Top

European Spine Journal

Published in:

01-04-2015 | Chinese Section

Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study

Authors: Bin Han, Fangcai Li, Gang Chen, Hao Li, Qixin Chen

Published in: European Spine Journal | Issue 4/2015

Abstract

Purpose

To assess the feasibility of temporary pedicle screw fixation for motion preservation of type II odontoid fractures unsuitable for anterior screw.

Methods

Between 2012 and 2013, temporary pedicle screw fixation was performed in 13 patients with type II odontoid fractures unsuitable for anterior screw. The patients were 10 men and 3 women with an average age of 40. The implant was removed after fracture union. Dynamic CT was performed ≥1 month after implant removal to evaluate atlantoaxial rotation and axial neck rotation. Literature data on axial neck rotation were obtained as a historical control.

Results

Fifty-two pedicle screws were placed successfully with satisfactory fracture reduction achieved in all patients. The average follow-up period was 14.2 months. At a mean of 9 months after the initial operation, fracture union was confirmed and implants were removed. The average total axial neck rotation was 116.5° ± 25.8° (78.2 ± 14.8 % of the historical controls). The average total atlantoaxial rotation was 34.2° ± 22.0° (27.3 ± 13.8 % of total axial neck rotation).

Conclusions

Temporary pedicle screw fixation is a feasible technique for motion preservation of type II odontoid fractures unsuitable for anterior screw.

Vaccaro AR, Madigan L, Ehrler DM (2000) Contemporary management of adult cervical odontoid fractures. Orthopedics 23:1109–1113PubMed

Maak TG, Grauer JN (2006) The contemporary treatment of odontoid injuries. Spine 31:S53–S60. doi:10.1097/01.brs.0000217941.55817.52 CrossRefPubMed

Lee PC, Chun SY, Leong JC (1984) Experience of posterior surgery in atlanto-axial instability. Spine 9:231–239CrossRefPubMed

Southwick WO (1980) Management of fractures of the dens (odontoid process). J Bone Joint Surg 62:482–486PubMed

Denaro V, Papalia R, Di Martino A, Denaro L, Maffulli N (2011) The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res 469:742–750. doi:10.1007/s11999-010-1677-x CrossRefPubMedCentralPubMed

Patel AA, Lindsey R, Bessey JT, Chapman J, Rampersaud R (2010) Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals. Spine 35:S209–S218. doi:10.1097/BRS.0b013e3181f32ca5 CrossRefPubMed

Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg 56:1663–1674PubMed

Clark CR, White AA 3rd (1985) Fractures of the dens. A multicenter study. J Bone Joint Surg 67:1340–1348PubMed

Subach BR, Morone MA, Haid RW Jr, McLaughlin MR, Rodts GR, Comey CH (1999) Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 45:812–819 discussion 819–820CrossRefPubMed

10.

Apfelbaum RI, Lonser RR, Veres R, Casey A (2000) Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg 93:227–236PubMed

11.

Platzer P, Thalhammer G, Ostermann R, Wieland T, Vecsei V, Gaebler C (2007) Anterior screw fixation of odontoid fractures comparing younger and elderly patients. Spine 32:1714–1720. doi:10.1097/BRS.0b013e3180dc9758 CrossRefPubMed

12.

Chi YL, Wang XY, Xu HZ, Lin Y, Huang QS, Mao FM, Ni WF, Wang S, Dai LY (2007) Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J 16:1157–1164. doi:10.1007/s00586-007-0331-0 CrossRefPubMedCentralPubMed

13.

Jeanneret B, Vernet O, Frei S, Magerl F (1991) Atlantoaxial mobility after screw fixation of the odontoid: a computed tomographic study. J Spinal Disord 4:203–211CrossRefPubMed

14.

Ochoa G (2005) Surgical management of odontoid fractures. Injury 36(Suppl 2):B54–B64. doi:10.1016/j.injury.2005.06.015 CrossRefPubMed

15.

Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM, Albert TJ, Fehlings MG, Vaccaro AR (2005) Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 5:123–129. doi:10.1016/j.spinee.2004.09.014 CrossRefPubMed

16.

Grob D, Bremerich FH, Dvorak J, Mannion AF (2006) Transarticular screw fixation for osteoarthritis of the atlanto axial segment. Eur Spine J 15:283–291. doi:10.1007/s00586-005-0963-x CrossRefPubMedCentralPubMed

17.

Sugimoto Y, Tanaka M, Nakanishi K, Misawa H, Takigawa T, Ozaki T (2007) Assessing the range of cervical rotation in patients with rheumatoid arthritis after atlantoaxial screw fixation using axial CT. Spine 32:2318–2321. doi:10.1097/BRS.0b013e3181557222 CrossRefPubMed

18.

Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129:47–53CrossRef

19.

Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471CrossRefPubMed

20.

Ruf M, Welk T, Muller M, Merk HR, Harms J (2010) Ventral cancellous bone augmentation of the dens and temporary instrumentation C1/C2 as a function-preserving option in the treatment of dens pseudarthrosis. J Spinal Disord Tech 23:285–292. doi:10.1097/BSD.0b013e3181aac6ff CrossRefPubMed

21.

Koller H, Resch H, Acosta F, Zenner J, Schwaiger R, Tauber M, Forstner R, Lederer S, Auffarth A, Hitzl W (2010) Assessment of two measurement techniques of cervical spine and C1–C2 rotation in the outcome research of axis fractures: a morphometrical analysis using dynamic computed tomography scanning. Spine 35:286–290. doi:10.1097/BRS.0b013e3181c911a0 CrossRefPubMed

22.

Andersson S, Rodrigues M, Olerud C (2000) Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J 9:56–59CrossRefPubMedCentralPubMed

23.

Mazur MD, Mumert ML, Bisson EF, Schmidt MH (2011) Avoiding pitfalls in anterior screw fixation for type II odontoid fractures. Neurosurg Focus 31:E7. doi:10.3171/2011.7.FOCUS11135 CrossRefPubMed

24.

Montesano PX, Anderson PA, Schlehr F, Thalgott JS, Lowrey G (1991) Odontoid fractures treated by anterior odontoid screw fixation. Spine 16:S33–S37CrossRefPubMed

25.

Osti M, Philipp H, Meusburger B, Benedetto KP (2011) Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J 20:1915–1920. doi:10.1007/s00586-011-1890-7 CrossRefPubMedCentralPubMed

26.

Harrop JS, Hart R, Anderson PA (2010) Optimal treatment for odontoid fractures in the elderly. Spine 35:S219–S227. doi:10.1097/BRS.0b013e3181f32716 CrossRefPubMed

27.

White AP, Hashimoto R, Norvell DC, Vaccaro AR (2010) Morbidity and mortality related to odontoid fracture surgery in the elderly population. Spine 35:S146–S157. doi:10.1097/BRS.0b013e3181d830a4 CrossRefPubMed

28.

Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895. doi:10.1097/01.BRS.0000058719.48596.CC PubMed

29.

Ebraheim N, Rollins JR Jr, Xu R, Jackson WT (1996) Anatomic consideration of C2 pedicle screw placement. Spine 21:691–695CrossRefPubMed

30.

Christe A, Heverhagen J, Ozdoba C, Weisstanner C, Ulzheimer S, Ebner L (2013) CT dose and image quality in the last three scanner generations. World J Radiol 5:421–429. doi:10.4329/wjr.v5.i11.421 CrossRefPubMedCentralPubMed

31.

Tuli SK, Chen P, Eichler ME, Woodard EJ (2004) Reliability of radiologic assessment of fusion: cervical fibular allograft model. Spine 29:856–860CrossRefPubMed

32.

Dvorak J, Penning L, Hayek J, Panjabi MM, Grob D, Zehnder R (1988) Functional diagnostics of the cervical spine using computer tomography. Neuroradiology 30:132–137CrossRefPubMed

33.

