Advertisement

Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis: a meta-analysis

  • Li Baogui
  • Chen JuwenEmail author
Orthopaedic Surgery
  • 14 Downloads

Abstract

Objective

For odontoid fractures, surgical treatment approaches including anterior odontoid screw fixation approach and the posterior C1–C2 arthrodesis approach are generally adopted in practice. However, the choice of different surgical procedures remains controversial. In addition to surgical technique, the fusion rate is an important factor contributing to the clinical efficacy. Therefore, this study was aimed to investigate the discrepancy in fusion rate between these two surgical approaches through synthesizing the currently available evidence on the topic.

Methods

A computerized search of Ovid, Medline, Embase, and the Cochrane library up to December 2017 for literature on the complication rate during odontoid fracture treatment was conducted. Risk ratio (RR) with its 95% confidence interval (CI) was pooled to assess fusion rates after surgical treatments, including anterior odontoid screw fixation approach or posterior C1–2 arthrodesis procedure, for patients with odontoid fractures.

Results

Thirteen studies were enrolled in the meta-analysis. Results show that no significant difference was found in the overall fusion rate (RR = 0.96, 95% CI 0.90–1.01). There was no significant heterogeneity among the studies (p value = 0.60). As to age- and economic-level subgroups, there was no statistical evidence to suggest an association of the patient age and economy development level with the choice of surgical approach. However, it is shown that better fusion rates of patients (≥ 60 years) in developed countries received a better fusion rates after posterior fixation compared with anterior group using the fixed-effect model (RR = 0.88, 95% CI 0.79–0.98).

Conclusion

Elderly patients (≥ 60 years) underwent posterior C1–2 arthrodesis fixation shows higher fusion rates in developed countries comparing with patients who underwent anterior odontoid screw fixation. Overall, there is no significant discrepancy between these two surgical approaches. However, the conclusion should be verified by further study enrolling larger sample size.

Keywords

Odontoid fractures Anterior odontoid screw Posterior C1–2 arthrodesis Complication rate Meta-analysis 

Notes

Acknowledgements

We thank the research team in the Orthopedics Department of Tian Jin 4th Center Hospital for their assistance with the study.

Author contributions

LB and CJ contribute equally to the paper. They together designed the research. LB analysed the data and prepared the typescript. CJ revised the manuscript. The other authors provided the subject data. Both two authors read and approved the final manuscript.

Funding

The authors declare that there is no funding support for this study.

Compliance with ethical standards

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work; there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis:A meta-analysis”.

Ethical approval

The study was approved by the Medical Ethics Committee of Tian Jin 4th Center Hospital, Tianjin, China.

Consent to publish

All authors Li Baogui and Chen Juwen of this paper “Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis:A meta-analysis” consent to publish on BMC Musculoskeletal Disorders once it is accepted.

