Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2021 | Research article

A new tool in percutaneous anterior odontoid screw fixation

Authors: Yan Wang, Min Li, Guanxing Cui, Jing Li, Zhiliang Guo, Dahai Zhang, Haijun Teng, Haijiang Lu

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation.

Methods

Twenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery.

Results

There were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group.

Conclusions

The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.

Available only for authorised users

Fiumara E, Tumbiolo S, Lombardo MC, Maugeri R, Porcaro S, Gioia F, Visocchi M, Iacopino DG. Type II Odontoid Fracture: a case series highlighting the treatment strategies. Acta Neurochir Suppl. 2019;125:317–24. https://doi.org/10.1007/978-3-319-62515-7_46.CrossRefPubMed

Wu AM, Jin HM, Lin ZK, Chi YL, Wang XY. Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture. J Orthop Surg Res. 2017;12(1):141. https://doi.org/10.1186/s13018-017-0640-x.CrossRefPubMedPubMedCentral

Sawarkar DP, Singh PK, Siddique SA, Agrawal D, Satyarthee GD, Gupta DK, Sinha S, Kale SS, Sharma BS. Surgical management of odontoid fractures at level one trauma center: a single-center series of 142 cases. Neurol India. 2015;63(1):40–8. https://doi.org/10.4103/0028-3886.152633.CrossRefPubMed

Umana GE, Visocchi M, Scalia G, Passanisi M, Fricia M, Fagone S, Nicoletti G, Cicero S. Minimally invasive percutaneous anterior odontoid screw fixation: institutional experience with a simple and effective technique. J Neurosurg Sci. 2020. https://doi.org/10.23736/s0390-5616.20.04886-9.

Chi YL, Wang XY, Xu HZ, Lin Y, Huang QS, Mao FM, Ni WF, Wang S, Dai LY. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J. 2007;16(8):1157–64. https://doi.org/10.1007/s00586-007-0331-0.CrossRefPubMedPubMedCentral

Rizvi SA, Fredo HL, Lied B, Nakstad PH, Ronning P, Helseth E. Surgical management of acute odontoid fractures: surgery-related complications and long-term outcomes in a consecutive series of 97 patients. J Trauma Acute Care Surg. 2012;72(3):682–90. https://doi.org/10.1097/TA.0b013e318236b675.CrossRefPubMed

Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM, Albert TJ, Fehlings MG, Vaccaro AR. Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 2005;5(2):123–9. https://doi.org/10.1016/j.spinee.2004.09.014.CrossRefPubMed

Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of percutaneous and open anterior screw fixation in the treatment of type II and rostral type III odontoid fractures. Spine. 2011;36(18):1459–63. https://doi.org/10.1097/BRS.0b013e3181f46ee8.CrossRefPubMed

Shousha M, Alhashash M, Allouch H, Boehm H. 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. Eur Spine J. 2019. https://doi.org/10.1007/s00586-019-05946-x.

10.

Patterson JT, Theologis AA, Sing D, Tay B. Anterior Versus Posterior Approaches for Odontoid Fracture Stabilization in Patients Older Than 65 Years: 30-day Morbidity and Mortality in a National Database. Clin Spine Surg. 2017;30(8):E1033–8. https://doi.org/10.1097/BSD.0000000000000494.CrossRefPubMed

11.

Faure A, Graillon T, Pesenti S, Tropiano P, Blondel B, Fuentes S. Trends in the surgical management of odontoid fractures in patients above 75 years of age: Retrospective study of 70 cases. Orthop Traumatol Surg Res. 2017;103(8):1221–8. https://doi.org/10.1016/j.otsr.2017.07.008.CrossRefPubMed

12.

Lee SH, Kim ES, Sung JK, Park YM, Eoh W. Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1-C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation. J Clin Neurosci. 2010;17(7):886–92. https://doi.org/10.1016/j.jocn.2009.10.008.CrossRefPubMed

13.

De Bonis P, Iaccarino C, Musio A, Martucci A, De Iure F, Donati R, Cultrera F, Tosatto L, Servadei F, Alesi D, Cavallo MA, Ghadirpour R, Molinari F, Lofrese G. Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study. Spine. 2019;44(13):951–8. https://doi.org/10.1097/BRS.0000000000002982.CrossRefPubMed

14.

Joaquim AF, Patel AA. Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? Neurosurg Focus. 2015;38(4):E11. https://doi.org/10.3171/2015.1.FOCUS14781.CrossRefPubMed

15.

Guo Q, Zhang M, Wang L, Lu X, Guo X, Ni B. Comparison of Atlantoaxial Rotation and Functional Outcomes of Two Nonfusion Techniques in the Treatment of Anderson-D'Alonzo Type II Odontoid Fractures. Spine. 2016;41(12):E751–8. https://doi.org/10.1097/BRS.0000000000001370.CrossRefPubMed

16.

Yuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, Liu X. The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1–2 without fusion: a retrospective cohort study. J Orthop Surg Res. 2018;13(1):3. https://doi.org/10.1186/s13018-017-0702-0.CrossRefPubMedPubMedCentral

17.

Mashhadinezhad H, Samini F, Mashhadinezhad A, Birjandinejad A. Clinical results of surgical management in type II odontoid fracture: a preliminary report. Turkish Neurosurg. 2012;22(5):583–7. https://doi.org/10.5137/1019-5149.JTN.5231-11.2.CrossRef

18.

Walker CT, Sonntag VKH. Odontoid Fusion. Acta Neurochir Suppl. 2019;125:289–94. https://doi.org/10.1007/978-3-319-62515-7_41.CrossRefPubMed

19.

Lee SC, Chen JF, Lee ST. Management of acute odontoid fractures with single anterior screw fixation. J Clin Neurosci. 2004;11(8):890–5. https://doi.org/10.1016/j.jocn.2004.03.023.CrossRefPubMed

20.

Song KJ, Lee KB, Kim KN. Treatment of odontoid fractures with single anterior screw fixation. J Clin Neurosci. 2007;14(9):824–30. https://doi.org/10.1016/j.jocn.2006.06.016.CrossRefPubMed

21.

Saur K, Sames M. Results of the treatment of odontoid fractures by osteosynthesis with a single axial screw. Acta Chir Orthop Traumatol Cech. 2008;75(1):48–51.PubMed

22.

Khattab MF, Nageeb Mahmoud A, Saeed Younis A, El-Hawary Y. A simple technique for easier anterior odontoid screw fixation. British J Neurosurg. 2019;33(2):135–9. https://doi.org/10.1080/02688697.2018.1550191.CrossRef

23.

ElSaghir H, Bohm H. Anderson type II fracture of the odontoid process: results of anterior screw fixation. J Spinal Disord. 2000;13(6):527–30; discussion 531. https://doi.org/10.1097/00002517-200012000-00011.CrossRefPubMed

24.

Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vecsei V, Gaebler C. Surgical treatment of dens fractures in elderly patients. J Bone Joint Surg Am. 2007;89(8):1716–22. https://doi.org/10.2106/JBJS.F.00968.CrossRefPubMed

25.

Evaniew N, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, Kwok D. Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality. Spine J. 2015;15(5):910–7 https://doi.org/10.1016/j.spinee.2014.03.029.CrossRef

26.

Agrillo A, Russo N, Marotta N, Delfini R. Treatment of remote type ii axis fractures in the elderly: feasibility of anterior odontoid screw fixation. Neurosurgery. 2008;63(6):1145–50; discussion 1150–1141. https://doi.org/10.1227/01.NEU.0000335780.87219.E9.CrossRefPubMed

27.

Kazan S, Tuncer R, Sindel M. Percutaneous anterior odontoid screw fixation technique. A new instrument and a cadaveric study. Acta Neurochir. 1999;141(5):521–4. https://doi.org/10.1007/s007010050334.CrossRefPubMed

28.

Horgan MA, Hsu FP, Frank EH. A novel endoscopic approach to anterior odontoid screw fixation: technical note. Minim Invasive Neurosurg. 1999;42(3):142–5. https://doi.org/10.1055/s-2008-1053387.CrossRefPubMed

29.

Wu AM, Wang XY, Xia DD, Luo P, Xu HZ, Chi YL. A novel technique of two-hole guide tube for percutaneous anterior odontoid screw fixation. Spine J. 2015;15(5):1141–5. https://doi.org/10.1016/j.spinee.2015.02.013.CrossRefPubMed

30.

Jenkins JD, Coric D, Branch CL Jr. A clinical comparison of one- and two-screw odontoid fixation. J Neurosurg. 1998;89(3):366–70. https://doi.org/10.3171/jns.1998.89.3.0366.CrossRefPubMed

31.

Sasso R, Doherty BJ, Crawford MJ, Heggeness MH. Biomechanics of odontoid fracture fixation. Comparison of the one- and two-screw technique. Spine. 1993;18(14):1950–3. https://doi.org/10.1097/00007632-199310001-00004.CrossRefPubMed

32.

Feng G, Wendlandt R, Spuck S, Schulz AP. One-screw fixation provides similar stability to that of two-screw fixation for type II dens fractures. Clin Orthop Relat Res. 2012;470(7):2021–8. https://doi.org/10.1007/s11999-012-2389-1.CrossRefPubMedPubMedCentral

Title: A new tool in percutaneous anterior odontoid screw fixation
Authors: Yan Wang
Min Li
Guanxing Cui
Jing Li
Zhiliang Guo
Dahai Zhang
Haijun Teng
Haijiang Lu
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03929-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A new tool in percutaneous anterior odontoid screw fixation

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

More metalwork removals in patients with olecranon fracture treated by tension band wiring than plate fixation-a propensity score matching analysis

Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects: a preliminary study

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Diagnosis and treatment of bullous pemphigoid that developed twice after total knee replacement arthroplasty: a case report

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis