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Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure

Neurospine 2020년 17권 3호 p.603 ~ 609
이태규, Han Moon-Soo, 이슬기, 문봉주, 이중길,
소속 상세정보
이태규 ( Lee Tae-Kyu ) - Chonnam National University Medical School Department of Neurosurgery
 ( Han Moon-Soo ) - Chonnam National University Medical School Department of Neurosurgery
이슬기 ( Lee Seul-Kee ) - Chonnam National University Medical School Department of Neurosurgery
문봉주 ( Moon Bong-Ju ) - Chonnam National University Medical School Department of Neurosurgery
이중길 ( Lee Jung-Kil ) - Chonnam National University Medical School Department of Neurosurgery

Abstract


Objective: Anterior odontoid screw fixation (AOSF) is a safe and effective treatment for type II and rostral type III odontoid fracture. This study aimed to report the outcomes of the AOSF surgery and evaluate the potential risk factors of surgical failure.

Methods: We enrolled 63 patients who underwent AOSF. Follow-up computed tomography was performed 6 months after the surgery and once a year thereafter to evaluate the union. Clinical data including the age, sex, presenting symptoms, cause of injury, fracture gaps, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were collected.

Results: Successful fusion was achieved in 55 patients (87.3%) and surgical failure occurred in 8 patients (12.7%). Variables such as age, sex, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were not significantly associated with the surgical failure. However, surgical failure was statistically significantly associated with the fracture gap. The overall mean fracture gap at the time of injury was 1.29 mm (range, 0?3.11 mm), and the incidence of surgical failure was 8.3 times higher when the fracture gap at the time of injury was > 2 mm (p=0.019).

Conclusion: When performing AOSF in patients with type II or rostral shallow type III odontoid fractures, the displacement of the odontoid fracture fragment should be appropriately reduced to the aligning position before screw insertion and downward reduction should be achieved by perforation of the apical cortex of the odontoid during screw fixation, even if the surgery is delayed.

키워드

Anterior odontoid screw fixation; Odontoid fracture; Lag screw; Fracture gap

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