Comparative Clinical Results of Surgical Approach Anterior Versus Posterior Fusion

Authors

1 Professor, Department of Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Iran

2 Radiologist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Neurosurgeon, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: In this retrospective study, we compared odontoid fractures type two patients treated with two methods of anterior and posterior surgery.
Methods: In this cross-sectional retrospective study, 39 patients under 65 years old with odontoid fractures type two and its subtypes witch had anterior and posterior surgery were included in the study. Necessuray experiments and information included open mouth radiography, AP, letral and CT scan if needed, and also demographic information, mechanism of injury, occurrence of neurologic symptoms at the time of admission, the length of hospital and ICU stay, and length of surgery were completed. Finally, the data were analyzed by SPSS software.
Results: Among 39 pateints, 25(64.1%) were male and 14(35.9%) were female. The length of ICU stay and surgery in posterior group were significantly higher than anterior group (p<0.05). Any complications such as: displacement, loosening, CSF fistula, esophageal rupture, hypoglossal nerve rupture were not not created or exacerbated. Fusion rate in 12 month was sinnificantly higher in posterior group but after 24 month there was not any significant changes between two groups.
Conclusion: According to the results, posterior surgery is the standard and selective method for the treatment of these odontoid type two fractures which have good clinical results and fewer complications.

Keywords


1. BRACKEN MB, FREEMAN Jr DH, HELLENBRAND K. Incidence of acute traumatic hospitalized spinal
cord injury in the United States, 1970–1977. American Journal of Epidemiology. 1981;113(6):615-22.
2. Kraus JF, Franti CE, Riggins RS, Richards D, Borhani NO. Incidence of traumatic spinal cord lesions. Journal
of chronic diseases. 1975;28(9):471-92.
3. Ersmark H, LöWENHIELM P. Factors influencing the outcome of cervical spine injuries. The Journal of
trauma. 1988;28(3):407-10.
4. Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M. Fractures of the C-2 vertebral body.
Journal of neurosurgery. 1994;81(2):206-12.
5. Schweigel JF. Management of the fractured odontoid with halo-thoracic bracing. Spine. 1987;12(9):838-9.
6. Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute axis fractures: a review of 229 cases. Journal of
neurosurgery. 1989;71(5):642-7.
7. Denaro V, Papalia R, Di Martino A, Denaro L, Maffulli N. The best surgical treatment for type II fractures of
the dens is still controversial. Clinical Orthopaedics and Related Research®. 2011;469(3):742-50.
8. Campanelli M, Kattner KA, Stroink A, Gupta K, West S. Posterior C1-C2 transarticular screw fixation in the
treatment of displaced type II odontoid fractures in the geriatric population—review of seven cases. Surgical
neurology. 1999;51(6):596-601.
9. Omeis I, Duggal N, Rubano J, Cerabona F, Abrahams J, Fink M, et al. Surgical treatment of C2 fractures in the
elderly: a multicenter retrospective analysis. Clinical Spine Surgery. 2009;22(2):91-5.
10. Harrop JS, Przybylski GJ, Vaccaro AR, Yalamanchili K. Efficacy of anterior odontoid screw fixation in
elderly patients with Type II odontoid fractures. Neurosurgical focus. 2000;8(6):1-4.
11. Mashhadinezhad H, Samini F, Mashhadinezhad A, Birjandinejad A. Clinical results of surgical management in
type II odontoid fracture: a preliminary report. Turkish neurosurgery. 2012;22(5):583-7.
12. Scheyerer MJ, Zimmermann SM, Simmen H-P, Wanner GA, Werner CM. Treatment modality in type II
odontoid fractures defines the outcome in elderly patients. BMC surgery. 2013;13(1):54.
13. Berlemann U, Schwarzenbach O. Dens fractures in the elderly: results of anterior screw fixation in 19 elderly
patients. Acta Orthopaedica Scandinavica. 1997;68(4):319-24.
14. Tashjian RZ, Majercik S, Biffl WL, Palumbo MA, Cioffi WG. Halo-vest immobilization increases early
morbidity and mortality in elderly odontoid fractures. Journal of Trauma and Acute Care Surgery.
2006;60(1):199-203.
15. Anderson LD, D'alonzo RT. Fractures of the Odontoid Process of the Axis. Journal of Bone & Joint Surgery,
American Volume. 2004;86(9.)
16. Nourbakhsh A, Shi R, Vannemreddy P, Nanda A. Operative versus nonoperative management of acute
odontoid type II fractures: a meta-analysis. Journal of Neurosurgery: Spine. 2009;11(6):651-8.
17. Jeanneret B, Vernet O, Frei S, Magerl F. Atlantoaxial mobility after screw fixation of the odontoid: a
computed tomographic study. Journal of spinal disorders. 1991;4(2):203-11.
18. Löhrer L, Raschke M, Thiesen D, Hartensuer R, Surke C, Ochman S, et al. Current concepts in the treatment
of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland. Injury.
2012;43(4):462-9.
19. Konieczny MR, Gstrein A, Müller EJ. Treatment algorithm for dens fractures: non-halo immobilization,
anterior screw fixation, or posterior transarticular C1-C2 fixation. JBJS. 2012;94(19):e144.
20. Rizvi SAM, Fredø HL, Lied B, Nakstad PH, Rønning P, Helseth E. Surgical management of acute odontoid
fractures: surgery-related complications and long-term outcomes in a consecutive series of 97 patients. Journal
of Trauma and Acute Care Surgery. 2012;72(3):682-90.
21. Wang L, Liu C, Tian J. Surgical treatment strategies of odontoid fractures. Zhonghua yi xue za zhi.
2013;93.5-7277:)72(