Strategies of percutaneous minimally invasive surgical techniques for patients with odontoid fractures

English Keywords:Odontoid fracture  Percutaneous  Minimally invasive  Strategies

English Abstract:

  【Abstract】 Objectives: To investigate the strategies of percutaneous minimally invasive surgical techniques for odontoid fractures. Methods: Retrospective analysis of 113 patients with odontoid fractures treated by minimally invasive percutaneous techniques in our department between July 2003 and May 2010. They were divided into 5 groups according to the type of fracture and the operative manner. Group 1: reducible, non-ⅡC type or part of chronic fracture with neat fractured surface treated by percutaneous anterior odontoid screw fixation, 65 cases. Group 2: considerable displacement, chronic or ⅡC fracture, or associated with one arch fracture of atlas treated by percutaneous anterior transarticular screw fixation, 29 cases. Group 3: combinated atlas-axis multiple fractures treated by percutaneous anterior odontoid screw fixation and anterior transarticular screw fixation, 6 cases. Group 4: considerable displacement, or ⅡC fracture without high-riding vertebral artery treated by percutaneous posterior transarticular screw fixation, 4 cases. Group 5: chronic fracture with irreducible atlantoaxial dislocation treated by percutaneous anterior microendoscopic release and transarticular screw fixation, 9 cases. The efficacy of different surgical manners was analyzed and complications were recorded. Results: 113 patients were followed up at least for 12 months(12-67 months), none of bend or breakage of screw. Group 1: the fracture line could be still observed in 7 patients at the last follow-up, the others had bone healing. Group 2: one patient had postoperative screw cutting, and underwent screw removal surgery and posterior fusion, the dynamic radiography showed cervical stability on 6 patients without bone graft, the others achieved bone healing. Group 3: all patients achieved bone healing. Group 4: one patient underwent second surgery of titanium cable fixation, and one patient had suspicious damage of the vertebral artery. Group 5: all patients achieved bone healing, the symptoms of 5 patients had complete relief, 3 patients had moderate relief, and 1 patient had mild relief. Conclusions: The majority of patients with odontoid fractures can be treated by minimally invasive surgical technique, the efficacy and safety can be obtained only by choosing the proper surgical indications for different surgical manners.