Abstract
Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous in clinical set ups lacking state of the art facilities. Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study. Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing patients in developing nations having rudimentary neurosurgical set up.
Highlights
Management of type II odontoid fractures has been long debated[1]
We discuss a simple technique for anterior odontoid screw placement which is comparable to placement of the same under guidance of an ‘O’ arm or neuro-navigation, in terms of accuracy of the placement, associated complications and peri-operative morbidity to the patients
All the patients were first evaluated with the help of X-ray, computerised tomography (CT) and magnetic resonance imaging (MRI) of the spine
Summary
Conservative management, a regular practice in earlier days, was later followed by prolonged application of halo vest. These techniques invariably lead to non union of the fracture and caused major discomfort to the patients[1,2]. It was Nakanishi and Bohler who initially described odontoid screw placement for type II odontoid fractures[3]. With recent advancements in neurosurgery and additions to its armamentarium with tools like Neuro-navigation and O arm, odontoid screws can be placed with high accuracy, ease and low morbidity[4,5,6]. We discuss a simple technique for anterior odontoid screw placement which is comparable to placement of the same under guidance of an ‘O’ arm or neuro-navigation, in terms of accuracy of the placement, associated complications and peri-operative morbidity to the patients
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