Anterior screw fixation of odontoid fractures

BACKGROUND: Anterior screw fixation is the best treatment for odontoid fractures when the fracture line is horizontal or oblique downward and backward, as it preserves atlantoaxial mobility, especially axial rotation. Some details regarding patient positioning and operative technique need to be stressed to obtain the best results and avoid complications. METHODS: Between 1989 and 1997, we treated 17 cases of odontoid fracture by anterior screw fixation. Only two patients presented with motor neurologic deficit. Fracture line was horizontal in 3 cases and oblique downward and backward in 14 cases. RESULTS: Adequate reduction and fixation was obtained in all cases except one, where posterior displacement of the screw occurred without neurologic complications. Functional result was satisfactory in all cases except two, where we noted significant limitation of cervical rotation. CONCLUSION: Successful anterior screw fixation gives the best anatomical and functional results for odontoid fractures. Correct installation is very important for operative success.     

颈前路单枚空心钉固定治疗齿状突Ⅱ型骨折

目的应用颈前路单枚空心钉固定治疗齿状突Ⅱ型骨折的临床观察。方法对21例齿状突ⅡA型5例、ⅡB型16例骨折行颈前路单枚空心钉固定治疗。结果 21例全部获得随访12-36个月,平均21个月。术后无感染,枕颈部疼痛消失,无吞咽不适感,6例术前ASIA分级为D级的患者在术后3个月恢复为E级。骨折平均愈合时间5.5个月,骨折愈合率为100%。随访X线片显示颈椎序列及生理曲度恢复满意,患者颈部屈伸及旋转活动恢复正常,未发生螺钉松动、移位及断裂等。结论采用颈前路单枚空心钉固定治疗齿状突Ⅱ型骨折是一种有效的手术方法。     

Anterior screw fixation of type IIB odontoid fractures in octogenarians

Purpose  

Type IIB odontoid fractures (OF) in elderly patients are life-threatening conditions. Optimal treatment of these fractures is still controversial. The aim of this study was to assess the clinical and radiological outcome of surgically treated type IIB OF by anterior screw fixation in octogenarians.     

前路螺钉内固定治疗Ⅱ型和浅Ⅲ型齿状突骨折

齿状突骨折临床多见，约占颈椎骨折的10％-15％，是一种严重的颈椎损伤，诊断治疗困难。Anderson-D’Alonzon分型中，Ⅱ型和浅Ⅲ型骨折不稳定，容易移位，非手术治疗骨折不愈合率高，故常采用手术治疗。前路螺钉固定治疗齿状突骨折自20世纪80年代首次用于临床以来，因其创伤小，骨折愈合率高，被认为是治疗齿状突骨折的理想术式。总结我院2000年12月。2006年6月前路螺钉内固定治疗28例齿状突骨折患者的经验，进一步评价该手术的安全性和疗效。[第一段]     

Posterolaterally displaced type IIA odontoid fractures

A case of type IIA odontoid fracture with posterolateral dislocation accompanied by spinal cord injury is presented. Cervical traction was employed but reduction could not be achieved with up to 8 kg of traction. The patient was treated with intraoperative reduction and C1-2 posterior transarticular screw fixation with supplemental bone-wire fusion, and rigid fixation was obtained without any complication. Received: 28 June 2000 / Accepted: 13 October 2000     

前路齿状突螺钉治疗齿状突骨折的初步报告

随着影像技术的发展和上颈椎手术经验的积累,多数学者将前路齿状突螺钉作为Anderson-D’AlonzonⅡ型和浅Ⅲ型骨折的首选方案。自2002年8月～2006年4月,我院采用前路齿状突螺钉治疗Ⅱ型和浅Ⅲ型齿状突骨折15例疗效良好。     

Management of odontoid fractures with percutaneous anterior odontoid screw fixation

