Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique

Shousha, Mootaz; Alhashash, Mohamed; Allouch, Hassan; Boehm, Heinrich

doi:10.1007/s00586-019-05946-x

Cited by 20 publications

(27 citation statements)

References 27 publications

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“…Cappuccio et al [44] recommended OCF in case of post-traumatic cervical instability because the C0/C1 joint sacrifice in an elderly ankylotic spine does not make a relevant clinical difference in the final functional outcome. In case of C2 fractures, Shousha et al [45] compared anterior odontoid screw fixation with AAF and also concluded that the posterior motion preservation techniques should be limited to younger patients.…”

Section: Discussionmentioning

confidence: 99%

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

Wenning

Hoffmann

2020

J Orthop Surg Res

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Background: The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods: Over a 5-year period (2010-2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results: Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Conclusion: Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

Wenning

Hoffmann

2020

J Orthop Surg Res

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“…13,14 Many studies have suggested that AOSF is safe and effective in stabilizing acute type II and rostral type III odontoid fractures. [8][9][10][11] Although controversy exists regarding the best way to manage odontoid fractures such as the anterior versus posterior approach, 15 it is certain that AOSF has several biomechanical advantages such as preservation of substantial C1-2 rotatory motion and a high union rate (88%-100%). [8][9][10][11] In this study, a successful fusion rate of 87.3% was achieved, and none of the patients experienced worsening pain or had increased NDI scores after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have identified predictive factors for surgical failure after AOSF and AOSF-related complications. 2,5,[15][16][17] Regarding patients' clinical characteristics, some studies have reported that old age is a predictive factor for surgical failure after AOSF for odontoid fractures and AOSF-related complications such as dysphagia and cardiopulmonary complications. 16,17 In contrast, some studies have reported that old age does not influence the union and that AOSF is suitable for elderly patients with odontoid fractures.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure

et al. 2020

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Objective: Anterior odontoid screw fixation (AOSF) is a safe and effective treatment for type II and rostral type III odontoid fracture. This study aimed to report the outcomes of the AOSF surgery and evaluate the potential risk factors of surgical failure. Methods: We enrolled 63 patients who underwent AOSF. Follow-up computed tomography was performed 6 months after the surgery and once a year thereafter to evaluate the union. Clinical data including the age, sex, presenting symptoms, cause of injury, fracture gaps, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were collected. Results: Successful fusion was achieved in 55 patients (87.3%) and surgical failure occurred in 8 patients (12.7%). Variables such as age, sex, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were not significantly associated with the surgical failure. However, surgical failure was statistically significantly associated with the fracture gap. The overall mean fracture gap at the time of injury was 1.29 mm (range, 0-3.11 mm), and the incidence of surgical failure was 8.3 times higher when the fracture gap at the time of injury was > 2 mm (p = 0.019). Conclusion: When performing AOSF in patients with type II or rostral shallow type III odontoid fractures, the displacement of the odontoid fracture fragment should be appropriately reduced to the aligning position before screw insertion and downward reduction should be achieved by perforation of the apical cortex of the odontoid during screw fixation, even if the surgery is delayed.

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“…Si hay una lesión neurológica se debe obtener una resonancia magnética de columna cervical para lesiones asociadas, en algunos casos también pudiera llegar a solicitarse una angiotomografía. 6 El tratamiento dependerá de la ubicación de la fractura de odontoides, según lo descrito por la clasificación de Anderson y D'Alonzo y los factores de riesgo del paciente para la falta de unión (la edad del paciente y sus comorbilidades) (Figuras 1 y 2). 7 La osteosíntesis de las fracturas de la apófisis odontoides es un desafío debido a la anatomía y a las estructuras vecinas críticas que hacen que la fijación quirúrgica sea una tarea exigente.…”

Section: Odontoid Fracture: Treatment Prognosis and Associated Morbimortality In A High Concentration Hospitalunclassified

Fractura de odontoides: tratamiento, pronóstico y morbimortalidad asociada en un Hospital de Alta Concentración

Piña¹

2021

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Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique

Cited by 20 publications

References 27 publications

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure

Fractura de odontoides: tratamiento, pronóstico y morbimortalidad asociada en un Hospital de Alta Concentración

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