Abstract
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.
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References
Aebi M, Etter C, Coscia M (1989) Fractures of the odontoid process. Treatment with anterior screw fixation. Spine 14:1065–1070
Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56:1663–1674
Apfelbaum RI, Lonser RR, Veres R, Casey A (2000) Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg 93(Suppl):S227–S236
Bohler J (1982) Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 64:18–27
Clark CR, White AA III (1985) Fractures of the dens. A multicenter study. J Bone Joint Surg Am 67:1340–1348
Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1–C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37:688–692
Dickman CA, Foley KT, Sonntag VK, Smith MM (1995) Cannulated screws for odontoid screw fixation and atlantoaxial transarticular screw fixation technical note. J Neurosurg 83:1095–1100
ElSaghir H, Bohm H (2000) Anderson type II fracture of the odontoid process: results of anterior screw fixation. J Spinal Disord 13:527–530
Fountas KN, Kapsalaki EZ, Karampelas I, Feltes CH, Dimopoulos VG, Machinis TG, Nikolakakos LG, Boev AN III, Choudhri H, Smisson HF, Robinson JS (2005) Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures. Spine 30:661–669
Fujii E, Kobayashi K, Hirabayashi K (1988) Treatment in fractures of the odontoid process. Spine 13:604–609
Graziano G, Jaggers C, Lee M, Lynch W (1993) A comparative study of fixation techniques for type II fractures of the odontoid process. Spine 18:2383–2387
Hashizume H, Kawakami M, Kawai M, Tamaki T (2003) A clinical case of endoscopically assisted anterior screw fixation for the type II odontoid fracture. Spine 28:E102–E105
Henry AD, Bohly J, Grosse A (1999) Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg Br 81:472–477
Hohl M (1964) Normal motions in the upper portion of the cervical spine. J Bone Joint Surg Am 46:1777–1779
Jenkins JD, Coric D, Branch CL Jr (1998) A clinical comparison of one- and two-screw odontoid fixation. J Neurosurg 89:366–370
Kazan S, Tuncer R, Sindel M (1999) Percutaneous anterior odontoid screw fixation technique. A new instrument and a cadaveric study. Acta Neurochir (Wien) 141:521–524
Lind B, Sihlbom H, Nordwall A (1988) Halo-vest treatment of unstable traumatic cervical spine injuries. Spine 13:425–432
Montesano PX, Anderson PA, Schlehr F, Thalgott JS, Lowrey G (1991) Odontoid fractures treated by anterior odontoid screw fixation. Spine 16(Suppl):S33–S37
Pepin JW, Bourne RB, Hawkins RJ (1985) Odontoid fractures, with special reference to the elderly patient. Clin Orthop 193:178–183
Ryan MD, Taylor TK (1982) Odontoid fractures. A rational approach to treatment. J Bone Joint Surg Br 64:416–421
Sasso R, Doherty BJ, Crawford MJ, Heggeness MH (1993) Biomechanics of odontoid fracture fixation. Comparison of the one- and two-screw technique. Spine 18:1950–1953
Schweigel JF (1987) Management of the fractured odontoid with halo-thoracic bracing. Spine 12:838–839
Subach BR, Morone MA, Haid RW Jr, McLaughlin MR, Rodts GR, Comey CH (1999) Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 45:812–819
Wang GJ, Mabie KN, Whitehill R, Stamp WG (1984) The nonsurgical management of odontoid fractures in adults. Spine 9:229–230
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Chi, YL., Wang, XY., Xu, HZ. et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J 16, 1157–1164 (2007). https://doi.org/10.1007/s00586-007-0331-0
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DOI: https://doi.org/10.1007/s00586-007-0331-0