Minimally invasive techniques have revolutionized the management of a variety of spinal disorders. The authors of this study describe a new instrument and a percutaneous technique for anterior odontoid screw fixation, and evaluate its safety and efficacy in the treatment of patients with odontoid fractures. Ten patients (6 males and 4 females) with odontoid fractures were treated by percutaneous anterior odontoid screw fixation under fluoroscopic guidance from March 2000 to May 2002. Their mean age at presentation was 37.2 years (with a range from 21 to 55 years). Six cases were Type II and four were Type III classified by the Anderson and D'Alonzo system. The operation was successfully completed without technical difficulties, and without any soft tissue complications such as esophageal injury. No neurological deterioration occurred. Satisfactory results were achieved in all patients and all of the screws were in good placement. After a mean follow-up of 15.7 months (range 10-25 months), radiographic fusion was documented for 9 of 10 patients (90%). Neither clinical symptoms nor screw loosening or breakage occurred. Our preliminary clinical results suggest that the percutaneous anterior odontoid screw fixation procedure using a new instrument and fluoroscopy is technically feasible, safe, useful, and minimally invasive.     

前路螺钉内固定治疗齿状突骨折的疗效分析

目的　研究颈前路螺钉内固定治疗齿状突骨折的疗效。方法　对 7例齿状突骨折患者 ,在X线监测下施行颈前路螺钉内固定法治疗。结果　随访 6～ 16个月 ,全部获得愈合 ,无并发症。结论　齿状突骨折应用螺钉内固定 ,可获得良好的治疗结果     

Anterior single-screw fixation in 24 patients with Type II odontoid fractures

BackgroundFractures of the odontoid process make up 9–15% of adult cervical fractures; Type II odontoid fractures are the most common type. Most patients with these fractures recover after early treatment utilizing the proper surgical approach.Purpose/AimsA retrospective study was performed to evaluate the bone union rate and to identify factors that might contribute to non-union in patients undergoing anterior single-screw fixation for Type II odontoid cervical fractures.MethodsFrom November 2000 to December 2008, 24 patients (16 males, 8 females) underwent anterior single-screw fixation for Type II odontoid cervical fractures. Prior to surgery, all patients had cervical spine radiographs and computed tomographic (CT) scans. Surgery to correct the fractures used the technique of Abfelbaum et al, and fluoroscopy was used to confirm spinal stability. At follow-up, bone fusion was considered successful if trabeculation across the fracture site was seen on lateral radiographic studies. Non-union was confirmed when the fracture line was visible on follow-up lateral radiographic studies. After surgery, all patients were followed at approximately 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, 9 months, and annually thereafter.ResultsAll 24 patients had odontoid fractures confirmed by radiographic films and CT scans. Twenty-three patients had Type II odontoid fractures that were posterior-oblique or horizontal, and one had an anterior oblique fracture. Twenty patients achieved successful fusion. The presence of a lag effect was significantly different between patients who had successful fusion and the four patients with fusion failure. All patients achieved immediate spinal stabilization after surgery and none experienced major neurologic sequelae.ConclusionsAnterior single-screw fixation is an effective and safe surgical approach for patients with Type II odontoid fractures. A satisfactory long-term outcome depends upon careful selection of patients for fracture orientation and attention to the technical aspects of surgery.     

Management of odontoid fractures with anterior screw fixation

Type II odontoid fractures are prone to undergo nonunion. Stabilization of such fractures with anterior screw fixation provides rigid internal fixation and preserves C1-C2 motion. During a 5-year period, 17 patients with displaced type II fractures of the odontoid were treated Thirteen were male and four were female with a mean age of 38.2 years. All patients were operated on for anterior screw fixation within a mean of 10.1 days from injury. Postoperatively, the patients were evaluated clinically and radiologically at regular intervals. With a mean follow-up of 3.2 years, union was observed in 16 of 17 patients (94%). One patient developed nonunion for which he required C1-C2 fusion subsequently. Screw back-out by a few millimeters was seen in another patient resulting in mild restriction of neck movements. No approach-related complications were noted. Anterior odontoid screw fixation has relatively low complication and high fusion rates. It not only restores normal anatomy but also gives better functional results by preserving intrinsic C1-C2 motion. Thus it should be considered the treatment of choice in acute displaced type II odontoid fractures.     

