Multi-holed biplane drill guide-assisted percutaneous anterior odontoid screw fixation.

Abstract

The use of percutaneous anterior screw fixation for odontoid fractures has been widely reported. Because the anatomical characteristics of the odontoid and the screw occupy three-dimensional space, it is challenging to establish the screw trajectory quickly and correctly during the operation. The purpose of this study was to introduce a multi-holed biplane drill guide that can be used to optimize the guide needle trajectory in percutaneous anterior odontoid screw fixation. Twenty-one patients with type II or rostral type III odontoid fractures were treated with percutaneous anterior single screw fixation. Of these, 12 patients had an unsatisfactory initial guide needle position. A drill guide was used to provide a variety of guide needle tracks. All 12 patients successfully underwent guided screw placement without vascular or neurological complications. Postoperative X-ray and/or CT scans showed that the internal fixation position was satisfactory. At the end of the follow-up period, all patients exhibited bony union without loosening or fractures of the internal fixation. With the imperfect initial position of the guide needle as a reference, the multi-holed biplane drill guide can provide a variety of needle trajectory options in the sagittal and coronal planes for percutaneous anterior odontoid screw fixation. The operator can quickly obtain the ideal guide needle trajectory.