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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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Acknowledgements

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

Funding

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

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Authors and Affiliations

  1. Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China

    Li Baogui & Chen Juwen

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  1. Li Baogui
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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.

Corresponding author

Correspondence to Chen Juwen.

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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.

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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.

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Baogui, L., Juwen, C. Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis: a meta-analysis. Arch Orthop Trauma Surg 139, 1329–1337 (2019). https://doi.org/10.1007/s00402-019-03164-0

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