A simple technique for easier anterior odontoid screw fixation

Abstract

Background: Anterior odontoid screw fixation (AOSF) is an osteosynthetic technique used for fixation of type 2 and rostral type 3 odontoid fractures. Compared to other treatment modalities, it provides immediate stability, preservation of the majority of the remaining C1–2 motion and an achieved union rate of 80–100%. AOSF requires a stable and reduced odontoid to allow for placement of guide wire and cannulated screw. Image guidance with neuro-navigation or intraoperative fluoroscopy are used for accurate placement of instrumentation. Minimally invasive techniques have been described, such as endoscopic or percutaneous placement of odontoid screws and the use of tubular retractor system. Major site-specific complications include neural injury, esophageal or pharyngeal perforation, hemorrhage, and airway obstruction.Purpose: To assess safety and efficacy of a new simple technique developed by the Authors for insertion of the odontoid screw through a less invasive anterior approach.Study design: Prospective case seriesMethods: Eight patients, 7 males, with odontoid fractures were treated with AOSF under fluoroscopic guidance between January 2014 and October 2015. The operation was successfully completed without technical difficulties using a beveled bone marrow biopsy needle (Jamshidi needle) as a sleeve for guide wire insertion.Results: No soft tissue complications such as esophageal or neuro-vascular injury occurred. Intraoperative bleeding was 25 mL on average. The operation time averaged 75 min. All of the screws were placed in good positions. After a mean follow-up of 12.1 months (range 8–18 months), radiographic fusion was documented for 7 of 8 patients (87.5%). Neither clinical complications nor hardware loosening or breakage occurred.Conclusion: Our short term clinical results suggest that the new less invasive anterior odontoid screw fixation procedure using a Jamshidi needle and fluoroscopy is technically easy with good clinical and radiological results.