title: Simultaneous anterior and posterior screw fixations confined to the axis for stabilization of a 3-part fracture of the axis (odontoid, dens, and hangman fractures): report of 2 cases.
abstract: Fractures of the axis are considered to be one of the most common injuries to the cervical spine, accounting for more than 20% of all cervical spine fractures. Multiple fractures of the axis are much rarer, accounting for 1% of all cervical fractures. Management of such complex fractures is still challenging, and there is no strong consensus for the treatment. The authors describe the cases of 2 patients who presented with 3-part fractures of the axis consisting of an odontoid Type II fracture and a Levine-Edwards Type IA fracture, which were treated with concurrent insertion of an anterior odontoid screw and bilateral posterior pedicle screws. The cases presented were characterized by 1) a Type II odontoid fracture; 2) a Type IA traumatic spondylolisthesis with no or a little translation and angulation of C-2 on C-3 in a ring fracture of the axis; and 3) no disorders at the C2-3 disc on MR images. Therefore, the authors performed surgery confined to the axis by concurrently inserting an anterior odontoid screw and posterior bilateral pedicle screws without arthrodesis of C2-3. This was followed with cervical soft collar fixation for only 1-2 weeks. The outcomes were favorable, including good osteosynthesis, high primary stability, early patient mobilization, and preserved range of motion of the cervical spine at C2-3 as well as at C1-2.
authors.affiliation: Department of Orthopedics, Funabashi Municipal Medical Center, Chiba, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shinbo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sameda
authors.forename: Sumio
authors.initials: S
authors.lastname: Ikenoue
authors.forename: Kan
authors.initials: K
authors.lastname: Takase
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Eiko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Enomoto
authors.forename: Aya
authors.initials: A
authors.lastname: Kanazuka
authors.forename: Masaya
authors.initials: M
authors.lastname: Mimura
mesh_terms: D000369:Aged, 80 and over; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D016103:Spinal Fractures / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*