title: Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures.
abstract: METHODS
  Retrospective analysis of the fusion rate of a group of 38 patients having undergone anterior screw fixation for type II and "shallow" type III odontoid fractures. OBJECTIVE.: To determine primarily the long-term fusion rate after anterior screw fixation and to study the clinical characteristics of patients that have a statistically significant or nonsignificant influence on successful outcome.
  
  
  BACKGROUND
  Long-term outcome of anterior screw fixation for odontoid fractures has been evaluated in very few studies. This information should be critical for further establishing this technique as a major therapeutic strategy for these cases.
  
  
  METHODS
  Thirty-eight patients, 25 males and 13 females (with mean age 48.4 +/- 0.4 years), with type II and rostral type III odontoid fractures, underwent anterior cannulated screw fixation during a 62-month period. Radiologic examination of the cervical spine with plain radiographs was performed at 6 weeks, and 2, 6, 12, and 24 months, while computerized tomography of the upper cervical spine (C1-C3) was obtained at 6 months after surgery. Follow-up was available for 31 patients, and the follow-up time ranged from 39 to 87 months (mean 58.4).
  
  
  RESULTS
  Radiographic evaluation of the follow-up group showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 27 (87.1%) patients. Pseudarthrosis developed in 4 (12.9%) patients; however, 3 (9.6%) of them without instability and 1 (3.2%) with instability. One (3.2%) patient had an instrumentation failure without instability.
  
  
  CONCLUSIONS
  In our series, anterior odontoid screw fixation comprised a safe therapeutic modality with high stability and low mechanical failure rates during short-term and long-term follow-up.
authors.affiliation: Department of Neurosurgery, The Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA, USA. knfountasmd@excite.com
authors.forename: Kostas N
authors.initials: KN
authors.lastname: Fountas
authors.forename: Eftychia Z
authors.initials: EZ
authors.lastname: Kapsalaki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Karampelas
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Feltes
authors.forename: Vassilios G
authors.initials: VG
authors.lastname: Dimopoulos
authors.forename: Theofilos G
authors.initials: TG
authors.lastname: Machinis
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Nikolakakos
authors.forename: Angel N
authors.initials: AN
authors.lastname: Boev
authors.forename: Haroon
authors.initials: H
authors.lastname: Choudhri
authors.forename: Hugh F
authors.initials: HF
authors.lastname: Smisson
authors.forename: Joe S
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed