![]() Conservative treatment for this type is associated with high bony nonunion rate, accordingly, surgical treatment is recommended. Type II fractures are mechanically unstable injuries. It is generally accepted that type I and type III odontoid fractures based on the classification of Anderson and D’Alonzo can be treated by conservative strategies such as cervical orthoses, halo vests, and rigid cervical collars. Its treatment remains challenging due to the complex anatomy of the craniocervical junction. Odontoid fractures are common, which represent approximately 9 to 20% of all cervical spine fractures. It has potential clinical value, which needs further testing with a higher level of research design. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. No fixation failure or reoperation occurred in either group. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in preoperative demographic data between the two groups. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery. The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument ( n = 13) or the new guide instrument we designed ( n = 16). Twenty-nine patients with odontoid fracture were retrospectively evaluated. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. All rights reserved.Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. ![]() In the current study, we were able to achieve stable fracture union in 83.7% patients.Īnterior odontoid screw fixation C2 Fracture Lag screw Odontoid fracture Odontoid screw Postoperative alignment Spinal instrumentation.Ĭopyright © 2021 Elsevier Inc. With careful patient selection, meticulous surgical planning, and intraoperative image-guided screw insertion, good fracture union outcomes can be obtained. One patient underwent re-exploration for screw readjustment and 2 underwent posterior instrumentation.Īnterior odontoid screw fixation is technically straightforward, less morbid, and preserves biomechanical cervical mobility, when compared with the posterior instrumentation. Transient dysphagia was the commonest complication (n = 12), whereas screw breakout (n = 2) and pullout (n = 2) were other hardware-related complications. The horizontal fracture displacement ≥2.5 mm (P = 0.02) and poor postoperative fracture alignment (P < 0.001) resulted in worse fracture union rates. Fracture union was noted in 41 (83.7%) patients. The bicortical screw purchase and superoposterior odontoid tip breach significantly affected the postoperative alignment (P = 0.035 each). The average time from injury to surgery was 23.1 ± 22.2 days. Follow-up cervical computed tomography was reviewed for fracture union.Ī total of 49 patients with a mean age of 37.3 ± 13.8 years were included in the study. The postoperative imaging findings were classified into grades I (excellent), II (good), and III (poor) based on the anatomical alignment with the screw. double screw) and follow-up records were documented. Patients' clinical, radiological (type of fracture, orientation, displacement, and diastasis), operative (single vs. The management of dens fractures remains controversial with various radiological and fracture morphological factors affecting the approach and outcomes.Īll cases of anterior odontoid screw fixation between 20 were retrospectively analyzed. Type II odontoid fractures are the commonest C2 fractures.
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