents choose treatment with a cervical orthosis, with 84% (77) of these opting for a semi rigid Aspen or Philadelphia collar compared to 16% (15) opting for a soft cervical collar. Three (3%) opted for operative intervention with a further three (3%) choosing Halo fixation. Nine respondents (8%) opted for no orthosis and treatment with analgesia alone. Length of immobilisation in cervical orthosis ranged from 6 to 12 weeks. Initial follow-up ranged from 1 week to 6 weeks, with 6% (6) discharged without follow up. There was also marked variation in the use of follow-up imaging with 17% (18) using plain radiographs, 62% (66) requesting lateral flexion / extension radiographs, 10% (11) using CT and 11% (12) not performing any imaging at final follow up. In 60% (64) of cases respondents did not change subsequent management as a result of imaging. CONCLUSION Type-2 fragility peg fractures have high morbidity and mortality. There is marked variation in the treatment modalities used, follow-up regime and use of imaging throughout the UK. Given the rapidly increasing incidence of these injuries and the associated mortality this should be a high priority field for further research. Further large scale studies are urgently required to inform best practice and standardise management of these injuries.
Collapse
Affiliation(s)
- Anna Watts
- Speciality Registrar Trauma and Orthopaedics, Sheffield Teaching Hospital NHS Foundation Trust, England.
| | | | - Lee Breakwell
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Neil Chiverton
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Ashley Cole
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Marcel Ivanov
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - James Tomlinson
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| |
Collapse
|
22
|
Jung MK, von Ehrlich-Treuenstätt GVR, Jung AL, Keil H, Grützner PA, Schneider NRE, Kreinest M. Evaluation of external stabilization of type II odontoid fractures in geriatric patients-An experimental study on a newly developed cadaveric trauma model. PLoS One 2021; 16:e0260414. [PMID: 34843595 PMCID: PMC8629171 DOI: 10.1371/journal.pone.0260414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background Along with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar. Methods Motion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed. Results The new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°. Conclusions In case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.
Collapse
Affiliation(s)
- Matthias K. Jung
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | | | - Andreas L. Jung
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | | | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
- * E-mail:
| |
Collapse
|
23
|
Chibbaro S, Mallereau CH, Ganau M, Zaed I, Teresa Bozzi M, Scibilia A, Cebula H, Ollivier I, Loit MP, Chaussemy D, Coca HA, Dannhoff G, Romano A, Nannavecchia B, Gubian A, Spatola G, Signorelli F, Iaccarino C, Pop R, Proust F, Baloglu S, Todeschi J. Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome. Neurosurg Rev 2021; 45:709-718. [PMID: 34232408 DOI: 10.1007/s10143-021-01594-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
Odontoid fractures constitute the most common cervical fractures in elderly. External immobilization is the treatment of choice for Type I and III; there is still no wide consensus about the best management of Type II fractures. Observational multicenter study was conducted on a prospectively built database on elderly patients (> 75 years) with Type II odontoid fracture managed conservatively during the last 10 years. All patients underwent CT scan on admission and at 3 months; if indicated, selected patient had CT scan at 6 and 12 months. All patients were clinically evaluated by Neck Disability Index (NDI), Charlson Comorbidity Index (CCI), and American Society of Anaesthesiologists classification (ASA) on admission; NDI was assessed also at 6 weeks, 3, 6, 12, and 24 months; furthermore, a quality of life (QoL) assessment with the SF-12 form was performed at 3 and 12 months. Among the 260 patients enrolled, 177 (68%) were women and 83 (32%) men, with a median age of 83 years. Patients were followed up for a minimum of 24 months: 247 (95%) showed an excellent functional outcome within 6 weeks, among them 117 (45%) showed a good bony healing, whereas 130 (50%) healed in pseudo-arthrosis. The residual 5% were still variably symptomatic at 12 weeks; however, only 5 out of 13 (2% of the total cohort) required delayed surgery. This study showed that a conservative approach to odontoid Type II fracture in elderly is an effective and valid option, resulting in an excellent functional outcome (regardless of bony fusion) in the majority of cases. Failure of conservative treatment can be safely addressed with surgical fixation at a later stage.
Collapse
Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospital, Oxford, UK
| | - Ismail Zaed
- Department of Neurosurgery, Humanitas University Hospital, Rozzano, Italy
| | - Maria Teresa Bozzi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Antonino Scibilia
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Helene Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Irene Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Marie-Pierre Loit
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Chaussemy
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Hugo-Andres Coca
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Romano
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | | | - Arthur Gubian
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Giorgio Spatola
- Department of Neurosurgery, Poli-Ambulanza Hospital, Brescia, Italy
| | | | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Neurosurgery, University Hospital of Modena, Modena, Italy
| | - Raoul Pop
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - François Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Seyyid Baloglu
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
24
|
Ma F, Liao Y, Tang Q, Tang C, Luo N, He H, Yang S, Wang Q, Zhong D. Morphometric Analysis of the Lateral Atlantoaxial Joints in Patients with an Old Type II Odontoid Fracture and Atlantoaxial Dislocation: A Study Based on CT Analysis. Spine (Phila Pa 1976) 2021; 46:726-733. [PMID: 33337679 DOI: 10.1097/brs.0000000000003894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI The morphological features of the lateral atlantoaxial joints (LAJs) in patients with old type II odontoid fractures and atlantoaxial dislocation have not been fully analyzed. Our study found the changes in morphological features of the LAJs in some patients, and revealed the causes and consequences of the changes in morphological features of the LAJs.
