Jain Amit Kumar, Tawari Manish, Rathore Lavlesh, Sahana Debabrata, Mishra Harshit, Kumar Sanjeev, Sahu Rajiv Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India.
J Craniovertebr Junction Spine. 2022 Apr-Jun;13(2):175-181. doi: 10.4103/jcvjs.jcvjs_22_22. Epub 2022 Jun 13.
Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique.
This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology.
The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure.
Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.
II型齿状突骨折因颈部疼痛和不稳定而需要手术稳定。前路齿状突螺钉固定是一种广为人知的技术。然而，某些患者需要后路固定。我们展示了采用戈尔-哈姆斯技术治疗9例患者的手术结果和经验。
这是一项对2019年1月至2021年12月期间采用后路固定技术治疗II型齿状突骨折的9例患者的回顾性研究。他们的临床资料从病例档案中收集。放射学数据从放射科存档中检索。手术指征为不稳定和难治性颈部疼痛。后路固定的手术决策以骨折形态为指导。
患者的平均就诊年龄为37.22±9.85岁。7例为II型，2例为IIa型齿状突骨折。所有患者均有难以忍受的颈部疼痛。1例患者有四肢瘫。骨折线6例为前下倾斜，2例为后下倾斜，1例为横行。骨折的前后移位范围为0至7mm（平均2.44±2.18mm）。3例患者存在部分横韧带撕裂但无寰枢椎脱位。5例需要C1-C2关节撑开。2例需要C1-C2关节间隔器。手术后，所有病例的颈部疼痛均得到缓解。8例患者实现了骨折完全复位。无术后并发症。平均随访16.22±9.61个月，无植入物失败。
在某些病例中，采用戈尔-哈姆斯技术进行后路C1-C2固定是前路固定的极佳替代方法。
