Management of acute odontoid fractures: operative techniques and complication avoidance

Shilpakar, Sushil Krishna; Mr, McLaughlin; Rw, Haid; Ge, Rodts; Br, Subach

doi:10.3171/foc.2000.8.6.4

Cited by 17 publications

(3 citation statements)

References 52 publications

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“…Though conservative management with halo rest is an option and still is used in some centers, surgical management is comparatively far more superior with regards to union at the fracture site 8, 9 .…”

Section: Discussionmentioning

confidence: 99%

Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

et al. 2016

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Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous in clinical set ups lacking state of the art facilities. Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study. Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing patients in developing nations having rudimentary neurosurgical set up.

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Section: Discussionmentioning

confidence: 99%

Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

et al. 2016

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“…Generally, surgical indications include fracture displacements longer than 5 mm, angulation deformities larger than 10°, and the combination with neurological dysfunction. Shilpakar et al believed that this kind of injury is more inclined to receive operation ( 5 ) and the symoptoms might be relaxed unless patients are fit for general anesthesia, or else the conservative treatment would lead to higher potential mortality. Surgical approaches are usually divided into an anterior approach (AA) and a posterior approach (PA).…”

Section: Introductionmentioning

confidence: 99%

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Bao¹,

Chen²,

Guo³

et al. 2023

Front. Surg.

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BackgroundOdontoid fractures account for 15%–20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures.MethodsThe relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3.ResultsTwelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA.ConclusionAA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.

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“…Surgical intervention is indicated in patients, presenting with a fracture dislocation greater than 5 mm, angulation greater than 10 degrees, and neurological deficits. 28) The surgical treatment options for stabilization procedures include the anterior Smith Robinson approach, which involves odontoid screw fixation, or the posterior approach, which involves either C1-2 arthrodesis or multilevel cervical fixation extending to the occiput to the subaxial cervical spine. The choice of anterior or posterior approach is controversial due to conflicting evidence, regarding the preferred approach.…”

Section: Introductionmentioning

confidence: 99%

Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review

Jo,

Lee,

Kwon

et al. 2023

Korean J Neurotrauma

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Objective Odontoid fractures are treated surgically through the anterior or posterior approach. Each surgical approach has its advantages and disadvantages, so the preferred approach remains debatable. There are few meta-analyses or systemic reviews on the mechanical complications of surgical treatment for odontoid fractures. This meta-analysis aimed to compare the operation-related morbidity, including mechanical complications, and mortality of patients with odontoid fractures, treated via the anterior or posterior approach. Methods A systematic search was performed on PubMed/Medline, Embase, and the Cochrane Library for the studies up to October 2023 on the complication rate of the surgical treatment of odontoid fractures, related to the surgical approach. The risk ratios (RR) with the 95% confidence intervals (CIs) were pooled to assess the mechanical complication rates, other complications, revision surgery, and mortality, depending on the surgical approach. Results A total of 1,519 studies were retrieved using the search strategy, and 782 patients from 15 articles were included in this meta-analysis. Mechanical complications were significantly more frequent in the anterior surgical group with low heterogeneity. The incidences of fracture nonunion and revision surgery were also higher in the anterior surgery group. However, there was no significant difference in systemic complications and mortality rates between the two groups. Conclusion The posterior approach was more advantageous than the anterior approach in terms of mechanical complications, fusion rates, and incidence of revision surgery. However, further studies, should be performed to strengthen these results.

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Management of acute odontoid fractures: operative techniques and complication avoidance

Cited by 17 publications

References 52 publications

Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review

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