References

  1. 1.
    Chutkan NB, King AG, Harris MB (1997) Odontoid fractures: evaluation and management. J Am Acad Orthop Surg 5(4):199Google Scholar
  2. 2.
    Maak TG, Grauer JN (2006) The contemporary treatment of odontoid injuries. Spine 31(11 Suppl):S53Google Scholar
  3. 3.
    Bohlman HH (1979) Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Jt Surg Am Vol 61(8):1119–1142Google Scholar
  4. 4.
    Clark CR (1985) Fractures of the dens. A multicenter study. J Bone Jt Surg Am Vol 67(9):1340–1348Google Scholar
  5. 5.
    Song KJ, Lee KB, Kim KN (2007) Treatment of odontoid fractures with single anterior screw fixation. J Clin Neurosci 14(9):824–830Google Scholar
  6. 6.
    Graziano G, Jaggers C, Lee M, Lynch W (1993) A comparative study of fixation techniques for type II fractures of the odontoid process. Spine 18(16):2383–2387Google Scholar
  7. 7.
    Lee SH, Sung JK (2006) Anterior odontoid fixation using a 4.5-mm Herbert screw: the first report of 20 consecutive cases with odontoid fracture. Surg Neurol 66(4):361Google Scholar
  8. 8.
    Hou Y, Yuan W, Wang X (2011) Clinical evaluation of anterior screw fixation for elderly patients with type II odontoid fractures. J Spinal Disord Tech 24(8):E75Google Scholar
  9. 9.
    Smith HE, Vaccaro AR, Maltenfort M, Albert TJ, Hilibrand AS, Anderson DG, Harrop J, Fehlings MG, Kopjar B, Brodke DS (2008) Trends in surgical management for type II odontoid fracture: 20 years of experience at a regional spinal cord injury center. Orthopedics 31(7):650–650Google Scholar
  10. 10.
    Ni B, Guo Q, Lu X, Xie N, Wang L, Guo X, Chen F (2015) Posterior reduction and temporary fixation for odontoid fracture-a salvage maneuver to anterior screw fixation. Spine 40(3):168–174Google Scholar
  11. 11.
    Grob D, Jeanneret B, Aebi M, Markwalder TM (1991) Atlanto-axial fusion with transarticular screw fixation. J Bone Jt Surg Br Vol 73(6):972–976Google Scholar
  12. 12.
    Elsaghir H, Böhm H (2000) Anderson type II fracture of the odontoid process: results of anterior screw fixation. J Spinal Disord 13(6):527–530Google Scholar
  13. 13.
    Ochoa G (2005) Surgical management of odontoid fractures. Inj Int J Care Inj 36(2):S54–S64Google Scholar
  14. 14.
    Polin RS, Szabo T, Bogaev CA, Replogle RE, Jane JA (1996) Nonoperative management of Types II and III odontoid fractures: the Philadelphia collar versus the halo vest. Neurosurgery 38(3):456–457Google Scholar
  15. 15.
    Shen Y, Miao J, Li C, Fang L, Cao S, Zhang M, Yan J, Kuang Y (2015) A meta-analysis of the fusion rate from surgical treatment for odontoid factures: anterior odontoid screw versus posterior C1-C2 arthrodesis. Eur Spine J 24(8):1649–1657Google Scholar
  16. 16.
    Sawarkar DP, Singh PK, Siddique SA, Agrawal D, Satyarthee GD, Gupta DK, Sinha S, Kale SS, Sharma BS (2015) Surgical management of odontoid fractures at level one trauma center: a single-center series of 142 cases. Neurol India 63(1):40–48Google Scholar
  17. 17.
    Wells GA, Shea BJ, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2014) The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric 18(6):págs. 727–734Google Scholar
  18. 18.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539Google Scholar
  19. 19.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560Google Scholar
  20. 20.
    Sterne JAC, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54(10):1046–1055Google Scholar
  21. 21.
    Andersson S, Rodrigues M, Olerud C (2000) Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc 9(1):56Google Scholar
  22. 22.
    Chiba K, Fujimura Y, Toyama Y, Fujii E, Nakanishi T, Hirabayashi K (1996) Treatment protocol for fractures of the odontoid process. J Spinal Disord 9(4):267Google Scholar
  23. 23.
    Fujii E, Kobayashi K, Hirabayashi K (1988) Treatment in fractures of the odontoid process. Spine 13(6):604–609Google Scholar
  24. 24.
