Neurosurgery Department, St Lukas Hospital, Lwowska 178a, 33-100 TARNOW, Poland.
Neurol Neurochir Pol. 2021;55(2):227-229. doi: 10.5603/PJNNS.a2021.0023. Epub 2021 Mar 9.
Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation.
The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment.
This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases 'odontoid fracture perforation' and 'anterior cervical spine perforation'. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration.
The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary.
Patients with oesophageal perforation should be treated with special care.
II 型齿状突骨折多见于老年人。由于保守治疗的骨折不愈合风险较高，因此广泛推荐手术固定。前路齿状突螺钉固定（AOSF）是一种允许广泛颈椎活动的方法，是一种相对安全的手术，被推荐为首选方法，尽管罕见的并发症可能导致危及生命的食管穿孔。
本研究旨在探讨导致这些罕见并发症的潜在危险因素及可能的治疗方法。
本文介绍了 2016 年在塔尔努夫圣卢克医院神经外科住院的一名患者的病例。使用 PubMed 进行文献回顾；搜索标准包括短语“齿状突骨折穿孔”和“前路颈椎穿孔”。搜索返回 235 篇文章，其中 55 篇与本文主题相关，只有 12 篇被认为适合考虑。
作者介绍了一名老年患者的病例，该患者有齿状突骨折病史。在初次 AOSF 后 10 周，患者因吐出螺钉而前往神经外科就诊。这意味着需要进一步检查，甚至需要进行食管重建手术或其他脊柱手术。在喉镜检查和胃镜检查中均未发现瘘管的迹象。在这种情况下，进行了保守治疗。由于齿状突骨折，需要进行颈椎后路非融合稳定。
应特别注意食管穿孔患者的治疗。
