Trends in the surgical management of odontoid fractures in patients above 75 years of age: Retrospective study of 70 cases

Faure, Alice; Graillon, Thomas; Pesenti, Sébastien; Tropiano, Patrick; Blondel, Benjamin; Fuentès, S.

doi:10.1016/j.otsr.2017.07.008

Cited by 28 publications

(18 citation statements)

References 28 publications

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“…Fractures at the odontoid base, classified as Type II injuries by Anderson and D'Alonzo system, are the most common type (more than 60%) of all odontoid fractures [8,11,14,15]. They were considered relatively unstable and had a high incidence of nonunion [5].…”

Section: Discussionmentioning

confidence: 99%

“…Conservative treatment for this type is associated with high bony nonunion rate, accordingly, surgical treatment is recommended [1,5]. Over the past few decades, the applications of several surgical strategies (odontoid screw fixation, Magerl technique, and Harms technique) have achieved satisfying clinical results [3,[9][10][11][12][13]. It was reported that posterior approaches can achieve high bone union rate [14,15], but they inevitably sacrificed atlantoaxial rotational motion [5,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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A new tool in percutaneous anterior odontoid screw fixation

Wang

Cui

et al. 2021

BMC Musculoskelet Disord

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Background Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation. Methods Twenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery. Results There were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group. Conclusions The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A new tool in percutaneous anterior odontoid screw fixation

Wang

Cui

et al. 2021

BMC Musculoskelet Disord

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“…Dagegen werden unter chirurgischer Therapie knöcherne Heilungsraten von bis zu 100 % angegeben [28]. Auch Metaanalysen zeigen eine signifikant höhere Knochenbruchheilung bei den operativ versorgten Patienten [26].…”

Section: Behandlungunclassified

Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients

et al. 2019

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Background Odontoid fractures in geriatric patients represent an entity of increasing incidence with a high rate of morbidity and mortality. The optimal diagnostic and therapeutic management is being controversially discussed in the literature. Methods In a consensus process and based on the current literature, the members of the working groups “Osteoporotic Fractures” and “Upper Cervical Spine” of the German Society for Orthopaedics and Trauma Surgery (DGOU) defined recommendations for the diagnostics and treatment of odontoid fractures in geriatric patients. Results For the diagnosis of odontoid fractures in symptomatic patients, computed tomography represents the gold standard, along with conventional radiographs. Magnetic resonance and dynamic imaging can be used as ancillary imaging modalities. With regard to fracture classification, the systems described by Anderson/DʼAlonzo and by Eysel/Roosen have proved to be of value. A treatment algorithm was developed based on these classifications. Anderson/DʼAlonzo type 1, type 3, and non-displaced type 2 fractures usually can be treated non-operatively. However, a close clinical and radiological follow-up is essential. In Anderson/DʼAlonzo type 2 fractures, operative treatment is associated with better fracture healing. Displaced type 2 and type 3 fractures should be stabilized operatively. Type 2 fractures with suitable fracture patterns (Eysel/Roosen 2A/B) can be stabilized anteriorly. Posterior C I/II-stabilization procedures are well established and suitable for all fracture patterns.

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“…This technique was pioneered by Goel et al 9 and modified by Harms and Melcher. 10 It was recently promoted by Faure et al 6 but they did admit that it was demanding and that the main technical challenge was related to bleeding of the venous plexus around the C2 nerve root and at the screw entry points on the C1 lateral masses. Huang et al 8 also expressed concerns regarding the risk of blood loss during exposure of the C1 lateral masses and noted the additional intraoperative risks of vertebral artery injury and nerve dysfunction after dissection of the C2 nerve root.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion

Lasswell

Medley

Callaghan

et al. 2021

Proc Inst Mech Eng H

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The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL). Each specimen was tested in a spinal loading simulator that separately applied axial rotation, flexion-extension and lateral bending. In each test condition, displacement controlled angular motion was applied in both directions at a speed of 2 deg/s until a resulting moment of 1.5 Nm was achieved. The measured ranges of motion (ROM) of the C1-C2 segments were compared for each test condition using nonparametric Friedman tests. The destabilized state had significantly more C1-C2 motion ( p < 0.05) than the intact state in all cases, and all constructs greatly reduced this motion. C2 pedicle screw constructs that used the C1PA clamp had significantly less C1-C2 motion ( p < 0.05) than those with C1LM screws in flexion-extension as well as axial rotation and no statistically significant difference was detected in lateral bending. C2 translaminar screw constructs that used the C1PA clamp had significantly less C1-C2 motion ( p < 0.05) than those with C1LM screws in flexion-extension and no statistically significant difference was detected in axial rotation or in lateral bending. Data from the current study suggested that constructs using the novel C1PA clamp would provide as good, or improved, biomechanical stability to the C1-C2 segment compared with constructs using C1LM screws.

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Trends in the surgical management of odontoid fractures in patients above 75 years of age: Retrospective study of 70 cases

Abstract: IV.

Cited by 28 publications

References 28 publications

A new tool in percutaneous anterior odontoid screw fixation

A new tool in percutaneous anterior odontoid screw fixation

Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients

Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion

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