A new tool in percutaneous anterior odontoid screw fixation

Yan Wang,Haijiang Lu,Haijun Teng,Guanxing Cui,Zhiliang Guo,Jing Li,Min Li,Dahai Zhang

doi:10.1186/s12891-020-03929-4

Abstract

BackgroundPercutaneous 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.MethodsTwenty-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.ResultsThere 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.ConclusionsThe 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.

Highlights

Odontoid fractures are common, which represent approximately 9 to 20% of all cervical spine fractures [1,2,3,4]
Percutaneous odontoid screw fixation is minimally invasive, which can shorten operation time and reduce blood loss compared with open technique [8]
The inclusion criteria were: the time from trauma to surgery was less than 30 days; the fracture was nonpathological; the surgical procedure was percutaneous; and the follow-up time after surgery was at least 6 months

Summary

Introduction

Odontoid fractures are common, which represent approximately 9 to 20% of all cervical spine fractures [1,2,3,4]. Its treatment remains challenging due to the complex anatomy of the craniocervical junction [5]. Anterior odontoid screw fixation can preserve normal atlantoaxial rotation [5, 8, 15, 16, 18] with union rate comparable to posterior approaches [17]. It is considered as the preferred treatment for odontoid fractures [17]. Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation

Objectives

Methods

Results

Conclusion