Anterior odontoid fixation using a 4.5-mm Herbert screw: The first report of 20 consecutive cases with odontoid fracture.
BACKGROUND
Anterior screw fixation provides the best anatomical and functional results for odontoid process fracture (type II and "shallow" type III) with intact transverse ligament. The purpose of this study is to evaluate the clinical results of the 4.5-mm-diameter cannulated Herbert screw in the anterior odontoid fixation.


METHODS
From May 2003 to November 2005, 20 consecutive cases of types II and III odontoid process fractures were treated with anterior screw fixation using a 4.5-mm Herbert screw. The Herbert screw has double threads, with different pitches on the distal and proximal ends. It has no head, so it can be inserted through articular cartilage and buried below bone surface.


RESULTS
There were 16 male and 4 female patients whose ages ranged from 15 to 76 years (mean, 43.7 years). The fracture type was type II-A in 4 patients, II-N in 9 patients, II-P in 5 patients, and III in 2 patients. The range of follow-up was 3 to 36 months (mean, 18.6 months). There were an overall bone fusion rate in 17 cases (85%), fibrous union in 1 (5%), and nonunion in 2 (10%). Overall, complication unrelated to hardware occurred in the one (postoperative dysphagia) without complication-related hardware failure.


CONCLUSIONS
The Herbert screw is very useful in anterior fixation for types II and III odontoid process fractures. This series showed successful clinical results comparable with that of the 3.5-mm cannulated cancellous screw and distinct advantages over conventional screws in the aspect of biomechanical properties and less invasiveness.
Lee
Sun-Ho
SH
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 700-721, Republic of Korea.
Sung
Joo-Kyung
JK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery; D001863:Bone Screws / Q000592:standards / Q000706:statistics & numerical data*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D009809:Odontoid Process / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome