Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures

Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the rang...

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Autores principales:	Yasser El Banna MD., Samer Samy MD., Islam Sorour MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2019
Materias:	odontoid fracture dens fracture temporary fixation c1-c2 atlantoaxial range of motion Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/09d32f2c95fa4f4290313d500c1f1d9b
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spelling	oai:doaj.org-article:09d32f2c95fa4f4290313d500c1f1d9b2021-12-02T10:17:29ZPosterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures10.21608/esj.2019.12243.10972314-89502314-8969https://doaj.org/article/09d32f2c95fa4f4290313d500c1f1d9b2019-07-01T00:00:00Zhttps://www.esj.journals.ekb.eg/article_75851.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the range of motion of the atlantoaxial joint after odontoid fracture healing is complete. Purpose: To assess the clinical and radiological outcome of the posterior C1-C2 temporary fixation technique in the treatment of a new odontoid fracture. Study Design: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. Patients and Methods: Twelve consecutive patients, suffering from type-II odontoid fracture, were retrospectively recruited for this study. The age ranged between 15 and 43 years with a mean age being 24±11.6 years. Eight patients were males and four were females. All cases suffered from acute posttraumatic type-II dens fracture. Eight patients suffered from reducible subluxation and four cases were in place. Only two patients were suffering from partial neurologic deficit preoperatively (grade 4). All patients were submitted to Harms’ atlantoaxial fixation procedure. Surgical removal of the implants was done after a mean of 15.5 (range, 12–20 weeks) weeks from the first surgery. All patients had MSCT scan to assess healing and then dynamic MSCT scan after removal to assess C1-C2 ROM. Results: All of our twelve patients completed the two procedures without significant events. Two patients with preoperative neurological illness had improved gradually with physiotherapy. All patients had complete healing of their factures. Postoperative dynamic CT scan showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°. Significantly better functional outcomes were observed after the temporary fixation removal using Visual Analog Scale (VAS) score for neck pain (P=0.0033), neck stiffness, and the patient satisfaction. Conclusion: Posterior atlantoaxial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved. (2019ESJ187) Yasser El Banna MD.Samer Samy MD.Islam Sorour MD.Egyptian Spine Associationarticleodontoid fracturedens fracturetemporary fixationc1-c2atlantoaxialrange of motionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 31, Iss 1, Pp 36-44 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	odontoid fracture dens fracture temporary fixation c1-c2 atlantoaxial range of motion Neurology. Diseases of the nervous system RC346-429
spellingShingle	odontoid fracture dens fracture temporary fixation c1-c2 atlantoaxial range of motion Neurology. Diseases of the nervous system RC346-429 Yasser El Banna MD. Samer Samy MD. Islam Sorour MD. Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
description	Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the range of motion of the atlantoaxial joint after odontoid fracture healing is complete. Purpose: To assess the clinical and radiological outcome of the posterior C1-C2 temporary fixation technique in the treatment of a new odontoid fracture. Study Design: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. Patients and Methods: Twelve consecutive patients, suffering from type-II odontoid fracture, were retrospectively recruited for this study. The age ranged between 15 and 43 years with a mean age being 24±11.6 years. Eight patients were males and four were females. All cases suffered from acute posttraumatic type-II dens fracture. Eight patients suffered from reducible subluxation and four cases were in place. Only two patients were suffering from partial neurologic deficit preoperatively (grade 4). All patients were submitted to Harms’ atlantoaxial fixation procedure. Surgical removal of the implants was done after a mean of 15.5 (range, 12–20 weeks) weeks from the first surgery. All patients had MSCT scan to assess healing and then dynamic MSCT scan after removal to assess C1-C2 ROM. Results: All of our twelve patients completed the two procedures without significant events. Two patients with preoperative neurological illness had improved gradually with physiotherapy. All patients had complete healing of their factures. Postoperative dynamic CT scan showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°. Significantly better functional outcomes were observed after the temporary fixation removal using Visual Analog Scale (VAS) score for neck pain (P=0.0033), neck stiffness, and the patient satisfaction. Conclusion: Posterior atlantoaxial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved. (2019ESJ187)
format	article
author	Yasser El Banna MD. Samer Samy MD. Islam Sorour MD.
author_facet	Yasser El Banna MD. Samer Samy MD. Islam Sorour MD.
author_sort	Yasser El Banna MD.
title	Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
title_short	Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
title_full	Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
title_fullStr	Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
title_full_unstemmed	Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures
title_sort	posterior c1-c2 temporary fixation without fusion for recent type-ii odontoid fractures
publisher	Egyptian Spine Association
publishDate	2019
url	https://doaj.org/article/09d32f2c95fa4f4290313d500c1f1d9b
work_keys_str_mv	AT yasserelbannamd posteriorc1c2temporaryfixationwithoutfusionforrecenttypeiiodontoidfractures AT samersamymd posteriorc1c2temporaryfixationwithoutfusionforrecenttypeiiodontoidfractures AT islamsorourmd posteriorc1c2temporaryfixationwithoutfusionforrecenttypeiiodontoidfractures
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Posterior C1-C2 Temporary Fixation without Fusion for Recent Type-II Odontoid Fractures

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