Type II Odontoid Fractures: Is the Anterior Screw a Good Solution for all Patients? A Case Series of 60 Consecutive Patients

• Published in: World neurosurgery Vol. 176; pp. e535 - e542
• Main Authors: Dantas, Fernando Luiz Rolemberg, Dantas, François, Cariri, Gustavo Agra, Caires, Antônio Carlos Vieira, Reis, Marco Túlio Domingos Silva e, Botelho, Ricardo Vieira
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2023
• Subjects: Adult; Aged; Anterior; Bone Screws; Deglutition Disorders; Fracture; Fracture Fixation, Internal - methods; Fractures, Bone; Fusion; Humans; Middle Aged; Odontoid process; Odontoid Process - diagnostic imaging; Odontoid Process - injuries; Odontoid Process - surgery; Radiography; Retrospective Studies; Screw; Spinal fracture; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Treatment Outcome; CT; OR; Screw; Anterior; Spinal fracture; Fracture; Fusion; Odontoid process
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.05.096

Type II odontoid fracture is the most common fracture type, and its treatment remains challenging. The objective of this study was to evaluate the results of anterior screw fixation for type II odontoid fractures in patients aged over and below 60 years. A retrospective analysis of consecutive patients diagnosed with type II odontoid fractures who were surgically treated using the anterior approach by a single surgeon was conducted. Demographic characteristics, including age, sex, type of fracture, time from trauma to surgery, length of stay (LoS), fusion rate, complications, and reoperation, were evaluated. Surgical outcomes were compared between patients over and below 60 years of age. Sixty consecutive patients underwent odontoid anterior fixation during the analysis period. The mean age of patients was 49.58 ± 23.22 years. Twenty-three (38.3%) patients were aged over 60 years, and the minimum follow-up period was two years. Of the patients, 93.3% developed bone fusion, which was observed in 86.9% of patients over 60 years. Complications related to hardware failure occurred in six (10%) patients. Transient dysphagia was observed in 10% of the cases. Three (5%) patients required reoperation. Patients over 60 years had a significantly increased risk of dysphagia compared with those below 60 years (P = 0.0248). There was no significant difference between the groups regarding nonfusion rate, reoperation rate, or LoS. Anterior fixation of the odontoid showed high fusion rates with a low rate of complications. It is a technique to be considered for treating type II odontoid fractures in selected cases.