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Anterior screw fixation for odontoid fracture: clinical results in 45 cases

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Résumé

Ce travail porte sur une étude rétrospective du vissage antérieur chez 45 patients présentant une fracture de l'odontoïde. La population comportait 36 hommes et 9 femmes dont les fractures étaient du type II dans 35 cas et du type III dans 10 cas. II y avait 34 fractures fraîches et 11 cas anciens. Les complications neurologiques ont été retrouvées chez 16 patients et 18 présentaient des lésions associées. Tous les patients ont bénéficié d'une ostéosynthèse par une seule vis. L'immobilisation postopératoire, le port d'un collier et le traumatisme chirurgical ont été réduites au minimum. Chez l'un des patients la vis est sortie de l'odontoïde et une fusion postérieure immédiate s'est avérée nécessaire. Le taux global de consolidation a été de 93% (41 fractures sur 44). Le délai de consolidation a été en moyenne de 5.2 mois. On a relevé deux retards de consolidation et trois pseudarthroses dont les causes ont été une pseudarthrose préopératoire avérée, une ostéoporose sévère et une situation inadéquate de la vis. Parmi les 11 lésions anciennes, huit ont consolidé. 96% des patients ont présenté une récupération neurologique. Le taux global des complications a été de 11%, regroupant une fausse route de vissage, une blessure de la paroi postérieure du pharynx et trois pseudarthroses. Selon les évaluations cliniques, la rotation de la tête a été préservée chez 90% des patients ayant consolidé. Le vissage antérieur est un traitement optimal pour les fractures fraĩches de type II et III de l'odontoïde, permettant un fort pourcentage de consolidation, la préservation de la mobilité du segment C1–C2 et un traumatisme chirurgical minime. II peut être même appliqué à certaines lésions anciennes. Une sélection précise du patient, sa densité osseuse, le temps écoulé depuis l'accident, une réduction préopératoire anatomique et une méthode chirurgicale méticuleuse faisant appel à un amplificateur de brillance performant, sont essentiels pour éviter les complications et les pseudarthroses.

Summary

Clinical results of anterior screw fixation in 45 patients with odontoid fractures were reviewed retrospectively. The patients were 36 males and 9 females, with fractures classified as 35 type II and 10 type III. There were 34 fresh and 11 old fractures. Neurological complications were present in 16 patients and 18 had associated injuries. All patients underwent single screw fixation. Postoperative immobilization, external support, and surgical trauma were minimal. In one patient a screw extruded from the dens and immediate posterior fusion was necessary. The overall rate of fracture union was 93% (41 out of 44 fractures). Fracture resolution averaged 5.2 months. There were two delayed unions and three nonunions, the causes of which were preoperatively established nonunion, severe osteoporosis, and inaccurate screw placement. Out of 11 old cases, 8 went on to union. Ninety-six percent of the patients recovered neurologically. The overall complication rate, including a misplaced screw, a retropharyngeal wall injury, and three nonunions, was 11%. Head rotation was preserved in 90% of the patients with fracture union according to clinical measurements. Anterior screw fixation is an excellent treatment for fresh type II and cephalad type III odontoid fractures, carrying a high union rate, preservation of the C1–2 motion segment, and minimal surgical trauma; it can be applied even to some old cases. Precise patient selection in regard to patient age, bone density, and time elapsed since injury as well as preoperative anatomical reduction and meticulous surgical technique with fine fluoroscopy are essential to avoid complications and nonunions.

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References

  1. Aebi M, Etter C, Coscía M (1989) Fracture of the odontoid process: treatment with anterior screw fixation. Spine 14: 1065–1070

    Google Scholar 

  2. Althoff B (1979) Fracture of the odontoid process: an experimental and clinical study. Acta Orthop Scand (Suppl) 177:1–95

    Google Scholar 

  3. Amyes EW, Anderson FM (1956) Fracture of the odontoid process. Arch Surg 72:377–393

    Google Scholar 

  4. Anderson LD, D'Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663–1674

    Google Scholar 

  5. Apuzzo ML, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T (1978) Acute fracture of the odontoid process: an analysis of 45 cases. J Neurosurg 48:85–91

    Google Scholar 

  6. Blockey NJ, Purser DW (1956) Fracture of the odontoid process of the axis. J Bone Joint Surg [Br] 38:794–817

    Google Scholar 

  7. Böhler J (1981) Schraubenosteosynthese von Frakturen des Dens axis. Unfallheilkd 84:221–223

    Google Scholar 

  8. Böhler J (1981) Anterior stabilization for acute fractures and nonunions of the dens. J Bone Joint Surg [Am] 64:18–27

    Google Scholar 

  9. Borne GM, Bedou GL, Pinaudeau M, Cristino G, Hussein A (1988) Odontoid process fracture osteosynthesis with a direct screw fixation technique in nine consecutive cases. J Neurosurg 68:223–226

