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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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A biomechanical comparison of a cement augmented odontoid screw with a posterior instrumented fusion in geriatric patients with an odontoid fracture type II

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  • Falko Schwarz - Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland
  • Nikolaus Berger-Rosch - Universität Ulm, Institut für Unfallchirurgische Forschung und Biomechanik, Ulm, Deutschland
  • Christian Liebsch - Universität Ulm, Institut für Unfallchirurgische Forschung und Biomechanik, Ulm, Deutschland
  • Hans-Joachim Wilke - Universität Ulm, Institut für Unfallchirurgische Forschung und Biomechanik, Ulm, Deutschland
  • Rolf Kalff - Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland
  • Albrecht Waschke - Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP106

doi: 10.3205/18dgnc448, urn:nbn:de:0183-18dgnc4485

Published: June 18, 2018

© 2018 Schwarz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Odontoid fractures are common fractures of the cervical spine in geriatric patients. Numerous of different surgeries are discussed without any evidence-based standard. An odontoid screw treatment can preserve atlantoaxial motion, but is known to have high rates of pseudarthrosis. An additional cement augmentation of the screw could reduce this complication. Posterior cervical instrumented fusion (PCIF) has higher fusion rates and is associated with a limitation of cervical movement. The aim of our study was a biomechanical comparison of both surgeries.

Methods: We compared both methods with 8 specimens per group incyclic stress tests and range of motion (ROM) investigations. After the tests a computer tomography of the specimens was done to compare the screw loosening. Median age of specimen was 81 years (range 68 – 92 years). The bone density, measured with a quantitative computer tomography, was similar in both groups (odontoid screw: 87.4 mg/cc K2HPO4; PCIF: 89.5 mg/cc K2PO4).

Results: A significant higher ROM was detected in the odontoid screw group before and after the stress tests (pre: p < 0.001; post: p < 0.05). Results of the stress tests showed comparable screw loosening of both groups (amplitude: p > 0.05; reduction of specimen height: p > 0.05). A computer tomography after the stress tests showed a higher screw loosening in the odontoid screw group.

Conclusion: The cement-augmented odontoid screw showed similar results in stress tests. For that reason this method should always be discussed in the treatment of a type II fracture in patients with a low bone density.