Anterior screw fixation of a dislocated type II odontoid fracture facilitated by transoral and posterior cervical manual reduction

Background  

Early fixation of type II odontoid fractures has been shown to provide high rates of long-term stabilization and osteosynthesis.     

Nonoperative treatment of displaced type II odontoid peg fractures with a Philadelphia collar

Although a consensus exists on the nonoperative management of types I and III odontoid peg fractures, treatment of type II fractures remains controversial. An increasing trend exists toward primary fixation of type II peg fractures due to a high rate of nonunion, especially if the displacement is >4 mm. This article reports the results of nonoperative treatment of patients with displaced odontoid peg fractures (>4 mm) using a Philadelphia collar.A retrospective review of clinical and radiological records was performed for nonoperatively treated patients who sustained displaced type II peg fractures between January 2003 and April 2008. The study group comprised 9 patients (2 men and 7 women), and all patients were treated with Philadelphia collars. Patients were followed up for an average of 24.8 months (range, 8-28 months) for clinical and radiological outcomes. Functional outcomes were measured according to the Smiley-Webster scale. Fractures united uneventfully in 6 patients, but nonunion developed in 3 patients. Average time to union was 12.3±2.94 weeks (95% confidence interval, 9.97-14.68 weeks; range, 10-16 weeks). No patient had clinical or radiological signs of instability or delayed onset myelopathy at follow-up. Three patients had excellent, 4 had good, and 2 had fair results as per the Smiley-Webster functional scoring system.Displaced type II peg fractures can be managed nonoperatively in patients who refuse surgery or those with multiple comorbidities. Adequate patient counseling and compliance with close clinicoradiological follow-up is paramount to avoid adverse clinical events and achieve an optimal functional outcome.     

Respiratory arrest following posteriorly displaced odontoid fractures. Case reports and review of the literature

Posterior displacement of the odontoid after fracture occurs much less frequently than does anterior displacement. Experience with four patients suggests that anatomic reduction may not be possible and prolonged attempts to gain reduction are not advisable. Those cases should be managed with early application of a halo vest. A rotating frame should be avoided. The potential for respiratory arrest, at least in the older individual, is great and can be precipitated even by a change of position in the process of turning on the rotating frame. The mechanism of the respiratory failure is obscure.     

后路椎弓根螺钉非融合内固定术治疗新鲜Ⅱ型齿状突骨折

[目的]评估C_(1/2)后路椎弓根螺钉骨折复位非融合内固定术对新鲜Ⅱ型齿状突骨折的疗效。[方法]回顾性分析2015年6月~2017年6月颈后路寰枢椎椎弓根螺钉复位固定非融合术+Ⅱ期去除内固定术治疗的齿状突骨折患者62例,其中男性39例,女性23例,年龄17~78岁。采用疼痛视觉模拟评分(VAS)、颈椎日本骨科协会评分(JOA)和影像检查评估临床疗效。[结果]本组62例患者均顺利完成手术,术中无脊髓、神经根和椎动脉损伤。手术时间75~160 min,平均(95.32±18.46) min;出血量90~400 ml,平均(150.47±50.92) ml。术后脑脊液漏2例,其中1例保守治疗后愈合,另1保守治疗失败后行二次手术修复硬膜治愈。切口浅表感染3例,经非手术治疗痊愈。随访时间24~36个月,平均(26.46±1.32)个月。术后12个月取出内固定物。末次随访时,VAS评分由术前(7.62±0.91)分降低至(2.91±1.23)分,差异有统计学意义(P0.05);JOA评分由术前(7.21±2.11)分上升至末次随访时(13.22±2.41)分,差异有统计学意义(P0.05)。所有患者C_(1/2)活动度得到保留。影像方面:术中所有患者C型臂X线机透视下显示寰枢椎完全复位,术后12个月所有患者骨折均达到骨性愈合,无内固定松动、移位;末次随访时,所有患者内固定物已取出,齿状突愈合良好,无畸形,C_(1/2)间隙正常。[结论]后路寰枢椎椎弓根螺钉复位固定非融合术+Ⅱ期去除内固定术治疗新鲜Ⅱ型齿状突骨折可保留C_(1/2)活动度,并取得满意的临床效果。