Collapse
Affiliation(s)
- Fei Ma
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Tyagi G, Patel KR, Singh GJ, Uppar AM, Beniwal M, Rao KVLN, Pruthi N, Bhat D, Somanna S, Chandramouli B, Dwarakanath S. Anterior Odontoid Screw Fixation for C2 Fractures: Surgical Nuances, Complications, and Factors Affecting Fracture Union. World Neurosurg 2021; 152:e279-e288. [PMID: 34058365 DOI: 10.1016/j.wneu.2021.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Type II odontoid fractures are the commonest C2 fractures. The management of dens fractures remains controversial with various radiological and fracture morphological factors affecting the approach and outcomes. METHODS All cases of anterior odontoid screw fixation between 2010 and 2020 were retrospectively analyzed. Patients' clinical, radiological (type of fracture, orientation, displacement, and diastasis), operative (single vs. double screw) and follow-up records were documented. The postoperative imaging findings were classified into grades I (excellent), II (good), and III (poor) based on the anatomical alignment with the screw. Follow-up cervical computed tomography was reviewed for fracture union. RESULTS A total of 49 patients with a mean age of 37.3 ± 13.8 years were included in the study. The average time from injury to surgery was 23.1 ± 22.2 days. The bicortical screw purchase and superoposterior odontoid tip breach significantly affected the postoperative alignment (P = 0.035 each). Fracture union was noted in 41 (83.7%) patients. The horizontal fracture displacement ≥2.5 mm (P = 0.02) and poor postoperative fracture alignment (P < 0.001) resulted in worse fracture union rates. Transient dysphagia was the commonest complication (n = 12), whereas screw breakout (n = 2) and pullout (n = 2) were other hardware-related complications. One patient underwent re-exploration for screw readjustment and 2 underwent posterior instrumentation. CONCLUSIONS Anterior odontoid screw fixation is technically straightforward, less morbid, and preserves biomechanical cervical mobility, when compared with the posterior instrumentation. With careful patient selection, meticulous surgical planning, and intraoperative image-guided screw insertion, good fracture union outcomes can be obtained. In the current study, we were able to achieve stable fracture union in 83.7% patients.
Collapse
Affiliation(s)
- Gaurav Tyagi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kautilya R Patel
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gyani Jail Singh
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bangalore Chandramouli
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Srinivas Dwarakanath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
| |
Collapse
|
26
|
Tomaszewski R, Sesia SB, Studer D, Rutz E, Mayr JM. Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series. Medicine (Baltimore) 2021; 100:e25334. [PMID: 33787631 PMCID: PMC8021376 DOI: 10.1097/md.0000000000025334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.
Collapse
Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children's Health Centre
- University of Silesia, Faculty of Science and Technology, Institute of Biomedical Engineering, Katowice, Poland
| | - Sergio B. Sesia
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern
| | - Daniel Studer
- Department of Pediatric Orthopedics, University Children's Hospital Basel, University of Basel, Switzerland
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Johannes M. Mayr
- Department of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Switzerland
| |
Collapse
|
27
|
Farah K, Meyer M, Reyre A, Cot K, Fuentes S. PICA injury secondary to anterior odontoid screw fixation: Case report of an exceptional complication. Neurochirurgie 2021; 67:310-314. [PMID: 33753130 DOI: 10.1016/j.neuchi.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Odontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation. CASE DESCRIPTION We report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders. CONCLUSION To the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.
Collapse
Affiliation(s)
- K Farah
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
| | - M Meyer
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - A Reyre
- Endovascular neuroradiology department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - K Cot
- Anesthesiology-intensive care department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - S Fuentes
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| |
Collapse
|
28
|
Yang S, Liu YJ, Jiang WM. Experience in surgical treatment of type Ⅱ odontoid fractures: A report of two cases and review of the literature. Chin J Traumatol 2021; 24:57-62. [PMID: 31757743 PMCID: PMC7878463 DOI: 10.1016/j.cjtee.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 02/04/2023] Open
Abstract
Two cases of type Ⅱ odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type Ⅱ odontoid fracture and a 42-year-old man with fracture end hardened type Ⅱ odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior C1-C2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type Ⅱ odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type Ⅱ odontoid fractures.
Collapse
Affiliation(s)
- Sen Yang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yi-Jie Liu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Wei-Min Jiang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| |
Collapse
|
29
|
Shi L, Deng R, Long QY, Chu L, Yu KX, Xu Z, Deng ZL. Endoscopically-Assisted Percutaneous Unilateral Atlantoaxial Screw-Rod Nonfusion Fixation Treatment for Type II Odontoid Fractures in Geriatric Patients: Case Series and Technical Note. Pain Physician 2020; 23:E241-E250. [PMID: 32214309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Considerable controversy exists regarding the optimal treatment for type II odontoid fractures in geriatric patients. Surgical intervention can help patients return to their prior level of function as rapidly as possible while avoiding the morbidity and mortality associated with prolonged and bedbound hospitalization. However, the optimal treatment is still a difficult choice for patients with increased risk from anesthesia. OBJECTIVES The objective of our study was to describe an innovative method of endoscopically-assisted percutaneous unilateral C1 lateral mass screw and C2 pedicle screw-rod nonfusion fixation for type II odontoid fractures in geriatric patients. STUDY DESIGN A case series design and technical notes. SETTING This study took place at Second Affiliated Hospital of Chongqing Medical University. METHODS Seven geriatric patients (> 65 years) with type II odontoid fractures and an American Society of Anesthesiologists (ASA) score of 2 or higher received endoscopically-assisted percutaneous unilateral atlantoaxial screw-rod nonfusion fixation. After surgery, all patients were required to wear a rigid collar full-time for 12 weeks. Intraoperative data, the bone union time, American Spinal Injury Association (ASIA) scale scores, Neck Disability Index (NDI) scores, and postoperative complications were collected for assessment.RESULTS The surgical goal was successfully achieved in all patients, 3 of whom had high ASA scores (>= 3) and underwent surgery under local anesthesia. The operative time ranged from 112 to 169 minutes (mean, 131.1 minutes). No neurovascular complications were observed intraoperatively or postoperatively. All patients rapidly returned to their prior level of function and were followed up for 12 to 24 months (average: 16.9 months). Bone union was achieved in all patients. LIMITATIONS This study is limited by being a retrospective study. CONCLUSIONS Endoscopically-assisted percutaneous unilateral atlantoaxial screw-rod nonfusion fixation is a feasible technique for type II odontoid fractures in geriatric patients. This method offers a compromise between non-operative and operative treatment and allows geriatric patients to rapidly return to their prior level of function. KEY WORDS Endoscopically-assisted surgery; geriatric patient; percutaneous atlantoaxial fixation; type II odontoid fracture; unilateral nonfusion fixation.