Dvorak J, Hayek J, Zehnder R (1987) CT-functional diagnostics of the rotatory instability of the upper cervical spine. Part 2. An evaluation on healthy adults and patients with suspected instability. Spine 12:726–731CrossRefPubMed

34.

Dvorak J, Antinnes JA, Panjabi M, Loustalot D, Bonomo M (1992) Age and gender related normal motion of the cervical spine. Spine 17:S393–S398CrossRefPubMed

35.

Castro WH, Sautmann A, Schilgen M, Sautmann M (2000) Noninvasive three-dimensional analysis of cervical spine motion in normal subjects in relation to age and sex. An experimental examination. Spine 25:443–449CrossRefPubMed

36.

Bland JM, Altman DG (1996) Measurement error. BMJ 313:744CrossRefPubMedCentralPubMed

37.

Henry AD, Bohly J, Grosse A (1999) Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg Br 81:472–477CrossRefPubMed

38.

Hsu WK, Anderson PA (2010) Odontoid fractures: update on management. J Am Acad Orthop Surg 18:383–394PubMed

39.

Resnick DK, Benzel EC (2002) C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50:426–428PubMed

40.

Resnick DK, Lapsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine 27:1494–1498CrossRefPubMed

41.

Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Xiang M, Zhao WD, Zhong SZ (2009) C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine 34:371–377. doi:10.1097/BRS.0b013e318193a21b CrossRefPubMed

42.

Kim SM, Lim TJ, Paterno J, Hwang TJ, Lee KW, Balabhadra RS, Kim DH (2004) Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability. J Neurosurg 100:277–283PubMed

43.

Parker SL, McGirt MJ, Garces-Ambrossi GL, Mehta VA, Sciubba DM, Witham TF, Gokaslan ZL, Wolinksy JP (2009) Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery 64:343–348. doi:10.1227/01.NEU.0000338955.36649.4F discussion 348–349CrossRefPubMed

44.

Koivikko MP, Kiuru MJ, Koskinen SK, Myllynen P, Santavirta S, Kivisaari L (2004) Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process. J Bone Joint Surg Br 86:1146–1151CrossRefPubMed

45.

Fountas KN, Kapsalaki EZ, Karampelas I, Feltes CH, Dimopoulos VG, Machinis TG, Nikolakakos LG, Boev AN 3rd, Choudhri H, Smisson HF, Robinson JS (2005) Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures. Spine 30:661–669. doi:10.1097/01.brs.0000155415.89974.d3 CrossRefPubMed

46.

Seiler JG 3rd, Johnson J (2000) Iliac crest autogenous bone grafting: donor site complications. J South Orthop Assoc 9:91–97PubMed

47.

Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–S15. doi:10.1016/j.injury.2011.06.015 CrossRefPubMed

48.

Panjabi MM (1990) Kinematics of the spine. Clinical Biomechanics of the Spine. Lippincott Williams & Wilkins, Philadelphia

49.

Platzer P, Thalhammer G, Sarahrudi K, Kovar F, Vekszler G, Vecsei V, Gaebler C (2007) Nonoperative management of odontoid fractures using a halothoracic vest. Neurosurgery 61:522–529. doi:10.1227/01.NEU.0000290898.15567.21 discussion 529–530CrossRefPubMed

50.

Costello JE, Cecava ND, Tucker JE, Bau JL (2013) CT radiation dose: current controversies and dose reduction strategies. AJR Am J Roentgenol 201:1283–1290. doi:10.2214/AJR.12.9720 CrossRefPubMed

Title: Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study
Authors: Bin Han
Fangcai Li
Gang Chen
Hao Li
Qixin Chen
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3693-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2015

Post-traumatic Collet–Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations

The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion

Erratum to: Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

Magnetic resonance imaging changes of intervertebral discs after kyphoplasty

Association between intervertebral disc degeneration and endplate perfusion studied by DCE-MRI