Abstract
BackgroundCervical trauma is a common cause of disability following spinal cord injury especially in athletic populations. The biomechanics in the atlantoaxial joint carry more than 50% of the rotational movement which can be affected in transverse ligament tear associated with odontoid fracture type II. Odontoid fracture type II is considered an unstable fracture with a high rate of nonunion in conservative treatment. Limitation of the odontoid screws in some cases gives the chance of posterior cervical fixation to have the superior role. Use of polyaxial screws in Harms technique gives the best results in maintaining majority of the biomechanics.PurposeOur aim in this study is to evaluate Harms technique in patients regarding pain improvement and restoration of the motor power and to report the complications.Study designThis is a retrospective case series study. We used the Frankel grading system to evaluate the postoperative neurological state.Patient and methodsBetween January 2015 and January 2018, 12 patients were introduced to the neurosurgical department at the Sohag University Hospital with post-traumatic type II odontoid fracture with failure of conservative treatment and not suitable for anterior odontoid screws. All patients underwent full laboratory, medical, and neurological evaluation and imaging study on the cervical spine. All patients underwent posterior cervical fixation C1–C2 by polyaxial screw Harms technique.ResultsMale ratio was predominant in our study: 75% with a mean age 34.4 years. Neck pain with limitation of the neck movement was the complaint for the all cases. Three cases came with neurological affection. Postoperative superficial infection reported in one patient; no vertebral artery or neural injuries were noticed in our study.ConclusionHarms technique C1–C2 fixation is a valuable choice in patients with type II odontoid fracture with failure of conservative treatment or not suitable for odontoid screw. Harms technique gives us the highest preservation of the biomechanics among the other posterior approaches.Trial registrationNCT03768843.
Highlights
The atlantoaxial C1–C2 joint considered an important articulation that gives about 50% of the cervical rotation around the odontoid process
Postoperative superficial infection reported in one patient; no vertebral artery or neural injuries were noticed in our study
Harms technique C1–C2 fixation is a valuable choice in patients with type II odontoid fracture with failure of conservative treatment or not suitable for odontoid screw
Summary
The atlantoaxial C1–C2 joint considered an important articulation that gives about 50% of the cervical rotation around the odontoid process. Odontoid fractures are defined as a fracture at the dens of the C2 cervical spine. In 1974, Anderson and D’Alonzo published the most commonly accepted classification for odontoid fractures. They classified the odontoid fractures into three categories. Type II odontoid fractures are the commonest type representing about 65–74% of the odontoid fractures. These fractures have similar biomechanical properties as. The biomechanics in the atlantoaxial joint carry more than 50% of the rotational movement which can be affected in transverse ligament tear associated with odontoid fracture type II. Purpose: Our aim in this study is to evaluate Harms technique in patients regarding pain improvement and restoration of the motor power and to report the complications
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