Comparison of Percutaneous and Open Anterior Screw Fixation in the Treatment of Type II and Rostral Type III Odontoid Fractures

Abstract

Prospective controlled study of the clinical and radiographic results of a group of 42 cases having undergone anterior screw fixation for type II and rostal type III odontoid fractures. The objective of this study is to determine the safety and efficacy of percutaneous anterior screw fixation as an alternative new technique in the management of type II and rostal type III odontoid fractures. Minimally invasive spinal techniques have only recently been developed. However, clinical and radiographic outcome of minimally invasive anterior screw fixation for odontoid fractures has been evaluated in very few studies. There have been no prospective clinical reports published on the comparison of percutaneous anterior screw fixation for type II and "shallow" type III odontoid fractures or a traditional open manner. Forty-two patients, 26 men and 16 women, with an average age of 47.1 years (32-65) were prospectively evaluated. All patients underwent percutaneous anterior screw fixation(n = 19) or open screw fixation (n = 23). The following data were compared between the two groups: operative time, blood loss, radiograph exposure time, the clinical and radiographic results, and complications. Radiologic examination of the cervical spine with plain radiographs was performed at 3, 6, and 12 months after surgery. In comparison with open fixation group, percutaneous fixation group had significantly less operating time and less blood loss. The radiation time and clinical outcome were basically identical in two groups. Radiographic evaluation showed satisfactory bony union and no evidence of abnormal movement at the fracture site in both percutaneous fixation group (18 of 19 cases) and open fixation group (22 of 23 cases). Two cases of postoperative dysphagia occurred in open screw fixation group. Percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type II and rostral type III odontoid fractures with potential advantages.