Cement-augmented anterior odontoid screw fixation in elderly patients with odontoid fracture

Abstract

ObjectivesOsteoporotic bone predisposes to hardware loosening in patients with odontoid fracture treated with anterior odontoid screw fixation. Cement augmentation is an established method to increase screw anchorage in such cases. The aim of this study was to determine the intra- and perioperative surgical complications of this technique and a comparison with a non-cement augmented group. Patients and methodsDuring the period January 2012 to November 2017, 24 elderly patients with odontoid fractures and reduced bone mineral density were treated with cement-augmented anterior odontoid screw fixation. Demographic and clinico-anatomical parameters were contemporaneously recorded. A comparison group of 28 elderly patients treated with odontoid screw fixation without cement-augmentation was used to determine the difference of bone fusion rate and whether cement-augmentation extended surgery duration. Results24 patients (18 female, 6 male) were treated with cement-augmented anterior odontoid screw fixation during the study period. The median patient age was 84 years (IQR 81–86 years). In 6/24 cases, asymptomatic cement leakage occurred. Five of these cases involved prevertebral cement leakage into the longus colli muscle. In the other case, cement leaked into the C2/3 joint. There was no significant difference in the time required to perform cement-augmented anterior screw fixation compared to fixation without cement-augmentation (median 65 min versus 56.5 min; p = .119). After a median follow-up of 11 months, the bony-fusion rate in the cement-augmented group was 75% (15/24 patients) versus 50% in the non-cement-augmented group (11/28 patients; p = .096). Revision surgery was necessary in none of the cases in the cement-augmented group and in three cases in the non-cement-augmented group (10.7%; p=.048). ConclusionAdditional cement augmentation for anterior odontoid fracture repair is a feasible and safe procedure in elderly patients with reduced bone mineral density. Moreover, given that cement-augmentation was associated with a trend towards a higher rate of medium-term bony fusion and a lower revision surgery rate, it is a treatment strategy that should be considered in the management of elderly patients with type IIb odontoid fractures.