Abstract
BackgroundIt is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique.This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients’ age.MethodsThe study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation.ResultsIn the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients’ age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001).ConclusionsActive cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients’ age, and intensity of spinal pain.
Highlights
From the viewpoint of spinal kinematics, direct osteosynthesis is the most effective method of surgical treatment of odontoid fractures
There are no clinical studies focusing on cervical mobility in patients following anterior odontoid screw fixation or conservative treatment involving immobilization in external hard collar or in halo vest
The present study reports ranges of motion of the head in patients following direct odontoid screw fixation
Summary
From the viewpoint of spinal kinematics, direct osteosynthesis is the most effective method of surgical treatment of odontoid fractures. Unlike posterior atlantoaxial fixation, the method preserves physiological range of motion in the upper cervical spine, which is responsible for nearly half of the entire range of motion of the head relative to the torso [1,2,3]. Our own clinical practice provided anecdotal evidence against motion sparing value of direct anterior odontoid osteosynthesis. It is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients’ age
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