Negri Brito Herika, Porto Sousa Marcelo, Palavani Lucca B, McClendon Jamal
Neurosurgery, Mayo Clinic, Phoenix, USA.
Neurosurgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, BRA.
Cureus. 2024 Jun 7;16(6):e61915. doi: 10.7759/cureus.61915. eCollection 2024 Jun.
Odontoid fractures in the elderly typically require surgical intervention due to poor adaptability to conservative treatment. Anterior screw fixation, despite its high fusion rates under specific conditions, may lead to complications such as screw extrusion, as demonstrated in the case discussed, necessitating subsequent posterior cervical fusion. This study aimed to describe early extrusion of an anterior odontoid screw and the importance of caution and thorough postoperative assessment in elderly patients undergoing anterior screw fixation for odontoid fracture. A 73-year-old female patient with a history of ground-level fall and subsequent cervical pain was diagnosed with an odontoid type II fracture and underwent odontoid screw placement in June 2023. However, in August, follow-up imaging revealed screw displacement and a fracture of the posterior arch of the C1 vertebral, which was initially overlooked. After seeking a second opinion, a new surgical approach was decided, involving removal and replacement of the odontoid screw, posterior and posterolateral C1-C2 spinal instrumentation, arthrodesis, and fusion with the use of morselized allograft. The patient was discharged on postoperative day 3 with mild cervical pain, wearing a soft collar, and neurologically intact. Given the current literature, odontoid screw extrusion rates are still small but can come with enormous potential complications. Also, the present case is a reminder to always double-check preoperative imaging and recognize early failure/malpositioning of hardware.
老年患者的齿状突骨折通常因对保守治疗适应性差而需要手术干预。尽管前路螺钉固定在特定条件下融合率较高，但如所讨论的病例所示，可能会导致螺钉挤出等并发症，这就需要随后进行后路颈椎融合术。本研究旨在描述前路齿状突螺钉的早期挤出情况，以及对接受前路螺钉固定治疗齿状突骨折的老年患者进行谨慎和全面术后评估的重要性。一名73岁女性患者，有平地摔倒史，随后出现颈部疼痛，被诊断为II型齿状突骨折，并于2023年6月接受了齿状突螺钉置入术。然而，8月的随访影像显示螺钉移位以及C1椎弓根骨折，最初这一情况被忽视了。在寻求第二种意见后，决定采用一种新的手术方法，包括取出并更换齿状突螺钉、C1 - C2后路及后外侧脊柱内固定、关节固定以及使用碎骨同种异体骨进行融合。患者术后第3天出院，颈部轻度疼痛，佩戴软颈托，神经功能完好。鉴于目前的文献，齿状突螺钉挤出率仍然较低，但可能会带来巨大的潜在并发症。此外，本病例提醒我们要始终仔细复查术前影像，并识别硬件的早期故障/位置不当情况。
