Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture

Ai-Min Wu,Yong-Long Chi,Xiang-Yang Wang,Zhong-Ke Lin,Hai-Ming Jin

doi:10.1186/s13018-017-0640-x

Abstract

BackgroundThe objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails.MethodsFifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 transarticular screw fixation technique in treatment of these patients. The visual analogue score (VAS) of neck pain and Neck Disability Index (NDI) of all patients were scored at pre-operation, 3 months after operation, and final follow-up. Additional, technique-related complications were recorded and collected.ResultsPercutaneous C1/2 transarticular screw fixation was performed successfully in all 15 patients whose odontoid screw fixation failed. No technique-related complications (such as nerve injury, spinal cord injury, and esophageal injury) occurred. The VAS of neck pain and NDI score improved significantly (P = 0.000) after operation, and no significant differences were found when compared to 93 non-salvage patients who successfully performed the percutaneous anterior odontoid screw fixation. No screw loose or breakage occurred, all of the odontoid fractures achieve radiographic fusion, bony fusion bridge could be observed at the C1/2 lateral articular facet on 9/15 patients.ConclusionsWe suggest that percutaneous anterior C1/2 transarticular screw fixation is a good alternative salvage technique if percutaneous odontoid screw fixation failed, and it is a minimally invasive, feasible, and safe technique.

Highlights

The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/ 2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails
Many posterior surgical techniques were reported in previous literatures [7,8,9], including Gallie’s The first cervical spine/the second cervical spine (C1/2) wiring [10] and Magerl’s posterior C1/2 transarticular screw fixation and posterior C1 lateral mass + C2 pedicle screw fixation [11, 12]; these posterior techniques were performed via an open surgical approach, with disadvantages of considerable tissue trauma, blood loss, higher risk of vertebral arteries injury, and some other risks of pneumonia, acute respiratory distress syndrome, and decubitus ulcer [13]
All of the 15 patients were followed up for an average of 30.5 months; no screw loose or breakage was occurred, all of the odontoid fractures achieve radiographic fusion, and bony fusion bridge could be observed at the C1/2 lateral articular facet on 9/15 patients

Summary

Introduction

The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/ 2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. Many posterior surgical techniques were reported in previous literatures [7,8,9], including Gallie’s C1/2 wiring [10] and Magerl’s posterior C1/2 transarticular screw fixation and posterior C1 lateral mass + C2 pedicle screw fixation [11, 12]; these posterior techniques were performed via an open surgical approach, with disadvantages of considerable tissue trauma, blood loss, higher risk of vertebral arteries injury, and some other risks of pneumonia, acute respiratory distress syndrome, and decubitus ulcer [13]. The trajectory of odontoid screw cannot be determined satisfactorily [24], such as the case reported by Salem et al [25] that the fracture position was unacceptable, and other surgical techniques need to be considered [25, 26]

Objectives

Methods

Results

Conclusion