TITLE:
Posterior Stabilization for Management of Neglected Odontoid Fractures
AUTHORS:
Mohammed Attia, Alaa Rashad
KEYWORDS:
Spine, Odontoid Fractures, Non-Union, Posterior Stabilization
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.2,
April
8,
2021
ABSTRACT: Background: Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. Objective: To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. Patients and Methods: 12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. Results: Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. Conclusion: Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.