Fiani Brian, Doan Thao, Covarrubias Claudia, Shields Jennifer, Sekhon Manraj, Rose Alexander
Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States.
University of Texas Medical Branch at Galveston, Galveston, Texas, United States.
Surg Neurol Int. 2021 Apr 19;12:170. doi: 10.25259/SNI_165_2021. eCollection 2021.
Odontoid process fractures are one of the most common spine fractures, especially in patients over age 70. There is still much controversy over the ideal candidate for anterior odontoid screw fixation (AOSF), with outcomes affected by characteristics such as fracture morphology, nonideal body habitus, and osteoporosis. Therefore, this systematic review seeks to discuss the optimal criteria, indications, and adverse postoperative considerations when deciding to pursue AOSF.
This investigation was conducted from experiential recall and article selection performed using the PubMed electronic bibliographic databases. The search yielded 124 articles that were assessed and filtered for relevance. Following the screening of titles and abstracts, 48 articles were deemed significant for final selection.
AOSF is often utilized to treat Type IIB odontoid fractures, which has been shown to preserve atlantoaxial motion, limit soft-tissue injuries/blood loss/vertebral artery injury/reduce operative time, provide adequate osteosynthesis, incur immediate spinal stabilization, and allow motion preservation of C1 and C2. However, this technique is limited by patient characteristics such as fracture morphology, transverse ligament rupture, remote injuries, short neck or inability to extend neck, barrel chested, and severe spinal kyphosis, in addition to adverse postoperative outcomes such as dysphagia and vocal cord paralysis.
Due to the fact that odontoid fractures have a significant morbidity in elderly population, treatment with AOSF is generally recommended for this population with higher risk for nonoperative fusion. Considerations should be made to achieve fracture stability and fusion, while lowering the risk for operative and postoperative complications.
齿突骨折是最常见的脊柱骨折之一，尤其是在70岁以上的患者中。对于前路齿突螺钉固定（AOSF）的理想适应证仍存在诸多争议，其治疗效果受骨折形态、身体条件不佳和骨质疏松等因素影响。因此，本系统综述旨在探讨决定采用AOSF时的最佳标准、适应证及术后不良情况的注意事项。
本研究通过经验回顾及使用PubMed电子文献数据库进行文章筛选。检索到124篇文章并评估其相关性。在筛选标题和摘要后，48篇文章被认为具有最终入选意义。
AOSF常用于治疗IIB型齿突骨折，已证明其可保留寰枢椎活动度、限制软组织损伤/失血/椎动脉损伤/缩短手术时间、提供充分的骨愈合、实现即刻脊柱稳定并保留C1和C2的活动度。然而，该技术受患者特征限制，如骨折形态、横韧带断裂、远处损伤、短颈或无法伸展颈部、桶状胸和严重脊柱后凸，此外还存在吞咽困难和声带麻痹等高风险的术后不良情况。
由于齿突骨折在老年人群中具有较高的发病率，对于非手术融合风险较高的该人群，一般建议采用AOSF治疗。应在实现骨折稳定和融合的同时，降低手术及术后并发症的风险。
