Comparison of percutaneous and open anterior screw fixation in the treatment of type II and rostral type III odontoid fractures.
METHODS
Prospective controlled study of the clinical and radiographic results of a group of 42 cases having undergone anterior screw fixation for type II and rostal type III odontoid fractures.


OBJECTIVE
The objective of this study is to determine the safety and efficacy of percutaneous anterior screw fixation as an alternative new technique in the management of type II and rostal type III odontoid fractures.


BACKGROUND
Minimally invasive spinal techniques have only recently been developed. However, clinical and radiographic outcome of minimally invasive anterior screw fixation for odontoid fractures has been evaluated in very few studies. There have been no prospective clinical reports published on the comparison of percutaneous anterior screw fixation for type II and "shallow" type III odontoid fractures or a traditional open manner.


METHODS
Forty-two patients, 26 men and 16 women, with an average age of 47.1 years (32-65) were prospectively evaluated. All patients underwent percutaneous anterior screw fixation(n = 19) or open screw fixation (n = 23). The following data were compared between the two groups: operative time, blood loss, radiograph exposure time, the clinical and radiographic results, and complications. Radiologic examination of the cervical spine with plain radiographs was performed at 3, 6, and 12 months after surgery.


RESULTS
In comparison with open fixation group, percutaneous fixation group had significantly less operating time and less blood loss. The radiation time and clinical outcome were basically identical in two groups. Radiographic evaluation showed satisfactory bony union and no evidence of abnormal movement at the fracture site in both percutaneous fixation group (18 of 19 cases) and open fixation group (22 of 23 cases). Two cases of postoperative dysphagia occurred in open screw fixation group.


CONCLUSIONS
Percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type II and rostral type III odontoid fractures with potential advantages.
Department of Orthopaedic Surgery, The Third Military Medical University, Chongqing, People's Republic of China. tonywjxq@yahoo.com.cn
Jian
J
Wang
Yue
Y
Zhou
Zheng Feng
ZF
Zhang
Chang Qing
CQ
Li
Wen Jie
WJ
Zheng
Jie
J
Liu
D000328:Adult; D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology; 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*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D016103:Spinal Fractures / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome