scholarly journals Direct anterior screw fixation for recent and remote odontoid fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-10 ◽  
Author(s):  
Ronald I. Apfelbaum ◽  
Russell R. Lonser ◽  
Robert Veres ◽  
Adrian Casey
Keyword(s):  
Screw Fixation ◽  
Fusion Rate ◽  
Odontoid Fractures ◽  
Hardware Failure ◽  
University Of Utah ◽  
Bone Fusion ◽  
Anterior Screw Fixation ◽  
Operative Findings ◽  
The University

Object The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1–2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. Methods One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for a recent fracture (< 6 months postinjury [129 patients]) or remote (≥ 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow-up period 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p ≤ 0.05) higher in fractures oriented in the horizontal and posterior oblique direction (as compared with anterior oblique), but this finding was independent (p ≥ 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Conclusions Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures (< 6 months postinjury). It confers immediate stability, preserves C1–2 rotatory motion, and achieves a fusion rate that compares favorably with alternative treatment methods. In contradistinction, in patients with remote fractures (≥ 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.

Direct anterior screw fixation for recent and remote odontoid fractures

2000 ◽  
Vol 93 (2) ◽  
pp. 227-236 ◽  
Author(s):  
Ronald I. Apfelbaum ◽  
Russell R. Lonser ◽  
Robert Veres ◽  
Adrian Casey
Keyword(s):  
Screw Fixation ◽  
Fusion Rate ◽  
Content Type ◽  
Odontoid Fractures ◽  
Hardware Failure ◽  
University Of Utah ◽  
Bone Fusion ◽  
Anterior Screw Fixation ◽  
Operative Findings ◽  
Fine Print

Object. The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1–2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. Methods. One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for recent (≤ 6 months postinjury [129 patients]) or remote (≥ 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow up 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p ≤ 0.05) higher in fractures oriented in the horizontal and posterior oblique direction (compared with anterior oblique), but this finding was independent (p ≥ 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and those unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Conclusions. Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures (< 6 months postinjury). It confers immediate stability, preserves C1–2 rotatory motion, and achieves a fusion rate that compares favorably with alternative treatment methods. In contradistinction, in patients with remote fractures (≥ 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.

Results of Long-Term Follow-Up in Patients Undergoing Anterior Screw Fixation for Type II and Rostral Type III Odontoid Fractures

Spine ◽  
2005 ◽  
Vol 30 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Kostas N. Fountas ◽  
Eftychia Z. Kapsalaki ◽  
Ioannis Karampelas ◽  
Carlos H. Feltes ◽  
Vassilios G. Dimopoulos ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Anterior Screw Fixation ◽  
Long Term Follow Up

Avoiding pitfalls in anterior screw fixation for Type II odontoid fractures

2011 ◽  
Vol 31 (4) ◽  
pp. E7 ◽  
Author(s):  
Marcus D. Mazur ◽  
Michael L. Mumert ◽  
Erica F. Bisson ◽  
Meic H. Schmidt
Keyword(s):  
Cervical Spine ◽  
Patient Selection ◽  
Operative Technique ◽  
Screw Fixation ◽  
Fusion Rate ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation ◽  
Key Points ◽  
High Fusion Rate

Anterior screw fixation of Type II odontoid fractures provides immediate stabilization of the cervical spine while preserving C1–2 motion. This technique has a high fusion rate, but can be technically challenging. The authors identify key points that should be taken into account to maximize the chance for a favorable outcome. Keys to success include proper patient and fracture selection, identification of suitable screw entry point and correct screw trajectory, achieving bicortical purchase, and placing 2 screws when feasible and applicable. The authors review the operative technique and present guidance on appropriate patient selection and common pitfalls in anterior screw fixation, with strategies for avoiding complications.

scholarly journals Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
L. Leitner ◽  
C. I. Brückmann ◽  
M. M. Gilg ◽  
G. Bratschitsch ◽  
P. Sadoghi ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Treatment Method ◽  
Preoperative Imaging ◽  
Screw Loosening ◽  
Gi Tract ◽  
Revision Operation ◽  
Odontoid Fractures ◽  
Esophagus Perforation ◽  
And Migration

Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

scholarly journals Odontoid fractures anterior screw fixation: A continuous series of 36 cases

2010 ◽  
Vol 96 (7) ◽  
pp. 748-752 ◽  
Author(s):  
C. Eap ◽  
L. Barresi ◽  
X. Ohl ◽  
R. Saddiki ◽  
C. Mensa ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Continuous Series ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

Radiographic and clinical follow-up review of Caspar plates in 49 patients

1996 ◽  
Vol 84 (6) ◽  
pp. 957-961 ◽  
Author(s):  
Christopher G. Paramore ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag
Keyword(s):  
The Elderly ◽  
Fusion Rate ◽  
Neurological Deficits ◽  
Repeat Surgery ◽  
Content Type ◽  
Hardware Failure ◽  
Plate Length ◽  
Number Of Patients ◽  
Plate Failure

✓ Although they are excellent clinical tools, Caspar anterior cervical plates have not been studied closely with regard to their mechanisms of failure. As more extensive operations are contemplated on older, sicker patients, it is imperative to know when a plating system might be prone to failure and what the mechanism of that failure might be. Therefore, the authors reviewed 49 patients undergoing Caspar plate placement in whom sufficient radiographs were obtained to determine if the fate of the hardware was related to the patient's age, type of operation, and the length of construct. Eleven of 49 patients suffered hardware failure, defined as any amount of screw backout or breakage, plate pullout, or pseudarthrosis. Four patients underwent hardware removal; one underwent posterior fusion for pseudarthrosis. Only two required treatment in a halo brace. There was an eventual fusion rate of 100%, including one fibrous union, and one of the patients who underwent repeat surgery was lost to follow-up review. No graft extrusions or new neurological deficits were incurred as a result of hardware failure. Plate length predicted plate failure in a statistically significant manner. Increasing age and reoperation correlated with plate failure but were not statistically significant in this small number of patients. Telescoping of the bone graft and vertebral bodies, with concomitant migration of the plate and slippage of the screws, was common. However, telescoping was more profound in the group in which the plates failed. The authors conclude that Caspar plate failures are more likely to occur in the elderly and in patients who need longer constructs. Bone fusion can be expected even when the hardware loosens.

Anterior Screw Fixation of Odontoid Fractures Comparing Younger and Elderly Patients

Spine ◽  
2007 ◽  
Vol 32 (16) ◽  
pp. 1714-1720 ◽  
Author(s):  
Patrick Platzer ◽  
Gerhild Thalhammer ◽  
Roman Ostermann ◽  
Thomas Wieland ◽  
Vilmos Vécsei ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Screw Fixation ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

Surgical Treatment of Acute Type II and Rostral Type III Odontoid Fractures Managed by Anterior Screw Fixation

2005 ◽  
Vol 98 (9) ◽  
pp. 895-900 ◽  
Author(s):  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Eftychia Z. Kapsalaki ◽  
Vassilios G. Dimopoulos ◽  
Carlos H. Feltes ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Acute Type ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Anterior Screw Fixation
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