Sommer Fabian, Kirnaz Sertac, Goldberg Jacob, McGrath Lynn, Navarro-Ramirez Rodrigo, Gadjradj Pravesh, Medary Branden, Härtl Roger
Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
Int J Spine Surg. 2022 Jun;16(3):442-449. doi: 10.14444/8250.
Spinal fractures are among the most common traumatic injuries in elderly patients, with the odontoid process being frequently affected. As this patient group usually has high rates of comorbidity and chronic diseases, a nonoperative approach may offer a reasonable solution for a favorable fracture pattern.
We modified the procedure by implanting a bilateral atlantoaxial joint spacer (model DTRAX) into the joint space and review our experience utilizing this technique for the treatment of patients with a fracture of the odontoid process.
A retrospective evaluation was performed on patients treated surgically for unstable traumatic fractures of the odontoid process. The stabilization was performed using a dorsal rod and screw instrumentation of the lateral mass of the atlas and the pars interarticularis of the axis. The procedure was further modified by implanting a bilateral atlantoaxial joint spacer (DTRAX) into the joint space bilaterally after the removal of the articular cartilage. Patients older than 70 years with a traumatic fracture of the odontoid process were included. Pain was assessed pre- and postoperatively using the visual analog scale (VAS). To verify fusion during follow-up, either x-ray imaging of the cervical spine or magnetic resonance imaging or computed tomography were performed.
A total of 5 patients were included in our study. Four patients had an American Society of Anesthesiology score of 3 and 1 had a score of 4. The average duration of surgery was 187 ± 38.1 minutes. The average blood loss during the procedure was 340 ± 270 mL. The average radiological follow-up period was 21.2 ± 17.5 months. Preoperatively, the average VAS pain score was 2.3 ± 3.3. Postoperatively, the mean VAS decreased to 0.6 ± 0.9. The average follow-up period for pain was 27.2 ± 19 months. No patient showed neurological deficits before or after surgery. Follow-up demonstrated solid fusion in all cases.
The fusion of the atlantoaxial joint with bilateral atlantoaxial joint spacers represents a suitable and feasible option for achieving high fusion rates in elderly patients with odontoid fractures.
A significant percentage of patients who are treated non-operatively will experience nonunion, which may cause instability of the atlantoaxial joint. Posterior fixation with screws and rods is a treatment option, but it leaves the cartilaginous joint surface in place, which can be an impediment to the fusion process. In other cases, degenerative collapse of the C1/C2 joint can cause compression of the C2 nerve root.
脊柱骨折是老年患者最常见的创伤性损伤之一，齿突经常受到影响。由于该患者群体通常合并症和慢性病发生率较高，对于有利的骨折类型，非手术方法可能提供合理的解决方案。
我们通过在关节间隙植入双侧寰枢关节间隔器（DTRAX模型）对手术进行了改良，并回顾了我们使用该技术治疗齿突骨折患者的经验。
对接受手术治疗的齿突不稳定创伤性骨折患者进行回顾性评估。使用寰椎侧块和枢椎关节突的背侧棒和螺钉器械进行固定。在去除关节软骨后，通过在双侧关节间隙植入双侧寰枢关节间隔器（DTRAX）对手术进行进一步改良。纳入70岁以上的齿突创伤性骨折患者。术前和术后使用视觉模拟量表（VAS）评估疼痛。为了在随访期间验证融合情况，进行了颈椎X线成像、磁共振成像或计算机断层扫描。
我们的研究共纳入5例患者。4例患者美国麻醉医师协会评分为3分，1例评分为4分。平均手术时间为187±38.1分钟。术中平均失血量为340±270毫升。平均影像学随访期为21.2±17.5个月。术前，平均VAS疼痛评分为2.3±3.3。术后，平均VAS降至0.6±0.9。疼痛的平均随访期为27.2±19个月。所有患者术前和术后均未出现神经功能缺损。随访显示所有病例均实现了牢固融合。
对于老年齿突骨折患者，双侧寰枢关节间隔器融合术是实现高融合率的合适且可行的选择。
相当一部分接受非手术治疗的患者会发生骨不连，这可能导致寰枢关节不稳定。螺钉和棒的后路固定是一种治疗选择，但它使软骨关节面保持原位，这可能会阻碍融合过程。在其他情况下，C1/C2关节的退行性塌陷可导致C2神经根受压。
