Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. The 7 patients who survived were followed for a minimum of 6 months. Two patients died of causes unrelated to their cervical fracture surgery. No neurological complications related to the procedure occurred. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Two patients, later in the study, had no injury to the ring of C1. Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures 2).ĭirect anterior screw fixation is an effective and safe method for treating recent odontoid fractures ( or = 18 months postinjury), a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure 3).Īlthough anterior screw fixation is the ideal choice for type Ⅱ odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type Ⅱ odontoid fractures 4).Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Surgeons must be prepared to perform both procedures to adequately treat these injuries 1)įull-Endoscopic Anterior Odontoid Screw Fixation is a feasible and effective option for Odontoid fracture type II treatment. Although both anterior and posterior approaches are acceptable, many clinical and radiological factors should be taken into account when choosing the best surgical approach. However, this technique results in loss of atlantoaxial motion, requires prone positioning, and demands a longer operative duration than AOSF, factors that can be a challenge in patients with severe medical conditions. It is also used as a salvage procedure after failed AOSF. posterior occipitocervical fusion allows direct open reduction of displaced fragments and can reduce any atlantoaxial instability. posterior occipitocervical fusion has a higher rate of fusion and is indicated in patients with severe atlantoaxial misalignment and with poor bone quality. Additionally, older patients may have a higher rate of pseudarthrosis using this technique, as well as postoperative dysphagia. AOSF can preserve atlantoaxial motion, but requires a reduced odontoid, an intact transverse ligament, and a favorable fracture line to achieve adequate fracture compression. reviewed the literature about specific patients and fracture characteristics that may guide treatment toward one technique over the other. Anterior odontoid screw fixation indicationsĪnterior odontoid screw fixation (AOSF) and posterior occipitocervical fusion are both well-accepted techniques for surgical treatment but with unique indications and contraindications as well as varied reported outcomes.
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