Collapse
Affiliation(s)
- Lei Shi
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Rui Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Qing-Yan Long
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Chu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Ke-Xiao Yu
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Zhou Xu
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhong-Liang Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| |
Collapse
|
30
|
Capek L, Rehousek P, Henys P, Bleibleh S, Jenner E, Kulvajtova M, Skala-Rosenbaum J. Cement augmentation of odontoid peg fractures: the effect of cement volume and distribution on construct stiffness. Eur Spine J 2020; 29:977-985. [PMID: 31902000 DOI: 10.1007/s00586-019-06286-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/13/2019] [Accepted: 12/31/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The cement augmentation of a conventional anterior screw fixation in type II odontoid process fractures for elderly patients significantly increased stiffness and load to failure under anterior-posterior load in comparison with non-augmented fixation. The amount and quality of bone cement are usually taken ad hoc in clinical practise. In this study, we wanted to clarify the role of bone cement amount and its quality to the stiffness of odontoid and vertebrae body junction. METHODS Finite-element method was used to achieve different scenarios of cement augmentation. For all models, an initial stiffness was calculated. Model (1) the intact vertebrae were virtually potted into a polymethylmethacrylate base via the posterior vertebral arches. A V-shaped punch was used for loading the odontoid in an anterior-posterior direction. (2) The odontoid fracture type IIa (Anderson-D'Alonzo classification) was achieved by virtual transverse osteotomy. Anterior screw fixation was virtually performed by putting self-drilling titanium alloy 3.5 mm diameter anterior cannulated lag screw with a 12 mm thread into the inspected vertebrae. A V-shaped punch was used for loading the odontoid in an anterior-posterior direction. The vertebrae body was assumed to be non-cemented and cemented with different volume. RESULTS The mean cement volume was lowest for body base filling with 0.47 ± 0.03 ml. The standard body filling corresponds to 0.95 ± 0.15 ml. The largest volume corresponds to 1.62 ± 0.12 ml in the presence of cement leakage. The initial stiffness of the intact C2 vertebrae was taken as the reference value. The mean initial stiffness for non-porous cement (E = 3000 MPa) increased linearly (R2 = 0.98). The lowest stiffness (123.3 ± 5.8 N/mm) was measured in the intact C2 vertebrae. However, the highest stiffness (165.2 ± 5.2 N/mm) was measured when cement leakage out of the odontoid peg occurred. The mean initial stiffness of the base-only cemented group was 147.2 ± 8.4 N/mm compared with 157.9 ± 6.6 N/mm for the base and body cemented group. This difference was statistically significant (p < 0.0061). The mean initial stiffness for porous cement (E = 500 MPa) remains constant. Therefore, there is no difference between cemented and non-cemented junction. This difference was not statistically significant (p < 0.18). CONCLUSION The present study showed that the low porous cement was able to significantly influence the stiffness of the augmented odontoid screw fixation in vitro, although further in vivo clinical studies should be undertaken. Our results suggest that only a small amount of non-porous cement is needed to restore stiffness at least to its pre-fracture level and this can be achieved with the injection of 0.7-1.2 ml of cement. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Lukas Capek
- Technical University of Liberec, Studentska 1402/2, 461 17, Liberec, Czechia
| | - Petr Rehousek
- Royal Orthopaedic Hospital, Bristol Rd South, Birmingham, B32 1AP, UK
- Third Faculty of Medicine, Charles University, Prague, Ruska 2411/87, 100 00, Praha 10, Vinohrady, Czechia
| | - Petr Henys
- Technical University of Liberec, Studentska 1402/2, 461 17, Liberec, Czechia.
| | - Sabri Bleibleh
- Royal Orthopaedic Hospital, Bristol Rd South, Birmingham, B32 1AP, UK
| | - Edward Jenner
- Royal Orthopaedic Hospital, Bristol Rd South, Birmingham, B32 1AP, UK
| | - Marketa Kulvajtova
- Third Faculty of Medicine, Charles University, Prague, Ruska 2411/87, 100 00, Praha 10, Vinohrady, Czechia
| | - Jiri Skala-Rosenbaum
- Third Faculty of Medicine, Charles University, Prague, Ruska 2411/87, 100 00, Praha 10, Vinohrady, Czechia
| |
Collapse
|
31
|
Bronson WH, Protopsaltis T. Management of Type II Odontoid Fractures in Adults. Bull Hosp Jt Dis (2013) 2019; 77:4-10. [PMID: 30865859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fractures of the odontoid represent as much as 20% of cervical spine fractures in adults, and they are the most common spine fracture in patients over 80 years of age. Despite their prevalence, the management of these fractures remains highly controversial. In particular, there is much debate concerning the management of type II fractures, or fractures occurring about the waist of the odontoid. We will review the epidemiology, evaluation, management-both operative and non-operative-and outcomes of adults with type II odontoid fractures. We will particularly focus on debates concerning hard collar versus halo, anterior versus posterior surgery, the management of odontoid nonunions, as well as questions about risks and benefits of surgery in the very elderly.
Collapse
|
32
|
Affiliation(s)
- Giovanni Grasso
- Section of Neurosurgery, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
| | - Ludovica Leone
- Section of Neurosurgery, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Fabio Torregrossa
- Section of Neurosurgery, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| |
Collapse
|
33
|
Abstract
Case series study.To report the clinical outcomes of posterior temporary C1-2 fixation for 3-part fracture of the axis (Type II odontoid fracture according to Grauer classification combined with Hangman fracture).The 3-part fracture of the axis is rare and the treatment is controversy.A total of 8 patients with 3-part fracture of the axis were included in this study. X-rays, CT, and MRI prior to surgery were used to evaluate the cervical spine injury. Grauer classification, fracture angulation, and fracture translation were used to evaluate the fracture of dens. The neck disability index (NDI) and range of neck rotary motion were used to assess the neck function.The preoperative fracture angulation and fracture translation were 4.6 ± 1.3° and 2.4 ± 0.6 mm, respectively. The average operation time and blood loss were 109 ± 27 minutes and 49 ± 15 mL. No infection, vascular injuries or neural structure injuries was observed. All patients acquired bone healing at 5.9 ± 2.0 months. The temporary instrumentation was removed at 10.8 ± 1.3 months. The average NDI before and 2 days after removal of instrumentation were 10.1 ± 4.0 and 7.1 ± 3.0, respectively. At 1-year follow-up after instrumentation removal, the NDI was 1.8 ± 0.7, which was much better than immediate NDI after instrumentation removal. The neck rotary motion (left rotation + right rotation) before and 2-day after instrumentation removal were 70.4 ± 6.3° and 119.6 ± 13.1°, respectively. At 1-year follow-up, the average neck rotary motion was 153.1 ± 9.1°, which had significant different with rotary motion 2-day after the removal of temporary instrumentation.With regard to the high fracture fusion rates, low complications, and excellent predictable outcomes in patients treated with posterior temporary C1-2 pedicle screw fixation, the technique may be a suitable choice for 3-part fracture of the axis.
Collapse
Affiliation(s)
- Suomao Yuan
- Spine Center, Qilu Hospital of Shandong University
| | - Bin Wei
- Reproductive Medicine Center, Maternal and Child Health Care Hospital of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China
| | - Yonghao Tian
- Spine Center, Qilu Hospital of Shandong University
| | - Jun Yan
- Spine Center, Qilu Hospital of Shandong University
| | - Wanlong Xu
- Spine Center, Qilu Hospital of Shandong University
| | - Lianlei Wang
- Spine Center, Qilu Hospital of Shandong University
| | - Xinyu Liu
- Spine Center, Qilu Hospital of Shandong University
| |
Collapse
|
34
|
Sarode DP, Demetriades AK. Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review. Spine J 2018; 18:1921-1933. [PMID: 29886165 DOI: 10.1016/j.spinee.2018.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/25/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Odontoid process fractures, of which type II constitute the majority, are an increasingly important cause of morbidity and mortality in the elderly population. The incidence of geriatric type II fractures is steadily increasing in line with the aging population. However, the decision between surgical and non-surgical intervention for type II fractures in the elderly remains controversial. PURPOSE The present study aims to synthesize the current published literature comparing outcomes following surgical and non-surgical interventions for type II odontoid fractures in the elderly population (≥65 years old). STUDY DESIGN/SETTING Systematic review and meta-analysis were performed. METHODS A systematic search of MEDLINE, MEDLINE In-Progress & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to identify available evidence in English language. Studies with extractable data for all type II odontoid fractures in participants aged 65 years or older and which compared surgical and non-surgical intervention were included. Methodological quality was assessed using the Downs & Black checklist. Primary outcomes were mortality at short-term follow-up (≤3 months), mortality at long-term follow-up (predetermined study endpoint or mean follow-up length), and radiological union rate. Funding was provided by The University of Edinburgh for travel expenses to present this paper at the Society of British Neurological Sciences 2016 Conference ($170). RESULTS Twelve studies (n=1,098), all non-randomized, met eligibility criteria. Methodological quality was particularly poor in the confounding, bias, and power domains of assessment. Substantial methodological and statistical heterogeneity allowed only a narrative synthesis of the primary outcomes. Overall, data on mortality at short-term follow-up appeared to favor neither surgical nor non-surgical intervention. A small favorable outcome in surgically managed patients over non-surgically managed patients in terms of mortality at long-term follow-up was not proven conclusive because of considerable heterogeneity in study methodologies. Inadequate reporting of the time point of union assessment introduced the potential for significant intra- and interstudy heterogeneity and precluded assessment of union rates. CONCLUSIONS Evidence on this controversial topic is sparse, markedly heterogeneous, and of poor quality. Well-designed prospective trials adhering to guidance published by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative are required to inform clinical practice on this contentious but growing issue. Future randomized controlled trials should include an assessment of frailty and medical comorbidities with suitable patients subsequently randomized to surgical or non-surgical treatment.
