Treatment of Anderson Type II Odontoid Fracture in Elderly Patients by Posterior Pedicle Screw Fixation Combined with Iliac Bone Grafting

Abstract BackgroundShort-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs). When it is used, the anterior middle columns of the fractured vertebral body lack good support, resulting in fractured vertebral bodies decreased height and difficult to reduct.Therefore,the purpose of this study was to evaluate the clinical effect of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.MethodsA total of 9 patients with TBFs who agreed to be treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation were retrospectively analysed. We measured the anterior and middlel heights of the injured vertebrae, the ratios of the anterior and middlel heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients at different stages before and after surgery, and evaluated the distribution of bone grafts and bone healing 3 days and 12 months after the operation.ResultsThe anterior height of the injured vertebrae before the operation; after application of the transpedicular reducer; and 3 days, 3 months, 6 months and 12 months after the operation were 17.56±3.74 mm; 27.70±2.53 mm; and 29.08±2.52 mm, 28.36±1.93 mm, 28.12±1.42 mm, and 27.96±0.72 mm, respectively. The mid-heights of the injured vertebrae were 21.36±4.20 mm; 26.74±1.00 mm; and 27.70±2.01 mm, 27.05±2.45 mm, 26.94±1.84 mm, and 26.83 ±2.45 mm, respectively. The Cobb angles of the injured vertebrae were 3.80±1.44°; 1.26±1.00°; and 0.72±0.70°, 1.03±0.65°, 1.12±0.63°, and 1.34±0.56°, respectively. The allogeneic bones were distributed in the anterior and middle columns 3 days after the operation, and the bone had healed well 12 months after the operation.ConclusionThe new transpedicular reducer has a good reduction, allogeneic bone support, and clinical treatment effect for TBFs through pedicle fracture reduction and bone grafting combined with pedicle screw fixation.

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Biomechanical Comparison of C1 Lateral Mass C2 Pars and C3 Lateral Mass Screw-Rod Construct vs C1 Lateral Mass C2 Pedicle Screw Fixation for Type II Odontoid Fractures

The Spine Journal ◽

10.1016/j.spinee.2017.08.018 ◽

2017 ◽

Vol 17 (10) ◽

pp. S183

Author(s):

Young Lu ◽

Nitin N. Bhatia ◽

Yu-Po Lee

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Type Ii ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Odontoid Fractures ◽

C2 Pedicle Screw ◽

Biomechanical Comparison

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Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/5/405 ◽

2008 ◽

Vol 8 (5) ◽

pp. 405-412 ◽

Cited By ~ 83

Author(s):

Yong Hun Pee ◽

Jong Dae Park ◽

Young-Geun Choi ◽

Sang-Ho Lee

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Iliac Bone ◽

Anterior Fusion ◽

Anterior Debridement ◽

Pyogenic Spondylodiscitis ◽

Subsidence Rate ◽

Cage Group ◽

Autologous Bone

Object An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. Methods The authors retrospectively reviewed the cases of 60 patients with pyogenic spondylodiscitis treated by anterior debridement between January 2003 and April 2005. Fusion using either cages or iliac bone struts was performed during the same course of anesthesia followed by posterior fixation. Twenty-three patients underwent fusion with autologous iliac bone strut, and 37 patients underwent fusion with 1 of the 3 types of cages. Results The infections resolved in all patients, as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. Patients in both groups were evaluated in terms of their preoperative and postoperative clinical and imaging findings. Conclusions Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.

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