    Kim SK, Shin JJ, Kim TH, Shin HS, Hwang YS, Park SK (2011) Clinical outcomes of halo-vest immobilization and surgical fusion of odontoid fractures. J Korean Neurosurg Soc 50(1):17–22Google Scholar
  25. 25.
    Konieczny MR, Gstrein A, Müller EJ (2012) Treatment algorithm for dens fractures: non-halo immobilization, anterior screw fixation, or posterior transarticular C1–C2 fixation. J Bone Jt Surg Am Vol 94(19):e144(141Google Scholar
  26. 26.
    Mashhadinezhad H, Samini F, Mashhadinezhad A, Birjandinejad A (2012) Clinical results of surgical management in type II odontoid fracture: a preliminary report. Turk Neurosurg 22(5):583–587Google Scholar
  27. 27.
    Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vécsei V, Gaebler C (2007) Surgical treatment of dens fractures in elderly patients. J Bone Jt Surg Am Vol 89(8):1716–1722Google Scholar
  28. 28.
    Ziai W, Hurlbert R (2000) A six year review of odontoid fractures: the emerging role of surgical intervention. Can J Neurol Sci 27(4):297–301Google Scholar
  29. 29.
    Joaquim AF, Patel AA (2015) Surgical treatment of type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? Neurosurg Focus 38(4):E11Google Scholar
  30. 30.
    Fagin AM, Cipolle MD, Barraco RD, Eid S, Li PM, Pasquale MD (2010) Odontoid fractures in the elderly: should we operate? J Trauma 68(3):583Google Scholar
  31. 31.
    Guo Q, Zhang M, Wang L, Lu X, Guo X, Ni B (2015) Comparison of atlantoaxial rotation and functional outcomes of two non-fusion techniques in the treatment of Anderson-D’Alonzo type II odontoid fractures. Spine 41:1Google Scholar
  32. 32.
    Omeis I, Duggal N, Rubano J, Cerabona F, Abrahams J, Fink M, Das K (2009) Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. Spine J 22(2):91–95Google Scholar
  33. 33.
    Smith HE, Kerr SM, Maltenfort M, Chaudhry S, Norton R, Albert TJ, Harrop J, Hilibrand AS, Anderson DG, Kopjar B (2008) Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study. J Spinal Disord Tech 21(8):535–539Google Scholar
  34. 34.
    Platzer P, Thalhammer G, Sarahrudi K, Kovar F, Vekszler G, Vécsei V, Gaebler C (2007) Nonoperative management of odontoid fractures using a halothoracic vest. Neurosurgery 61(3):522–529Google Scholar
  35. 35.
    Th KC, Mirza SK, Jarell AD, Chapman JR, Shaffrey CI, Newell DW (2000) Type II odontoid fractures in the elderly: early failure of nonsurgical treatment. Neurosurg Focus 8(6):e7Google Scholar
  36. 36.
    Schoenfeld AJ, Bono CM, Reichmann WM, Warholic N, Wood KB, Losina E, Katz JN, Harris MB (2011) Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine 36(11):879Google Scholar
  37. 37.
    Platzer P, Thalhammer G, Ostermann R, Wieland T, Vécsei V, Gaebler C (2007) Anterior screw fixation of odontoid fractures comparing younger and elderly patients. Spine 32(16):1714–1720Google Scholar
  38. 38.
    Aldrian S, Erhart J, Schuster R, Wernhart S, Domaszewski F, Ostermann R, Widhalm H, Platzer P (2012) Surgical vs nonoperative treatment of Hadley type IIA odontoid fractures. Neurosurgery 70(3):676Google Scholar
  39. 39.
    Chaudhary A, Drew B, Orr RD, Farrokhyar F (2010) Management of type II odontoid fractures in the geriatric population: outcome of treatment in a rigid cervical orthosis. J Spinal Disord Tech 23(5):317Google Scholar
  40. 40.
    Pepin JW, Bourne RB, Hawkins RJ (1985) Odontoid fractures, with special reference to the elderly patient. Clin Orthop Relat Res 193(193):178Google Scholar
  41. 41.
    Bednar DA, Parikh J, Hummel J (1995) Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship. J Spinal Disord 8(2):166–169Google Scholar
  42. 42.
    Seybold EA, Bayley JC (1998) Functional outcome of surgically and conservatively managed dens fractures. Spine 23(17):1837–1845Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopedics DepartmentTian Jin 4th Center HospitalTianjinChina

Personalised recommendations