Artikel
Does degeneration of the upper cervical spine influence the bony healing potential in different strategies for osteosynthesis – a retrospective analysis of 91 cases
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Autoren
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René Hartensuer
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurge, Münster, Deutschland
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Malte Masthoff
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurge, Münster, Deutschland
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Oliver Riesenbeck
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurge, Münster, Deutschland
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Michael J. Raschke
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurge, Münster, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: More than one third of the rotational capacity of the cervical spine is located between C1 and C2. Some authors have shown, that degeneration of the upper spine will increase the risk of fracture. Taking this physiological rotational capacity of the upper cervical spine into account, we hypothesized that degeneration between the atlas and the odontoid process will influence the probability of bony healing, once a fracture has occurred to the odontoid.
Methods: We conducted a single-center retrospective Study and identified 191 patients in which an odontoid fracture was treated as an inpatient. In 91 cases it was possible to access all necessary imaging to rate the type of fracture according to Anderson and D'Alsonso and Grauer et al., the grade of degeneration according to Lakesmann et al. and bony healing. Bony healing was rated by CT-scan only. In addition, different treatment strategies were reviewed to correlate the detected rates of pseudarthrosis with the grade of degeneration.
Results: In all 91 cases 50 (54,9%) showed no signs of degeneration. 24 (23,1%) showed a mild, 12 (13,2%) a moderate and 5 (5,5%) a severe degeneration. In 59 cases, out of 91 cases fracture consolidation was seen. No significant differences could be found between the moderate and mild denegation group compared to the group without any signs of degeneration. Only the group of severe degenerations showed a tendency of increased rates of pseudarthrosis (75%). Further analysis showed, that Patients with severe degeneration and pseudarthrosis mainly suffered from a type II fracture according to Anderson and D'Alsonso and type IIB according to Grauer et al. No significant differences were seen between different treatment strategies (anterior dens screw vs. posterior C1-2 fusion) in this retrospective study.
Conclusion: Arthrosis between the atlas and the odontoid is discussed to be a potential risk for fracture and for pseudarthosis after fracture. The contribution of nondegenerate, mild/moderate and severe degeneration reported in comparable studies showed similar trends.
There are hints in the literature, that degeneration between atlas and odontoid may increase the risk of an odontoid fracture and might therefore impede bony healing.
The present study with all limitations of a retrospective investigation shows, that this effect might be overestimated for mild and moderate degeneration but seems to be relevant in severe degeneration in this region. This should be taken into account for the optimal individual treatment strategy.
