Posterior Reduction and Temporary Fixation for Odontoid Fracture

作者：Ni, Bin^*; Guo, Qunfeng; Lu, Xuhua; Xie, Ning; Wang, Liang; Guo, Xiang; Chen, Fei

来源：Spine, 2015, 40(3): E168-E174.

DOI：10.1097/BRS.0000000000000709

• odontoid fracture
• dens fracture
• open reduction
• temporary fixation
• lateral mass screw
• pedicle screw
• fusion
• C1-C2
• atlantoaxial
• range of motion
• rotation

Study Design. A prospective study.
Objective. To evaluate the outcomes of posterior reduction and temporary fixation using the C1-C2 screw-rod system for odontoid fracture unsuitable for anterior screw fixation.
Summary of Background Data. Anterior screw fixation has become the most widely used surgical procedure for the stabilization of odontoid fractures. However, if there is any contraindication for anterior fixation, posterior atlantoaxial fusion is preferred, eliminating the normal rotation of the atlantoaxial complex.
Methods. A consecutive series of 22 patients with odontoid fracture unsuitable for anterior screw fixation were involved in this study. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed. Once fracture healing was obtained, instrumentation was removed. The visual analogue scale of neck pain, neck stiffness, American Spinal Injury Association impairment scale, patient satisfaction, and neck disability index were recorded. The range of motion of C1-C2 in flexion-extension and rotation was calculated.
Results. The average age at internal fixation surgery was 40.2 +/- 11.3 years. The mean duration of follow-up was 41.8 +/- 26.8 months. There were no complications associated with instrumentation. All patients returned to their preoperative work. Fracture healing was observed in 21 patients and the instrumentation was removed. After and neck stiffness were relieved (all P < 0.01). Patient satisfaction and neck disability index had improved (all P < 0.01). The range of motion of C1-C2 returned to 4.75 degrees +/- 1.62 degrees and 25.70 degrees +/- 5.51 degrees in flexion-extension and in rotation, respectively. No osteoarthritis was observed at the C1-C2 lateral mass joints.
Conclusion. Posterior reduction and temporary fixation using the C1-C2 screw-rod system was an optimal salvage maneuver to anterior screw fixation for odontoid fracture. It could effectively avoid the motion loss of C1-C2 caused by posterior atlantoaxial fusion.

• 出版日期2015-2-1
• 单位天津市中医药研究院附属医院; 中国人民解放军第二军医大学