Posterior reduction and temporary fixation for odontoid fracture: a salvage maneuver to anterior screw fixation.
METHODS
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.


BACKGROUND
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 removing the instrumentation, the visual analogue scale was reduced 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°±1.62° and 25.70°±5.51° in flexion-extension and in rotation, respectively. No osteoarthritis was observed at the C1-C2 lateral mass joints.


CONCLUSIONS
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.


METHODS
3.
From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
Bin
B
Ni
Qunfeng
Q
Guo
Xuhua
X
Lu
Ning
N
Xie
Liang
L
Wang
Xiang
X
Guo
Fei
F
Chen
D000328:Adult; D001863:Bone Screws; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*