Collapse
Affiliation(s)
- Deep P Sarode
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom; Edinburgh Spinal Surgery Outcomes Study Group, Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom
| | - Andreas K Demetriades
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom; Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom; Edinburgh Spinal Surgery Outcomes Study Group, Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom.
| |
Collapse
|
35
|
Wang H, Xue R, Wu L, Ding W, Ma L. Comparison of clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures. Medicine (Baltimore) 2018; 97:e11452. [PMID: 30024518 PMCID: PMC6086456 DOI: 10.1097/md.0000000000011452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to compare clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures, and hope to provide references in decision making and surgical planning for both spinal surgeons and surgically treated patients.This is a retrospective study. By retrieving the medical records from January 2005 to July 2015 in our hospital, 53 Type II odontoid fracture patients were reviewed. According to the instrumentation type, patients were divided into 2 groups: Wiring group and Screw group. Three categorized factors were analyzed statistically: patient characteristics: age, body mass index, preoperative neurological status, duration, complicated injuries; surgical variables: surgery time, blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, pain at the bone donor area, instrumentation failure, revision rate; and radiographic parameters: preoperative and final follow-up data of C0-2 curvature, C2-7 curvature, C2-C7 sagittal vertical axis, C7 slope, fracture classification, separation, and displacement of odontoid fracture, fusion rate. An additional comparison of surgical outcomes was done, including patient satisfaction, visual analog scale score for neck pain, neck stiffness, medical expense.There was no statistically significant difference between the 2 groups in patient characteristics of age, sex, body mass index, preoperative neurological status, duration, and complicated injuries. No statistically significant difference was noted in surgical variables of blood loss, vertebral artery injury, spinal cord or nerve root injury, major systemic complications, wound infection, bone harvested zone pain, instrumentation failure, revision rate. The surgery time was shorter in Wiring group than that in Screw group, with a statistically significant difference. We noted no significant difference between the 2 groups when comparing radiographic parameters of preoperative and final follow-up data of C0-2 curvature, C2-C7 sagittal vertical axis, fracture classification, the separation and displacement of odontoid fracture, and fusion rate. Although we noted no significant difference in preoperative C2-7 curvature and C7 slope, the final follow-up data showed that C2-7 curvature and C7 slope were smaller in Wiring group than that in Screw group. We noted no significant difference in visual analog scale score, neck stiffness, and neurological status at final follow-up. The medical expense was less in Wiring group; the patient satisfaction was lower in the Wiring group than that in the Screw group.The modified Gallie graft fusion-wiring technique provided solid fusion and stabilization for patients with Type II odontoid fractures, Gallie graft fusion-wiring resulted in less surgery time, less medical expense, but lower patient satisfaction when compared with the posterior cervical screw constructs.
Collapse
|
36
|
Arrieta Salinas A, Malafarina V, Miranda Orella L, Martínez Velilla N. [Odontoid fracture in an elderly patient: a case report]. Rev Esp Geriatr Gerontol 2018; 53:178-179. [PMID: 28739203 DOI: 10.1016/j.regg.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Vincenzo Malafarina
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Departamento de Nutrición, Ciencias de la Alimentación y Fisiología, Facultad de Farmacia y Nutrición, Universidad de Navarra, Pamplona, Navarra, España
| | - Luis Miranda Orella
- Servicio de Radiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Nicolás Martínez Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Navarrabiomed, CIBER de Fragilidad y Envejecimiento, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| |
Collapse
|
37
|
Wang LN, Li T, Yang X, Wang L, Liu LM, Liu H, Song YM. Comparison of two temporary fixation techniques for the treatment of type II odontoid fracture. Acta Orthop Belg 2018; 84:108-115. [PMID: 30457509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To evaluate and compare the clinical and radiographic results between temporary C1-C2 pedicle screw fixation and cable-dragged reduction and cantilever beam internal fixation. Between 2010 and 2013, temporary C1-C2 pedicle screw fixation (Group P, 28 patients) and cable-dragged reduction following cantilever beam internal fixation (Group C, 33 patients) were performed on type II odontoid fracture cases. Implants were removed after fracture union. All of the 61 surgeries were performed successfully with no iatrogenic neurological worsen. One patient in Group P detected intra-operative vertebral artery injury. All patients gained fracture union. Among the observed indexes, only blood loss in Group P (128.9 ± 73.9ml) is statistically higher than in Group C (97.3 ± 5 4.2ml). Pedicle screw fixation carries the risk of vertebral artery injury, especially in patients with high-riding vertebral artery. Cable-dragged reduction following cantilever beam internal fixation could avoid the potential risk of vertebral injury, but it prolonged the fixed segments. We thought cable-dragged reduction following cantilever beam internal fixation could be an alternative method for treating type II odontoid fracture.
Collapse
|
38
|
Osuafor CN, Smith B, El-Kininy N, Donegan C. Dysphagia in the Elderly Following Anterior Cervical Surgery: A Multidisciplinary Approach. Ir Med J 2017; 110:657. [PMID: 29465847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dysphagia is a risk factor for adverse health outcomes like aspiration, recurrent chest infections and malnutrition. Here, we describe a case of an 82-year-old lady who presented with a two-month history of dysphagia after an anterior odontoid screw fixation for a type II odontoid process fracture. This case highlights the importance of a multidisciplinary approach to patient care.
Collapse
Affiliation(s)
- C N Osuafor
- Geriatric and General Medicine Department, Beaumont Hospital, Dublin, Ireland
| | - B Smith
- Speech and Language Department, Beaumont Hospital, Dublin, Ireland
| | - N El-Kininy
- Geriatric and General Medicine Department, Beaumont Hospital, Dublin, Ireland
| | - C Donegan
- Geriatric and General Medicine Department, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
39
|
Chen ZX, Zhang H, Tian NF, Wang XY, Lin Y, Wu YS. Anterior endoscopically assisted bone grafting for iatrogenic distraction of odontoid fracture after percutaneous anterior screw fixation: A case report. Medicine (Baltimore) 2017; 96:e8509. [PMID: 29145253 PMCID: PMC5704798 DOI: 10.1097/md.0000000000008509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE The complication of iatrogenic distraction of odontoid fracture after anterior screw fixation has not been reported in the literature. We treated the patient with endoscopically assisted bone grafting with good results. The new technique was not reported in the management of odontoid fracture or nonunion before. PATIENT CONCERNS A 22-year-old man presented with neck pain after a motorcycle crash. The cervical spine radiograph and computed tomographic scan demonstrated the base of dens displaced 2 mm anteriorly. DIAGNOSES Radiographic images showed a type II odontoid fracture. INTERVENTIONS The patient was treated by percutaneous anterior screw fixation. The postoperative radiograph and CT demonstrated an iatrogenic distraction of the odontoid with a gap of 6 mm.The follow-up radiograph did not show any sign of bone union 1 month and a half later. A revision surgery was given by anterior endoscopically assisted bone grafting. The patient was encouraged to sit out of bed immediately after the surgery with the protection of a soft cervical collar for 3 months. OUTCOMES No complications such as neural structures or vascular injuries were found. Bone union was achieved at the 1-year follow-up CT scans. Physical examination showed a full range of motion in the neck. LESSONS We reported a case of iatrogenic odontoid distraction that was managed by anterior endoscopically assisted bone grafting. It is a technically feasible and minimally invasive procedure.
Collapse
|
40
|
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] [What about the content of this article? (0)] [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.
Collapse
|
41
|
Wu AM, Jin HM, Lin ZK, Chi YL, Wang XY. Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture. J Orthop Surg Res 2017; 12:141. [PMID: 28962628 PMCID: PMC5622415 DOI: 10.1186/s13018-017-0640-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. METHODS Fifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 transarticular screw fixation technique in treatment of these patients. The visual analogue score (VAS) of neck pain and Neck Disability Index (NDI) of all patients were scored at pre-operation, 3 months after operation, and final follow-up. Additional, technique-related complications were recorded and collected. RESULTS Percutaneous C1/2 transarticular screw fixation was performed successfully in all 15 patients whose odontoid screw fixation failed. No technique-related complications (such as nerve injury, spinal cord injury, and esophageal injury) occurred. The VAS of neck pain and NDI score improved significantly (P = 0.000) after operation, and no significant differences were found when compared to 93 non-salvage patients who successfully performed the percutaneous anterior odontoid screw fixation. No screw loose or breakage occurred, all of the odontoid fractures achieve radiographic fusion, bony fusion bridge could be observed at the C1/2 lateral articular facet on 9/15 patients. CONCLUSIONS We suggest that percutaneous anterior C1/2 transarticular screw fixation is a good alternative salvage technique if percutaneous odontoid screw fixation failed, and it is a minimally invasive, feasible, and safe technique.
Collapse
Affiliation(s)
- Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Hai-Ming Jin
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Zhong-Ke Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Yong-Long Chi
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| |
Collapse
|
42
|
Zhang W, Yu H, Liang C, Jiao W, Cao J, Li C. [Treatment of odontoid fracture combined with lower cervical spinal cord injuries without fracture or dislocation]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:982-986. [PMID: 29806437 PMCID: PMC8458596 DOI: 10.7507/1002-1892.201703113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/10/2017] [Indexed: 11/03/2022]
Abstract
Objective To discuss the clinical characteristics, mechanism, and treatment of odontoid fracture combined with lower cervical spinal cord injuries without fracture or dislocation. Methods According to the inclusion and exclusion criteria, 7 male patients aged 37-71 years (mean, 51.4 years), suffered from odontoid fractures combined with lower cervical spinal cord injuries without fracture or dislocation were analyzed retrospectively between June 2007 and October 2015. The trauma causes were traffic accidents in 2 cases, fall in 2 cases, and hit injury in 3 cases. The time from injury to admission was 2 hours to 3 days with an average of 9 hours. According to Anderson-Grauer classification of odontoid fracture, 1 case of type IIA, 3 cases of type IIB, 2 cases of type IIC, and 1 case of shallow type III were found. The cervical spinal cord injuries affected segments included C 4, 5 in 1 case, C 4-6 in 2 cases, and C 5-7 in 4 cases. All the cervical spine had different degenerative changes: 2 of mild, 3 of moderate, and 2 of severe. The lower cervical spinal cord injury was assessed by Sub-axial Injury Classification (SLIC) with scoring of 4-6 (mean, 5.1). The visual analogue scale (VAS) score was used to evaluate the occipital neck pain with scoring of 7.8±1.0; the neurological function was assessed by American Spinal Injury Association (ASIA) as grade B in 1 case, grade C in 4 cases, and grade D in 2 cases; and Japanese Orthopedic Association score (JOA) was 9.2±3.9. For the odontoid fractures, 4 cases were fixed with anterior screw while the others were fixed with posterior atlantoaxial fixation and fusion. For the lower cervical spine, 4 cases were carried out with anterior cervical corpectomy and titanium fusion while the others with anterior cervical disecotomy and Cage fusion. Results The operation time was 178-252 minutes (mean, 210.2 minutes); the intraoperative blood loss was 60-140 mL (mean, 96.5 mL) and with no blood transfusion. All incisions healed primarily. All the patients were followed up 12-66 months (mean, 18 months). There was no direct surgical related complications during operation, and all bone grafting got a fusion at 6-9 months (mean, 7.7 months) after operation. There was no inter-fixation failure or loosening. At last follow-up, the VAS score declined to 1.7±0.7 and JOA score improved to 15.1±1.7, showing significant differences when compared with preoperative ones ( t=18.064, P=0.000; t=-7.066, P=0.000). The neurological function of ASIA grade were also improved to grade D in 5 cases and grade E in 2 cases, showing significant difference ( Z=-2.530, P=0.011). Conclusion Complex forces and degeneration of lower cervical spine were main reasons of odontoid fracture combined with lower cervical spinal cord injuries without fracture or dislocation. The type of odontoid fracture and neurological deficit status of lower cervical spinal cord were important to guide making strategy of one-stage operation with a satisfactory clinic outcome.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000, P.R.China
| | - Haiyang Yu
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000,
| | - Chengmin Liang
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000, P.R.China
| | - Wei Jiao
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000, P.R.China
| | - Jie Cao
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000, P.R.China
| | - Chao Li
- Department of Spinal Surgery, Fuyang City People's Hospital, Fuyang Anhui, 236000, P.R.China
| |
Collapse
|
43
|
Lopes A, Andrade A, Silva I, Paiva W, Brock R, Teixeira M. Brain Abscess After Halo Fixation for the Cervical Spine. World Neurosurg 2017; 104:1047.e7-1047.e11. [PMID: 28522382 DOI: 10.1016/j.wneu.2017.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Halo fixation is one of the possible treatments for cervical spine fractures. However, improper use of these devices may lead to many complications, such as pin loosening, halo dislocation, pin site infection, and intradural penetration. CASE DESCRIPTION We report the case of a 43-year-old man who first presented with a seizure and an altered level of consciousness 5 months after halo-vest placement for an odontoid fracture. Brain imaging showed a brain abscess, under the previous left parietal pin. The patient underwent abscess drainage and antibiotics were administered for 12 weeks. On hospital discharge, he presented with only mild impairments. CONCLUSIONS Misapplication of halo fixation devices may lead to serious complications, including intracranial pin penetration and brain abscesses. Proper use of the recommended technique may decrease the risk for complications related to the procedure.
Collapse
Affiliation(s)
| | | | - Igor Silva
- Hospital das Clínicas FMUSP, São Paulo, Brazil
| | | | - Roger Brock
- Hospital das Clínicas FMUSP, São Paulo, Brazil
| | | |
Collapse
|
44
|
Kočiš J, Kelbl M, Veselý R, Kočiš T. [Management of Odontoid Fractures with Compression Screw and Anterior Transarticular Screw Fixation in Elderly Patients]. Acta Chir Orthop Traumatol Cech 2017; 84:35-39. [PMID: 28253944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE OF THE STUDY In the management of dens axis fractures in patients older than 65 years of age the posterior approach is preferred due to osteoporosis and the risk of a failure of anterior osteosynthesis. The posterior approach, however, is associated with a higher incidence of complications. A combination of anterior transarticular fixation of C1/2 (ATS) with compression osteosynthesis of dens axis significantly increases the stability of osteosynthesis. MATERIAL AND METHODS In the period from 2009 to 2015 our hospital admitted 13 patients older than 65 years of age with a diagnosed type III dens axis fracture based on AO classification. 8 patients sustained a dens axis fracture combined with a stable atlas fracture. The cohort consisted of 13 women aged 67 to 90 years, with the mean age of 82.3 years. None of the female patients were affected neurologically. The dens axis fracture was treated by anterior approach. Once the screw was inserted in the dens axis, two more screws were added, the entrance points of those screws were medial and lateral to the odontoid screw and direction was divergently via C1/2 joints in order to reinforce stability. The patients were monitored at 6-week, 3-, 6- and 12-month follow-ups. Bone healing was confirmed by CT scan. RESULTS No complications were recorded during the surgery in any of the 13 patients. In one female patient the stabilization failed in the early postoperative period. A reoperation from anterior approach with the use of the same method was necessary. In eleven patients bone healing occurred after 6 to 12 months. In two patients pseudoarthrosis was formed with no clinical symptoms. No neurological deterioration or a patient s death was reported in the monitored period within 12 months after the treatment. DISCUSSION Where dens axis fractures in elderly patients are managed operatively, the posterior approach and transarticular fixation of C1/2 with sublaminar loop are preferred. This procedure is considered more reliable, owing to the fears of a failure of osteosynthesis by anterior approach. The most frequent cause of a failure is the pulling out of the screw through the anterior wall of dens axis base in patients with osteoporosis. Concurrently, the anterior approach is regarded as more considerate. The ATS fixation increases stability compared to isolated compression osteosynthesis, which makes it possible to manage the dens axis fractures by a more considerate anterior approach. CONCLUSIONS The ATS is a method that increases stability of compression osteosynthesis in managing dens axis in elderly patients. Key words: dens axis, upper cervical spine fracture, elderly, triple screw technique, anterior transarticular C1/2 stabilization.
Collapse
Affiliation(s)
- J Kočiš
- Klinika traumatologie Lékařské fakulty Masarykovy univerzity v Úrazové nemocnici Brno
| | | | | | | |
Collapse
|
45
|
Nemeth ZH, Difazio LT, Bilaniuk JW, Siegel BK, Durling-Grover R, Rolandelli RH, Adams JM. The Incidence of Severe Dysphagia after Odontoid Fracture. Am Surg 2017; 83:e15-e17. [PMID: 28234111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Zoltan H Nemeth
- Division of Trauma, Department of Surgery, Critical Care and Injury Prevention, Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Hlubek RJ, Nakaji P. Nonoperative Management of Odontoid Fractures: Is Halo Vest Immobilization Warranted? World Neurosurg 2016; 98:839-840. [PMID: 27832990 DOI: 10.1016/j.wneu.2016.10.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
47
|
Dodd KW, Weston BW, Marinelli WA, Moore JC. An unusual cause of cardiopulmonary arrest. Intern Emerg Med 2016; 11:833-5. [PMID: 27141847 DOI: 10.1007/s11739-016-1455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Kenneth W Dodd
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA.
