Article
Long-term Follw-up in Patients undergoing Anterior Screw Fixation for Odontoid Fractures
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Authors
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Ahmed Elnewihi
- Magdeburg, Deutschland
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Raimund Firsching
- Otto-von-Guericke-Universität, Universitätsklinik für Neurochirurgie, Magdeburg, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: Dens fractures represent roughly 10% of all cervical fractures (Winking, 2009). Little evidence can be found in the literature about the frequency of the secondary instability following ventral fixation by means of screws. In this study, the long-term follow-up of the ventrally-operated patients with dens fractures is presented to find out how often secondary instability occurs.
Methods: In the period from January 2002 to November 2016, 257 patients with dens fracture were treated in the Neurosurgery Clinic of the Magdeburg University hospital. Depending on the fracture type, 75 patients (29.2%) were conservatively treated, 11 patients (4.3%) were treated with a halo fixator, 18 patients (7%) were operated primarily from dorsal, and 153 (59.5%) were ventrally operated by means of a double-threaded screw. The data was obtained retrospectively from patient records and follow-up examinations. Out of 153 patients, 112 (73.2%) were studied while 41 patients did not appear for postoperative control. 50 patients (44.6%) were males and 62 patients (55.4%) were females. The patients ages ranged between 15 and 101 years (a median of 80).
Results: Postoperative radiological examinations revealed a primary stable and fused dens fracture without neurological deficits in 76 patients (67.85%), out of which 32 were males (28.6%), 44 were females (39.25%). With 26 patients (23.2%) aged between 55 and 96 (a median of 79.1 years), it was necessary to perform a second dorsal operation due to secondary instability. Additional stabilization by means of dorsal Osteosynthesis was indicated for 7 patients (6.25%), but it was rejected. in 3 cases (2.7%), a revision surgery was necessary to correct the screw position. Overall, 36 patients (32%) were with manifested secondary instability, aged between 55 and 99 years (median of 81). 18 patients were females (50%) and 18 were males (50%). The preoperative pain symptoms improved after ventral care in 81 cases (72.3%) while said pain symptoms persisted in 31 cases (27.7%).
Conclusion: Ventral care is an effective method for dens fracture treatment with low instability incidence and high fusion rate.
