Cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of old odontoid fracture combined with atlantoaxial dislocation

English Keywords:Old odontoid fracture  Atlantoaxial dislocation  Dragged reduction  Cable  Cantilever beam  Internal fixation and fusion

English Abstract:

  【Abstract】 Objectives: To report the clinical outcomes of cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of old odontoid fracture complicated with atlantoaxial dislocation. Methods: From September 2011 to December 2015, 42 cases with old odontoid fracture complicated with atlantoaxial dislocation were surgically treated in our hospital, including 29 males and 13 females with an average age of 43.8±12.2(range, 16-67 years) years old. According to Anderson-D′Alonzo classification, 31 cases were type Ⅱ and 11 cases were type Ⅲ. Each patient had a trauma history, clinical features included neck pain in all patients, restricted cervical movement in 35 cases, varying degrees of neural function impairment in 30 cases. All patients had anterior atlantoaxial dislocation and underwent skull traction before surgery. 27 cases were partially reduced, however, the other 15 were not reduced at all. Therefore, the cable-dragged reduction/cantilever beam internal fixation and fusion was performed on all the patients. The operation time, intraoperative blood loss and complications were recorded. The clinical JOA score and NDI score and radiographic implant stability, atlantoaxial reduction and bone graft fusion at follow-up were performed. Results: The surgeries lasted for an average of 123±18min(range, 115-220min) and mean blood loss was 110±80ml(range, 30-350ml). All patients were followed up for 34.1±14.8 months on an average(range, 6-54 months). The neck pain was relieved significantly for all patients after surgery. The JOA score and NDI score at final follow-up were significantly improved compared with the preoperative scores(P<0.001). The postoperative imaging showed complete reduction in 35 patients and partial reduction in the other 7 cases. The SAC was 8.5±3.3mm preoperatively and 14.9±3.0mm at final follow-up(P<0.001). Partial absorption of bone graft occurred in one patient, the cable was found broken and penetrated into spinal cord at 12-month follow-up. Bony fusion was achieved in 41 patients at 6 months after surgery with the fusion rate of 97.6%. Fat liquefaction and delayed wound healing occurred in 1 patient. Cerebrospinal fluid leakage occurred in 2 patients, and was treated by effective drainage and antibiotics, no case presented with wound infection. There was no vertebral artery injury or instrument failure noted. Conclusions: Cable-dragged reduction/cantilever beam internal fixation and fusion has the advantages of easier manipulation, lower risk and satisfactory reduction. It is reliable and effective for old odontoid fracture complicated with atlantoaxial dislocation.