title: Cement-augmented anterior odontoid screw fixation for osteoporotic type II odontoid fractures in elderly patients: prospective evaluation of 11 patients.
abstract: OBJECTIVE
  Osteoporosis is considered to be a relative contraindication for anterior screw fixation of odontoid fractures because of reduced screw purchase. In the presence of osteoporosis, the most frequent mode of implant failure is via cut-out through the anterior wall of C2. Under in vitro conditions, cement-augmented odontoid screws show significant biomechanical advantages as compared to non-augmented screws. Against this background, we present our prospectively collected data on cement-augmented anterior screw fixation of osteoporotic odontoid fractures in elderly patients.
  
  
  METHODS
  11 patients (8 female, 3 male, median age 83 years, range 73-89 years) with an isolated, osteoporotic type II odontoid fracture were treated. After closed reduction and standard anterior approach to the C2/3 level, a self-tapping, short-threaded 3.5-mm lag screw was placed. High-viscosity polymethylmethacrylate cement was injected via a cannulated Jamshidi needle into the base of the C2 vertebral body around the screw shaft and the screw was further tightened. Thin slice CT reconstructions for follow-up evaluation were done consistently postop and 12 months after surgery.
  
  
  RESULTS
  Anatomic fracture reposition was achieved in all patients. Cement application was uneventful and well controllable. Cement leakage towards the fracture gap was not detectable. There were no major perioperative complications and no early revision surgeries. After 1 year, thin slice CT with three-dimensional reconstruction demonstrated solid osseous healing of the odontoid fracture in 8 out of 10 patients.
  
  
  CONCLUSIONS
  Additional cement augmentation for anterior odontoid fracture repair is technically easy and safe. In elderly people with osteoporotic odontoid fractures, the procedure seems to be a useful supplementary option.
authors.affiliation: Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. albrecht.waschke@med.uni-jena.de.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Waschke
authors.affiliation: Department of Trauma Surgery, Bergmannstrost Hospital, Halle, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ullrich
authors.affiliation: Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kalff
authors.affiliation: Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Falko
authors.initials: F
authors.lastname: Schwarz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000145:classification / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011446:Prospective Studies; D016103:Spinal Fractures / Q000145:classification / Q000601:surgery*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Anterior screw fixation; Cement augmentation; Elderly; Odontoid fracture; Osteoporosis; Poor bone quality