Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl-Gallie technique.

Abstract

This single-centre retrospective study compared anterior odontoid screw fixation and posterior atlantoaxial fusion in the surgical treatment of type II B odontoid fractures according to Grauer in elderly patients. Between 1994 and 2014, 133 consecutive patients above 60years presenting with type II B odontoid fracture were treated surgically in our department. They were divided retrospectively into two groups. Group A included 47 patients in whom anterior odontoid screw fixation was performed. Group B with 86 patients underwent posterior atlantoaxial fusion. The clinical and radiological data were analysed. Any reoperation during the follow-up was recorded and evaluated. The mean age in group A (74.19years) was significantly less than in group B (78.16years). The mean operative time in group A (64.5min) was significantly shorter than in group B (116min). Again, the mean amount of blood loss in group A (79ml) was significantly less than in group B (379ml). The mean postoperative hospital stay was significantly shorter in group A (17.4days) than in group B (30days). The mean follow-up was 29.3months in group A and 32months in group B. The rate of pseudoarthrosis was significantly higher in group A (25.5%) than in group B (3.5%). Furthermore, the need for revision surgery was significantly increased in group A (23.4%) than in group B (10.47%). Odontoid screw fixation is a less invasive surgery for type II B odontoid fractures in elderly patients. However, posterior atlantoaxial fusion provides a superior surgical outcome regarding fracture healing and the need for surgical revisions. These slides can be retrieved under Electronic Supplementary Material.