Abstract
Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated with Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring, and 11 were treated with Harms-Goel C1-C2 screw-rod fixation technique. The bony fusion rate was 100% in both groups. The mean time to fusion was 69.7 (95%CI 53.1, 86.3) days in Magerl’s C1-C2 transarticular screw fixation technique and 75.2 (95%CI 51.8, 98.6) days in Harms-Goel C1-C2 screw-rod fixation technique. No severe complications were observed in either group. Displaced reducible, nonunited type II odontoid fracture with cervical myelopathy should be treated by surgery. Both fixation techniques promote bony fusion and provide substantial construct stability.
Highlights
Odontoid fractures account for approximately 7–13% of all cervical spinal fractures [1,2].Anderson and D’Alonzo introduced a classification system in 1974 that had three subtypes according to the location of the fracture line [3]
This study aims to report the results of Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique for the treatment of patients with nonunited type II odontoid fracture with atlantoaxial instability
We retrospectively reviewed 21 patients with nonunited type II odontoid fracture with atlantoaxial instability who had undergone surgical fusion at Chiang Mai University
Summary
Odontoid fractures account for approximately 7–13% of all cervical spinal fractures [1,2]. Anderson and D’Alonzo introduced a classification system in 1974 that had three subtypes according to the location of the fracture line [3]. The type II odontoid fracture is clinically important because fracture through the waist (fracture line occurs between the junction of the odontoid process and the body of the axis) relates to a high nonunion rate due to interruption of blood supply and its own instability [4]. Clinical manifestations of type II odontoid fracture are not always immediately identifiable, and missed diagnosis often occurs due to poor visualization of plain radiography [2]. The delayed or untreated acute fracture may result in nonunion and subsequent atlantoaxial instability causing late cervical myelopathy [5].
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