The role of single odontoid screw fixation in treatment of odontoid fracture type II

Ahmed Rizk Elkholy,Ebrahim Ahmed Shamhoot,Ashraf Mohamed Farid

doi:10.1186/s41984-020-00085-8

Ahmed Rizk Elkholy, Ebrahim Ahmed Shamhoot + Show 1 more

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https://doi.org/10.1186/s41984-020-00085-8

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Journal: Egyptian Journal of Neurosurgery	Publication Date: Jun 19, 2020
License type: open-access

Affiliation: Tanta University

Abstract

BackgroundOdontoid fractures are the most common cervical fractures specially type II. Anterior odontoid screw fixation has many advantages with low incidence of surgical complications.PurposeTo evaluate the role of single odontoid screw fixation in surgical treatment of odontoid fracture type II.Study designA retrospective clinical case series.Patients and methodsTwelve patients with acute traumatic odontoid fracture type II were surgically treated by anterior single odontoid screw fixation. The visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the functional outcome among our patients. Plain radiography and CT cervical spine were done in all cases preoperatively and during our period of follow-up (6 months). Preoperative MRI cervical spine was done in all cases.ResultsThe study included 12 patients, four of them (33.3%) were females, and 8 (66.7%) were males with a mean age of 41.7 ± 11.4 years. All patients had acute traumatic odontoid fracture type II, oblique fractures in 10 (83.3%) cases, and transverse fractures in 2 (16.7%) cases. All cases operated for anterior single odontoid screw fixation. During our period of follow-up, VAS and neck disability index were improved in all cases. There were 5 cases (41.7%) with transient dysphagia. Solid fusion was achieved in all cases except in one patient (8.3%) (fibrous union).ConclusionSingle odontoid screw fixation is useful and safe procedure in surgical treatment of odontoid fractures type II. Careful attention to the technical aspects of the procedure and selection of patients are essential for good outcome.

Highlights

IntroductionOdontoid fractures are classified into three types according to the fracture site: Type I: the fracture line traverses the odontoid tip above the transverse ligament, type II: the fracture line traverses the odontoid base (the most common type), and type III: fracture includes the body of C2
Careful attention to the technical aspects of the procedure and selection of patients are essential for good outcome
Odontoid fractures are classified into three types according to the fracture site: Type I: the fracture line traverses the odontoid tip above the transverse ligament, type II: the fracture line traverses the odontoid base, and type III: fracture includes the body of C2

Summary

Introduction

Odontoid fractures are classified into three types according to the fracture site: Type I: the fracture line traverses the odontoid tip above the transverse ligament, type II: the fracture line traverses the odontoid base (the most common type), and type III: fracture includes the body of C2. Posterior C1–C2 fixation is the traditional method for surgical treatment of odontoid fractures with good fusion rates ranged from 92.8 to 100% [2] It is, associated with high rates of morbidity and mortality and resulted in decreased cervical motion specially axial rotation [4,5,6]. Nakanishi in [7] and Bohler in [8] introduced the anterior screw fixation for surgical treatment of odontoid fracture type II This procedure achieves immediate stabilization, maintains rotation of C1 on C2, and it has Elkholy et al Egyptian Journal of Neurosurgery (2020) 35:14 low incidence of complications with good fusion rates [9,10,11].

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