The complications of percutaneous anterior odontoid screw fixation

English Keywords:Odontoid fracture  Internal fixation  Percutaneous  Minimally invasive  Complications

English Abstract:

  【Abstract】 Objectives: To analyze the complications and prevention of percutaneous anterior odontoid screw fixation. Methods: 122 patients with fresh odontoid fractures from June 2006 to December 2013 were included in this study, with 79 males and 43 female, the averaged age of 45.6 years. 88 cases were type Ⅱ and 34 cases were shallow type Ⅲ odontoid fractures according to Anderson-D′Alonzo classification. All of the patients underwent the percutaneous anterior odontoid screw fixation. The operation time, blood loss, screw loose or cut off, surround soft tissue(vessels, nerve and esophageal) injury, and wound infection were recorded. Anteroposterior/lateral films and CT scans were obtained at post-operation and follow-up to assess the position of screw and whether achieve bony union. Results: The length of skin wound was about 0.8-1cm, the operation time was 40.7±12.2 minutes, the blood loss was less than 20ml. None of intraoperative posterior pharyngeal wall, esophagus, blood vessels and important nerve and other surround tissue injury were observed. Total of 21 patients with complications were recorded. Three cases had anterior axis fracture when introduce the odontoid screw, for one case, another odontoid screw was added and two other cases were treated with Halo-Vest fixation after operation. One case with enlarged gap of fracture line, additional endoscopic bone graft was performed and achieved fusion. For one case with mild displacement of the fracture line, bony union was achieved with post-operative orthosis. Nine cases had the over long screws but without clinical symptoms, bony fusion was achieved after post-operative cervical orthosis. One case of paralysis of superior laryngeal nerve was recorded two days after surgery and recovered after drug treatment. One case of wound infection was treated by antibiotics. Two cases had screw loose and cut out at 2 and 3 months postoperatively, respectively, secondary surgery of anterior atlantoaxial transarticular screw fixation and posterior atlantoaxial transarticular screw fixation was performed. After followed-up of 36-92 months(average, 57.6±14.9 months), 119/122(97.5%) had bony fusion, three cases of fiber connection, no further prolonged cervical orthosis was used and secondary surgery was performed, and the fracture did not displace and without screw loose. Conclusions: Percutaneous anterior odontoid screw fixation is a feasible, safe and minimally invasive technique. The most complications are mild and with good prognosis after treatment. The rate of complications that needs secondary surgical revision is low.