title: A novel technique of two-hole guide tube for percutaneous anterior odontoid screw fixation.
abstract: BACKGROUND
  Surgical stabilization is recommended for odontoid fractures with mechanical instability. Compared with C1-C2 fusion, percutaneous anterior odontoid screw fixation has the advantages of preserving C1/C2 motion and being a minimally invasive procedure. However, determining the optimal screw trajectory is often difficult. When an initial suboptimal K-wire hole is drilled, it is especially difficult to drill a second optimal K-wire trajectory because the initial hole will be entered inadvertently.
  
  
  OBJECTIVE
  To design a novel device, two-hole guide tube, to make drilling a second optimal K-wire trajectory easier, and thus, avoid unnecessary additional surgical time and reduce the likelihood of needing to change the procedure to traditional open surgery.
  
  
  METHODS
  A technical report.
  
  
  METHODS
  Fifty-three patients with odontoid fractures were treated by percutaneous anterior odontoid screw fixation in our hospital, and the initial K-wire trajectories of 16 cases (12 men and 4 women) among the 53 patients were imperfect. The two-hole guide tube was applied for drilling the second trajectory in each of these 16 cases.
  
  
  RESULTS
  No complications associated with this technique occurred. Satisfactory results and good screw placement was achieved in all patients. Radiographic fusion was confirmed for 15 of 16 patients. None of the patients experienced clinical symptoms or screw loosening or breakage in this study.
  
  
  CONCLUSIONS
  Our novel device, two-hole guide tube, can be used to reduce the difficulty associated with redrilling an optimal K-wire trajectory if the initial trajectory is imperfect during percutaneous anterior odontoid screw fixation. Moreover, by referring to the initial misplaced K-wire, a more accurate trajectory for the second K-wire can be achieved.
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China.
authors: Ai-Min
authors: AM
authors: Wu
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China. Electronic address: knightman@yeah.net.
authors: Xiang-Yang
authors: XY
authors: Wang
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China.
authors: Dong-Dong
authors: DD
authors: Xia
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China.
authors: Peng
authors: P
authors: Luo
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China.
authors: Hua-Zi
authors: HZ
authors: Xu
authors: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109# XueYuan Western Rd, Wenzhou, Zhejiang, 325027, People's Republic of China.
authors: Yong-Long
authors: YL
authors: Chi
mesh_terms: D000328:Adult; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D016103:Spinal Fractures / Q000601:surgery*
keywords: Guide tube; K-wire; Minimally invasive; Odontoid fracture; Percutaneous; Technique note; Trajectory