Abstract
BackgroundAnterior odontoid screw fixation (AOSF) has been one of the most popular treatments for odontoid fractures. However, the true efficacy of AOSF remains unclear. In this study, we aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures.MethodsWe searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and potential sources of heterogeneity were explored by meta-regression analysis.ResultsOf 972 references initially identified, 63 were eligible for inclusion. 54 studies provided data regarding non-union. The pooled non-union rate was 10% (95% CI: 7%–3%). 48 citations provided re-operation information with a pooled proportion of 5% (95% CI: 3%–7%). Infection was described in 20 studies with an overall rate of 0.2% (95% CI: 0%–1.2%). The main approach related complication is postoperative dysphagia with a pooled rate of 10% (95% CI: 4%–17%). Proportions for the other approach related complications such as postoperative hoarseness (1.2%, 95% CI: 0%–3.7%), esophageal/retropharyngeal injury (0%, 95% CI: 0%–1.1%), wound hematomas (0.2%, 95% CI: 0%–1.8%), and spinal cord injury (0%, 95% CI: 0%–0.2%) were very low. Significant heterogeneities were detected when we combined the rates of non-union, re-operation, and dysphagia. Multivariate meta-regression analysis showed that old age was significantly predictive of non-union. Subgroup comparisons showed significant higher non-union rates in age ≥70 than that in age ≤40 and in age 40 to <50. Meta-regression analysis did not reveal any examined variables influencing the re-operation rate. Meta-regression analysis showed age had a significant effect on the dysphagia rate.Conclusions/SignificancesThis study summarized the rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid factures. Elderly patients were more likely to experience non-union and dysphagia.
Highlights
Odontoid fractures account for 10%–15% of all cervical spine fractures [1]
The follow-up duration ranged from 1.5 months to 9 years. 88.9% of the injuries were type II dens fractures according to Anderson and D’Alonzo’s classification [8]
We conducted this study to provide a better understanding of the frequency of non-union, infection, re-operation, and approach related complications after anterior screw fixation for type II and type III odontoid fractures
Summary
Odontoid fractures account for 10%–15% of all cervical spine fractures [1]. Despite of the frequency of odontoid fractures, its management remains controversial and ranges from conservative treatment to surgical intervention [2,3,4,5,6,7]. Conservative treatment consists of skull traction, cervical collar, brace, and halo vest Such methods are unpopular for unstable odontoid fractures (type II and shallow type III based on the classification of Anderson and D’lonzo [8]) because of the high non-union rate [2,3]. Anterior odontoid screw fixation (AOSF) has been one of the surgical treatments for unstable odontoid fractures since it was independently introduced by Bohler and Nakanishi [11,12]. This technique seems an ideal treatment as it preserves C1–C2 movement and obviates bone graft harvest. We aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures
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