scholarly journals Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

2015 ◽  
Vol 38 (4) ◽  
pp. E11 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Alpesh A. Patel
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Salvage Procedure ◽  
Type Ii ◽  
Fracture Characteristics ◽  
Odontoid Fractures ◽  
Instrumented Fusion ◽  
Cervical Injuries ◽  
Cervical Spine Fractures ◽  
Fracture Compression

Odontoid fractures comprise as many as 20% of all cervical spine fractures. Fractures at the dens base, classified by the Anderson and D’Alonzo system as Type II injuries, are the most common pattern of all odontoid fractures and are also the most common cervical injuries in patients older than 70 years of age. Surgical treatment is recommended for patients older than 50 years with Type II odontoid fractures, as well as in patients at a high risk for nonunion. Anterior odontoid screw fixation (AOSF) and posterior cervical instrumented fusion (PCIF) are both well-accepted techniques for surgical treatment but with unique indications and contraindications as well as varied reported outcomes. In this paper, the authors review the literature about specific patients and fracture characteristics that may guide treatment toward one technique over the other. AOSF can preserve atlantoaxial motion, but requires a reduced odontoid, an intact transverse ligament, and a favorable fracture line to achieve adequate fracture compression. Additionally, older patients may have a higher rate of pseudarthrosis using this technique, as well as postoperative dysphagia. PCIF has a higher rate of fusion and is indicated in patients with severe atlantoaxial misalignment and with poor bone quality. PCIF allows direct open reduction of displaced fragments and can reduce any atlantoaxial subluxation. It is also used as a salvage procedure after failed AOSF. However, this technique results in loss of atlantoaxial motion, requires prone positioning, and demands a longer operative duration than AOSF, factors that can be a challenge in patients with severe medical conditions. Although both anterior and posterior approaches are acceptable, many clinical and radiological factors should be taken into account when choosing the best surgical approach. Surgeons must be prepared to perform both procedures to adequately treat these injuries.

scholarly journals Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Technique and Technical Report

2020 ◽  
Author(s):  
Vit Kotheeranurak ◽  
Khanathip Jitpakdee ◽  
Phattareeya Pholprajug ◽  
Pritsanai Pruttikul ◽  
Weerasak Singhatanadgige ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Invasive Technique ◽  
Type Ii ◽  
Level Of Evidence ◽  
Odontoid Fractures ◽  
Technical Report ◽  
Effective Option ◽  
Cervical Motion ◽  
Cervical Spine Fractures

Abstract Background: Odontoid fractures are common among cervical spine fractures and are categorized into three types. Unstable type II fractures are among the most challenging to treat, and the best treatment approach has been debated. Anterior odontoid screw fixation, a surgical treatment option, yields a high union rate and helps preserve cervical motion; however, there are risks for approach-related complications. Here, we report a novel minimally invasive technique of full-endoscopic anterior odontoid fixation (FEAOF).Methods: The authors introduce the technique and describe in detail the technical approach of FEAOF for the surgical treatment of type II odontoid fractures.Conclusions: FEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.Level of Evidence: Not applicable

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

Surgical Treatment of Unstable Type II Odontoid Fractures in Skeletally Mature Individuals

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S209-S218 ◽  
Author(s):  
Alpesh A. Patel ◽  
Ron Lindsey ◽  
Jason T. Bessey ◽  
Jens Chapman ◽  
Raja Rampersaud
Keyword(s):  
Surgical Treatment ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Unstable Type

scholarly journals Treatment of type II odontoid fracture in the elderly

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Screw Fixation ◽  
Holistic Approach ◽  
The Elderly ◽  
Spinal Fracture ◽  
Cannulated Screw ◽  
Odontoid Fracture ◽  
Zenker’S Diverticulum ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

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

Anterior Screw Fixation of Posteriorly Displaced Type II Odontoid Fractures

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Fred H. Geisler ◽  
Charles Cheng ◽  
Attila Poka ◽  
Robert J. Brumback
Keyword(s):  
Structural Integrity ◽  
Screw Fixation ◽  
Odontoid Process ◽  
Cervical Vertebra ◽  
High Rate ◽  
Posterior Arch ◽  
Treatment Technique ◽  
Type Ii ◽  
Fracture Union ◽  
Odontoid Fractures

Abstract Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Two patients, later in the study, had no injury to the ring of C1. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. No neurological complications related to the procedure occurred. Two patients died of causes unrelated to their cervical fracture surgery. The 7 patients who survived were followed for a minimum of 6 months. Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. Normal range of motion of the neck was documented at follow-up in all surviving patients. Although this series represents a limited experience with this treatment technique, anterior odontoid screw fixation has significant advantages over accepted methods of cervical stabilization for Type II-P odontoid fractures. Immediate cervical stabilization is obtained, with a predictably high rate of fracture union and preservation of atlantoaxial motion. We believe this technique to be the treatment method of choice for Type II-P odontoid fractures displaced 4 mm or more accompanied by fractures of the posterior arch of the first cervical vertebra.

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