    Google Scholar 

  10. Brooks AL, Jenkins EB (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg [Am] 60: 279–284

    Google Scholar 

  11. Clark CR, White AA (1985) Fractures of the dens. J Bone Joint Surg [Am] 67:1340–1348

    Google Scholar 

  12. Dunn ME, Seljeskog EL (1986) Experience in the management of odontoid process injuries: an analysis of 128 cases. Neurosurgery 18:306–310

    Google Scholar 

  13. Esmark H, Kalen R (1987) Injuries of the atlas and axis. Clin Orthop 217:257–260

    Google Scholar 

  14. Esses SI, Bednar DA (1991) Screw fixation of odontoid fractures and nonunions. Spine 16:S483-S485

    Google Scholar 

  15. Etter C, Coscia M, Jaberg H, Aebi M (1991) Direct anterior fixation of dens fractures with a cannulated screw system. Spine 16:S25-S32

    Google Scholar 

  16. Fujii E, Kobayashi K, Hirabayashi K (1988) Treatment in fractures of the odontoid process. Spine 13:604–609

    Google Scholar 

  17. Geisler FH, Cheng C, Poka A, Brumback RJ (1989) Anterior screw fixation of posteriorly displaced type II odontoid fractures. Neurosurgery 25:30–38

    Google Scholar 

  18. Jeanneret B, Vernet O, Frei S, Magerl F (1991) Atlantoaxial mobility after screw fixation of the odontoid; a computed tomographic study. J Spinal Disord 4:203–211

    Google Scholar 

  19. Knöringer P (1987) Double-threaded compression screws for osteosynthesis of acute fractures of the odontoid process. In: Voth D, Glees P (eds) Diseases in the cranio-cervical junction. Anatomical and pathological aspects and detailed clinical accounts. de Gruyter, Berlin, pp 127–136

    Google Scholar 

  20. Lesoin F, Autricque A, Franz K, Villette L, Jomin M (1989) Transcervical approach and screw fixation for upper cervical spine pathology. Surg Neurol 27:459–465

    Google Scholar 

  21. Lind B, Nordwall A, Sihlbom H (1987) Odontoid fractures treated with halo-vest. Spine 12:173–177

    Google Scholar 

  22. McGraw RW, Rusch RM (1973) Atlanto-axial arthrodesis. J Bone Joint Surg [Br] 55:482–489

    Google Scholar 

  23. Montesano PX, Anderson PA, Schlehr F, Thalgott JS, Lowrey G (1991) Odontoid fractures treated by anterior odontoid screw fixation. Spine 16:S33–37

    Google Scholar 

  24. Nakanishi T, Sasaki T, Takahata T, Aoki Y, Sueyasu M, Uzawa M, Washiya S, Imanaka K (1980) Internal fixation of odontoid fracture (in Japanese). Seikeisaigaigeka (Orthop Surg Traumatol) 23:399–406

    Google Scholar 

  25. Nakanishi T, Sasaki T, Tokita N, Hirabayashi K (1982) Internal fixation for the odontoid fracture. Orthop Trans 6:176

    Google Scholar 

  26. Pentelenyi T, Szarvas I, Bodrogi L (1988) Up-to-date method of treatment of most frequent axis-injuries: screw-fixation of the odontoid fractures. Acta Chir Hung 29:349–357

    Google Scholar 

  27. Schaffler MB, Alson MD, Heller JG, Garfin SR (1992) Morphology of the dens. A quantitative study. Spine 17:738–743

    Google Scholar 

  28. Schtzker J, Rorabeck CH, Waddell JP (1971) Fractures of the dens (odontoid process): an analysis of thirty-seven cases. J Bone Joint Surg [Br] 53:392–405

    Google Scholar 

  29. Schweigel JF (1977) Treatment of odontoid fractures by the halo-thoracic brace technique. J Bone Joint Surg [Br] 59:509

    Google Scholar 

  30. Seljeskog EL (1978) Non-operative management of acute upper cervical injuries. Acta Neurochir 41:87–100

    Google Scholar 

  31. Southwick WO (1980) Management of fractures of the dens (odontoid process). J Bone Joint Surg [Am] 62:482–487

    Google Scholar 

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Chiba, K., Fujimura, Y., Toyama, Y. et al. Anterior screw fixation for odontoid fracture: clinical results in 45 cases. Eur Spine J 2, 76–81 (1993). https://doi.org/10.1007/BF00302707

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