Odontoid fracture complications6/30/2023 ![]() ![]() A hollow hand drill was used to enlarge the trajectory over the Kirschner wire. Under fluoroscopy, a 2-mm Kirschner wire was drilled from the midline of anterior-inferior edge of C2 to the apical cortical bone of dens. After exposing the anterior cervical spine, the anterior-inferior edge of C2 was exposed. The standard Smith-Robertson method was used to expose the prevertebral space. A transverse incision was made along the skin crease at the C5–6 level. After the patient was placed in a supine position on the operating table, we tried to achieve the correct alignment of the C2 vertebral body and fragment of the odontoid process with Gardner-Wells tongs using 2 fluoroscopies (open-mouth and lateral view). General anesthesia was used in all patients. The screw direction angle was measured between the inferior endplate of the vertebral body and the inserted screw in the cervical lateral plain radiographs ( Fig. Fracture gap was measured as the largest gap between the superior fracture line of the odontoid process and the inferior fracture line of C2 vertebral body using preoperative CT scans. Fracture displacement was measured perpendicularly from a line through the posterior margin of the odontoid fracture, drawn parallel to the posterior wall of the C2 vertebral body using preoperative CT scans. To analyze the clinical characteristics of the patient, clinical data at the time of treatment, including 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. Follow-up was discontinued when the fracture was considered clinically and radiologically stable. Surgical failure was defined as a definite fracture gap with abnormal motion at the fractured site on dynamic radiographs and CT that may require additional surgical treatment, such as posterior cervical fixation with or without fusion. Successful fusion was defined as the presence of a bony bridge and definite continuity of the cortical bone or absence of motion and fracture gap at the fractured site on dynamic radiographs despite persistent cortical bone discontinuity within a fracture gap on CT. Similarly, follow-up CT was performed 6 months after the surgery and once a year thereafter to evaluate the union. During follow-up, anteroposterior, lateral, flexion, and extension plain radiographs were taken postoperatively, 6 months after the surgery, and once a year thereafter. All AOSF surgeries were performed by a single surgeon. Patients with AOSF contraindications (such as disruption of transverse ligament, fracture > 6 months ago, comminuted fracture, and pathologic fracture) and those with < 12 months of clinical or radiological follow-up after surgery were excluded from the study. The indications for AOSF were an Anderson and D’Alonzo type II or a rostral shallow type III odontoid fracture with intact transverse ligament on MRI. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of the spine were also performed in all patients. All patients were preoperatively assessed using anteroposterior, lateral, and open-mouth plain radiographs. This study included 63 patients who underwent AOSF between January 2001 and June 2019 at our institution. This study fulfilled all the requirements for patient anonymity and was approved by the Institutional Review Board of Chonnam National University Medical School Research Institution, Republic of Korea (CNUH-2020-054). We have also evaluated the potential risk factors of surgical failure associated with this technique. In this study, we report the outcomes of AOSF surgery for odontoid fractures by analyzing the radiologic and clinical data. However, a few studies have reported AOSF-related complications or nonunion related risk factors after AOSF. Many studies have suggested that AOSF is a safe and effective treatment with the provision of immediate stabilization of the spine, preservation of substantial C1–2 rotatory motion, and a high union rate ranged of 88%–100%. Various treatment strategies have been attempted to prevent potential spinal cord injury and craniocervical deformities, spanning from conservative treatment with external immobilization to surgical treatment with anterior odontoid screw fixation (AOSF) or posterior cervical screw fixation with or without fusion. Type II and rostral shallow type III odontoid fractures are considered highly unstable and require surgical treatment. Odontoid fracture is common type of cervical spine fracture accounting for 5%–20% of all cervical spine fractures, and it is classified into 3 types according to the fracture location in the sagittal plane. ![]()
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