Anterior single-screw fixation in 24 patients with Type II odontoid fractures

Kuo Feng Fan*, Jen Chung Liao, Chi Chien Niu, Lih Huei Chen, Wen Jer Chen, Mel S. Lee

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

3 Scopus citations

Abstract

Background: Fractures of the odontoid process make up 9-15% of adult cervical fractures; Type II odontoid fractures are the most common type. Most patients with these fractures recover after early treatment utilizing the proper surgical approach. Purpose/Aims: A retrospective study was performed to evaluate the bone union rate and to identify factors that might contribute to non-union in patients undergoing anterior single-screw fixation for Type II odontoid cervical fractures. Methods: From November 2000 to December 2008, 24 patients (16 males, 8 females) underwent anterior single-screw fixation for Type II odontoid cervical fractures. Prior to surgery, all patients had cervical spine radiographs and computed tomographic (CT) scans. Surgery to correct the fractures used the technique of Abfelbaum et al, and fluoroscopy was used to confirm spinal stability. At follow-up, bone fusion was considered successful if trabeculation across the fracture site was seen on lateral radiographic studies. Non-union was confirmed when the fracture line was visible on follow-up lateral radiographic studies. After surgery, all patients were followed at approximately 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, 9 months, and annually thereafter. Results: All 24 patients had odontoid fractures confirmed by radiographic films and CT scans. Twenty-three patients had Type II odontoid fractures that were posterior-oblique or horizontal, and one had an anterior oblique fracture. Twenty patients achieved successful fusion. The presence of a lag effect was significantly different between patients who had successful fusion and the four patients with fusion failure. All patients achieved immediate spinal stabilization after surgery and none experienced major neurologic sequelae. Conclusions: Anterior single-screw fixation is an effective and safe surgical approach for patients with Type II odontoid fractures. A satisfactory long-term outcome depends upon careful selection of patients for fracture orientation and attention to the technical aspects of surgery.

Original languageEnglish
Pages (from-to)26-31
Number of pages6
JournalFormosan Journal of Musculoskeletal Disorders
Volume4
Issue number1
DOIs
StatePublished - 02 2013
Externally publishedYes

Keywords

  • Fracture fixation
  • Odontoid fracture
  • Spinal injuries

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