- Department of Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | - Benjamin W Weston
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA
| | - William A Marinelli
- Department of Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Johanna C Moore
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA
| |
Collapse
|
48
|
Tubbs RS, Kirkpatrick CM, Fisahn C, Iwanaga J, Moisi MD, Hanscom DR, Chapman JR, Oskouian RJ. New Landmark for Localizing the Site of the Subdental Synchondrosis Remnant: Application to Discerning Pathology from Normal on Imaging. World Neurosurg 2016; 96:80-84. [PMID: 27591099 DOI: 10.1016/j.wneu.2016.08.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We hypothesized that the entry site of the basivertebral vein into the basivertebral foramen of C2 might localize the subdental synchondrosis between the odontoid process and body of C2, which may be helpful for odontoid fracture classification. METHODS Twenty-five dry adult C2 specimens underwent thin-cut computed tomography and were sectioned sagittally. The basivertebral foramen was then correlated to internal bony anatomy. Fifty magnetic resonance images were reviewed, and the location of the subdental synchondrosis was determined. RESULTS A basivertebral foramen was identified on the posterior surface of all dry C2 specimens. The openings were found at a distance of 30%-44% on an inferosuperior point along the vertical height of C2. For bony specimens with a subdental synchondrosis remnant (75%), entry of acupuncture needles into the basivertebral foramen was always directly at the level of the synchondrosis remnant. For magnetic resonance imaging (MRI), a subdental synchondrosis or its remnants were seen on all studies. The distance from the base of C2 to the subdental synchondrosis ranged from 9-13 mm. This equated to an inferosuperior point 32%-43% along the vertical height of C2. A strong correlation existed when comparing the location of the basivertebral foramen of bony specimens and the subdental synchondrosis location on MRI. CONCLUSIONS The basivertebral foramen is a consistently present anatomic reference point for the subdental synchondrosis even if the latter cannot be seen on conventional radiographic imaging. Our MRI data might also be useful in helping differentiate lesions affecting C2 from normal subdental cartilaginous remnants that can be encountered on imaging.
Collapse
Affiliation(s)
- R Shane Tubbs
- Seattle Science Foundation, Swedish Medical Center, Seattle, Washington, USA
| | | | - Christian Fisahn
- Seattle Science Foundation, Swedish Medical Center, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
| | - Joe Iwanaga
- Seattle Science Foundation, Swedish Medical Center, Seattle, Washington, USA
| | - Marc D Moisi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - David R Hanscom
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| |
Collapse
|
49
|
Abstract
Study design: Retrospective review Objectives: To present and discuss the outcome of halo jacket immobilisation of cervical spine injuries. Setting: National Spinal Injuries Unit in a Scottish University teaching Hospital. Methods: Retrospective review of case-notes and radiographs of all patients treated with halo jacket both as primary means of immobilisation or as adjunct to surgical stabilisation between 1992–1999 and followed up at a weekly halo clinic. Results: Out of a total one hundred and four patients with cervical spine injury, eighty-six were treated with Halo jacket as primary means of cervical immobilisation. Halo was used as adjunct to surgical stabilisation for the rest. There were nine cases of true failure. This is a failure rate of 10% for primary halo immobilisation. Of the nine patients who had failure of bony healing, four had fibrous healing, three had surgery to stabilise spine, two were subsequently lost to follow-up. The highest incidence of recurrence of subluxation occurred in patients with fracture/subluxation with a healing rate of 85%. Patients with ankylosing spondylitis did well. Odontoid fractures had 18% failure rate. The commonest complication was loss of reduction, followed by pin-site infection. Conclusion: Halo is an effective non-surgical treatment for the injured cervical spine at both upper and lower levels.
Collapse
Affiliation(s)
- M Hosssain
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, 1345 Govan Road, Glasgow.
| | | | | |
Collapse
|
50
|
Tsuji S, Inoue S, Tachibana T, Maruo K, Arizumi F, Yoshiya S. Post-Traumatic Torticollis Due to Odontoid Fracture in a Patient With Diffuse Idiopathic Skeletal Hyperostosis: A Case Report. Medicine (Baltimore) 2015; 94:e1478. [PMID: 26356707 PMCID: PMC4616647 DOI: 10.1097/md.0000000000001478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Descriptive case report.To report a rare case of post-traumatic torticollis by odontoid fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH).Cervical fractures in DISH can result from minor trauma, and a delay in presentation often prevents their timely diagnosis. Cervical fractures in patients with spinal DISH usually occur in extension injuries, and almost always occur in the lower cervical spine. Reports of odontoid fractures with torticollis in patients with spinal DISH are rare.A 73-year-old man with DISH presented with severe neck pain and a cervical deformity presenting as torticollis without neurological deficits. He gave a history of a fall while riding a bicycle at a low speed 3 months ago. X-ray showed torticollis in the right side, and computed tomography (CT) showed a type-II odontoid fracture and subluxation at the C1-2 level.We performed a staged treatment because this patient had severe neck pain associated with a chronic course. Initially, the fracture dislocation was reduced under general anesthesia and was stabilized with a halo vest. We then performed posterior occipitocervical in situ fusion after confirming the correction of the cervical deformity by CT. The patient showed significant amelioration of neck symptoms postoperatively, and bony fusion was achieved 1 year after surgery.For post-traumatic torticollis due to an odontoid fracture, plain CT is useful for diagnosis and posterior occipitocervical in situ fusion following correction and immobilization with a halo vest is a safe and an effective treatment.
Collapse
Affiliation(s)
- Shotaro Tsuji
- From the Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | | | | | | | | | | |
Collapse
|