Texakalidis Pavlos, Matsoukas Stavros, Cloney Michael, Krushelnytskyy Mykhaylo, Swong Kevin, El Tecle Najib, Koski Tyler, Dahdaleh Nader S
Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL, USA.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadeplhia, PA.
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):126-132. doi: 10.4103/jcvjs.jcvjs_42_25. Epub 2025 Jul 3.
Odontoid fractures are often managed surgically. The most common approaches are anterior dens screw (ADS) and posterior arthrodesis (PA), with the latter being associated with significantly higher fusion rates. PA techniques can include wiring, C1-C2 transarticular (TA) screws, and C1 lateral mass (LM)-C2 pars/pedicle screws. Most comparative studies group multiple PA techniques together when comparing PA versus ADS. Our objective was to systematically review the literature and identify studies that separately provide fusion rates of each different posterior C1-C2 arthrodesis (PA) technique utilized compared to ADS.
A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effects meta-analysis was performed, and the statistic was used to assess heterogeneity.
In total, 15 studies comprising 685 patients (ADS: 377; wiring: 58; TA: 150; C1 LM-C2 pars/pedicle screws: 100). The average age of the patients ranged across the included studies between 22 and 82.4 years old. The mean last follow-up was >12 months in eight studies. Only two studies reported a follow-up period of <6 months. Most of the odontoid fractures were type II based on the Anderson-D'Alonzo classification. Use of C1 LM-C2 pars/pedicle screws was associated with significantly higher odds of fusion compared to ADS (C1 LM-C2 pars/pedicle: 97%; ADS: 87.2%; odds ratio [OR]: 3.89; 95% confidence interval [CI]: 1.34-11.29; 0%). TA screws were associated with significantly higher odds of fusion compared to ADS (TA: 98%; ADS: 87%; OR: 4.19; 95% CI: 1.67-10.47; 0%). There was no difference in the rate of fusion between wiring and ADS (wiring: 84.4%; ADS: 92.6%; OR: 0.34; 95% CI: 0.08-1.40; 48.8%).
C1-C2 TA screws and C1 LM-C2 pars/pedicle screws are both associated with statistically significant higher rates of fusion compared to ADS for odontoid fractures. ADS showed higher rates of fusion compared to wiring, although this did not reach statistical significance.
齿突骨折常采用手术治疗。最常见的手术方法是前路齿突螺钉固定术（ADS）和后路关节融合术（PA），后者的融合率明显更高。PA技术可包括钢丝固定、C1-C2经关节（TA）螺钉固定以及C1侧块（LM）-C2椎弓根/椎弓根螺钉固定。大多数比较研究在对比PA与ADS时，将多种PA技术合并在一起。我们的目的是系统回顾文献，找出分别提供与ADS相比每种不同的后路C1-C2关节融合术（PA）技术融合率的研究。
根据系统评价和Meta分析的首选报告项目指南进行系统的文献回顾。进行随机效应Meta分析，并使用统计量评估异质性。
总共纳入15项研究，共685例患者（ADS组：377例；钢丝固定组：58例；TA螺钉固定组：150例；C1 LM-C2椎弓根/椎弓根螺钉固定组：100例）。纳入研究中患者的平均年龄在22岁至82.4岁之间。八项研究的平均末次随访时间超过12个月。只有两项研究报告的随访期小于6个月。根据Anderson-D’Alonzo分类，大多数齿突骨折为II型。与ADS相比，使用C1 LM-C2椎弓根/椎弓根螺钉固定的融合几率显著更高（C1 LM-C2椎弓根/椎弓根螺钉固定组：97%；ADS组：87.2%；优势比[OR]：3.89；95%置信区间[CI]：1.34-11.29；P<0.001）。与ADS相比，TA螺钉固定的融合几率显著更高（TA螺钉固定组：98%；ADS组：87%；OR：4.19；95% CI：1.67-10.47；P<0.001）。钢丝固定与ADS之间的融合率无差异（钢丝固定组：84.4%；ADS组：92.6%；OR：0.34；95% CI：0.08-1.40；P = 0.488）。
对于齿突骨折，与ADS相比，C1-C2 TA螺钉固定和C1 LM-C2椎弓根/椎弓根螺钉固定的融合率在统计学上均显著更高。与钢丝固定相比，ADS显示出更高的融合率，尽管未达到统计学显著性。
