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.

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

P22. Anterior Screw Fixation in Type II Odontoid Fractures: Is it a Reliable Method in the Elderly?

2006 ◽  
Vol 6 (5) ◽  
pp. 94S
Author(s):  
Woo-Kie Min ◽  
Joo-Kyung Sung ◽  
In-Ho Jeon ◽  
Chang-Wug Oh ◽  
Shin-Yoon Kim ◽  
...  
Keyword(s):  
Reliable Method ◽  
Screw Fixation ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

scholarly journals P.139 Fixation of Type II Odontoid fractures with anterior single screw

2018 ◽  
Vol 45 (s2) ◽  
pp. S53-S53
Author(s):  
AM Seleem ◽  
NM Sayed
Keyword(s):  
Cervical Spine ◽  
Screw Fixation ◽  
Type Ii ◽  
Union Rate ◽  
Cervical Spine Injuries ◽  
Odontoid Fractures ◽  
Hardware Failure ◽  
Single Screw ◽  
Spine Injuries ◽  
Rotatory Motion

Background: More than 60% of spinal injuries affect the cervical spine,and approximately 20% of all cervical spine injuries involve the axis.The most common axis injury is odontoid fracture.The management of odontoid fractures became less controversial than before. Methods: Thirty consecutive patients(25 males and 5 females)who underwent anterior single screw fixation for recent Type II odontoid fractures at King Fahd Hospital,Al-Madina Al-Munawarah,in Saudi Arabia(SA) between January 2004 and December 2007 were included in this study.Data including clinical examination,imaging studies and operative technique were used to analyze the results of this surgical technique. Results: Single screw for fixation of type II odontoid fracture was found easier and simpler than double screws with the same advantages.This method resulted in immediate spinal stability and preserves normal rotation at C1–2 in all patients.Radiological evidence of bone union achieved in 22 patients(73% of cases);and nonunion in 8 patients(27% of cases).Complications related to surgical procedure and hardware failure were recorded in 4 patients(13% of cases). Conclusions: Direct anterior single screw fixation is an effective,simple,and safe method for treating type II odontoid fractures.It is associated with rapid patient mobilization,minimal postoperative pain,and shorter hospital stay.By this technique,the required anatomical and functional outcome can be obtained through immediate stability of the axis,preserves C1–2 rotatory motion,and achieved high union rate.

Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1089-1094 ◽  
Author(s):  
Wolfgang Börm ◽  
Erich Kast ◽  
Hans-Peter Richter ◽  
Klaus Mohr
Keyword(s):  
Screw Fixation ◽  
Age Groups ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

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.

The use of bioabsorbable screws to fix Type II odontoid fractures: a biomechanical study

2011 ◽  
Vol 15 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Ali Nourbakhsh ◽  
Shashikant Patil ◽  
Prasad Vannemreddy ◽  
Alan Ogden ◽  
Debi Mukherjee ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Bending Stiffness ◽  
Type Ii ◽  
Rotational Stiffness ◽  
Odontoid Fractures ◽  
Lag Screw ◽  
Anterior Screw Fixation ◽  
Titanium Screws ◽  
Bioabsorbable Screws ◽  
Screw Group

Object Anterior screw fixation of the Type II odontoid fracture stabilizes the odontoid without restricting the motion of the cervical spine. The metal screw may limit bone remodeling because of stress shielding (if not placed properly) and limit imaging of the fracture. The use of bioabsorbable screws can overcome such shortcomings of the metal screws. The purpose of this study was to compare the strength of a 5-mm bioabsorbable screw with single 4-mm metal and double 3.5-mm lag screw fixation for Type II fractures of the odontoid process. Methods Three different modalities of anterior screw fixation were used in 19 C-2 vertebrae. These fixation methods consisted of a single 5-mm cannulated bioabsorbable lag screw (Group A), a single 4-mm cannulated titanium lag screw (Group B), and two 3.5-mm cannulated titanium lag screws (Group C). Anteroposterior (AP) stiffness and rotational stiffness were evaluated in all constructs. Results There was no statistical difference among the ages of the cadavers in each group (p = 0.52). The AP bending stiffness in Groups A, B, and C was 117 ± 86, 66 ± 43, and 305 ± 130 Nm/mm, respectively. The AP bending stiffness in Group C was significantly higher than that in Groups A and B (p = 0.01 and p = 0.001, respectively). The difference in AP bending stiffness values of bioabsorbable and 4-mm metal screws was not statistically significant (p = 0.23). The rotational stiffness of the double 3.5-mm metal screws was significantly greater than that of the 5-mm bioabsorbable and the 4-mm titanium screws. Conclusions Double screw fixation with 3.5-mm screws provides the stiffest construct in Type II odontoid fractures. Bioabsorbable lag screws (5 mm) have the same AP bending and rotational stiffness as the single titanium lag screw (4 mm) in odontoid fractures.

Comparison of Percutaneous and Open Anterior Screw Fixation in the Treatment of Type II and Rostral Type III Odontoid Fractures

Spine ◽  
2011 ◽  
Vol 36 (18) ◽  
pp. 1459-1463 ◽  
Author(s):  
Jian Wang ◽  
Yue Zhou ◽  
Zheng Feng Zhang ◽  
Chang Qing Li ◽  
Wen Jie Zheng ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Anterior Screw Fixation
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