Direct Anterior Screw Fixation of Odontoid Fracture : Experience of 16 Cases

概要

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Direct anterior screw fixation for type II and type III (Anderson & D'Alonzo) odontoid fracture is a new alternative to posterior atlanto-axial (A-A) arthrodesis in that normal upper cervical motion can be preserved. Thirteen patients of Type II and three of Type III odontoid fractures were treated with anterior odontoid screw stabilization during the past four years. The fractured odontoid fragments were displaced anteriorly (3-8mm) in nine patients and posterior displacement (4-15mm) was seen in six patients. No displacement was seen in one case. Three of these patients had concomitant Jefferson's fracture. Preoperative reduction of the displaced odontoid fragment and postoperative stability of the A-A complex were obtained in fourteen cases. They were followed for a minimum of 5 months (mean 27 months). In two patients, the odontoid fused with permissible displacement (3, 4mm) due to incomplete preoperative reduction. No neurological complications related to the procedure were seen. Another two patients showed fracture resolution delayed to over 8 months and 10 months respectively, probably due to the significant anterior fracture gap resulted from excessive posterior angulation during screw fixation and extreme instability of the fracture site. The anterior screw fixation of odontoid fracture is an ideal method of treatment, but it should be performed in selected patients by a surgeon with experience.
日本脊髄外科学会の論文
1998-11-30