1
|
Mathkour M, Cardona JJ, Chaiyamoon A, Glynn RM, Jenkins S, Graham RA, Johal J, Gardner B, Iwanaga J, Dumont AS, Tubbs RS. Classifications of Odontoid Process Fractures: A Systematic Review and Proposal of a New Simplified Classification System Based on Embryology. Cureus 2022; 14:e32520. [PMID: 36654633 PMCID: PMC9838683 DOI: 10.7759/cureus.32520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/15/2022] Open
Abstract
Odontoid fractures are the most common cervical spine fractures in the elderly. Although many classification systems have been developed for them, the ambiguity in various definitions can potentially lead to misunderstandings. This paper aims to review the terminologies and current classification systems of odontoid fractures and propose a new, simplified anatomical classification. Given the descriptive variability of odontoid fractures in current classifications, we systematically reviewed the literature using PRISMA guidelines querying the National Library of Medicine PubMed database. The initial literature search yielded 175 publications. A total of seven reports met the inclusion criteria and were ultimately included for a full review. The classification systems previously used to categorize fractures of the odontoid process often need to be more transparent, imprecise, and incongruous. To simplify them, a new embryologically accurate system is proposed. A new embryological and anatomically-based system, combining the former systems' specific attributes, allows a more straightforward and adaptable classification of odontoid fractures.
Collapse
Affiliation(s)
- Mansour Mathkour
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
- Neurosurgery Division, Jazan University, Riyadh, SAU
| | - Juan J Cardona
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Arada Chaiyamoon
- Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA
| | - Ryan M Glynn
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
| | - Skyler Jenkins
- Orthopaedics, St. George's University, St. George's, GRD
| | - Rachel A Graham
- Internal Medicine, Sophie Davis School of Biomedical Education, New York, USA
| | - Jaspreet Johal
- Neurology, Lehigh Valley Health Network, Philadelphia, USA
| | - Brady Gardner
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
- Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Neurology, Tulane University School of Medicine, New Orleans, USA
| |
Collapse
|
2
|
The impact of odontoid screw fixation techniques on screw-related complications and fusion rates: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:475-497. [DOI: 10.1007/s00586-020-06501-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
|
3
|
Baogui L, Juwen C. Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1-C2 arthrodesis: a meta-analysis. Arch Orthop Trauma Surg 2019; 139:1329-1337. [PMID: 30877428 DOI: 10.1007/s00402-019-03164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For odontoid fractures, surgical treatment approaches including anterior odontoid screw fixation approach and the posterior C1-C2 arthrodesis approach are generally adopted in practice. However, the choice of different surgical procedures remains controversial. In addition to surgical technique, the fusion rate is an important factor contributing to the clinical efficacy. Therefore, this study was aimed to investigate the discrepancy in fusion rate between these two surgical approaches through synthesizing the currently available evidence on the topic. METHODS A computerized search of Ovid, Medline, Embase, and the Cochrane library up to December 2017 for literature on the complication rate during odontoid fracture treatment was conducted. Risk ratio (RR) with its 95% confidence interval (CI) was pooled to assess fusion rates after surgical treatments, including anterior odontoid screw fixation approach or posterior C1-2 arthrodesis procedure, for patients with odontoid fractures. RESULTS Thirteen studies were enrolled in the meta-analysis. Results show that no significant difference was found in the overall fusion rate (RR = 0.96, 95% CI 0.90-1.01). There was no significant heterogeneity among the studies (p value = 0.60). As to age- and economic-level subgroups, there was no statistical evidence to suggest an association of the patient age and economy development level with the choice of surgical approach. However, it is shown that better fusion rates of patients (≥ 60 years) in developed countries received a better fusion rates after posterior fixation compared with anterior group using the fixed-effect model (RR = 0.88, 95% CI 0.79-0.98). CONCLUSION Elderly patients (≥ 60 years) underwent posterior C1-2 arthrodesis fixation shows higher fusion rates in developed countries comparing with patients who underwent anterior odontoid screw fixation. Overall, there is no significant discrepancy between these two surgical approaches. However, the conclusion should be verified by further study enrolling larger sample size.
Collapse
Affiliation(s)
- Li Baogui
- Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China
| | - Chen Juwen
- Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China.
| |
Collapse
|
4
|
Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases. Arch Orthop Trauma Surg 2019; 139:43-51. [PMID: 30317379 DOI: 10.1007/s00402-018-3050-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. METHODS Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. RESULTS Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment. CONCLUSIONS Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.
Collapse
|
5
|
Purvis TE, De la Garza-Ramos R, Abu-Bonsrah N, Goodwin CR, Groves ML, Ain MC, Sciubba DM. External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes. Clin Neurol Neurosurg 2018; 168:18-23. [PMID: 29505977 DOI: 10.1016/j.clineuro.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/03/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries undergoing either external fixation or surgical fusion. PATIENTS AND METHODS Baseline and outcome data were obtained from the 2002-2011 Nationwide Inpatient Sample (NIS) for patients under the age of 18 with a diagnosis of cervical spine fracture without spinal cord injury or cervical spine subluxation. Patients who underwent external immobilization or internal fixation were included for analysis. Variables analyzed included length of stay, in-hospital mortality, discharge disposition, total hospital charges, and development of at least one in-hospital complication. RESULTS A total of 2878 pediatric patients with cervical spine injury were identified; 1462 patients (50.8%) with atlantoaxial (C1-2) injury and 1416 (49.2%) with subaxial (C3-7) injury. Among atlantoaxial injury patients, external fixation was associated with lower total charges ($73,786 vs. $98,158, p = .040) and a lower likelihood of developing at least one complication (1.9% vs. 6.8%, p = .029) compared to surgical fusion, and was a more common treatment for subluxation alone (16.4% vs. 2.6%, p < .001). Among subaxial injury patients, there were no significant differences in age (p = .262), length of stay (p = .196), occurrence of at least one complication (p = .334), or total charges (p = .142). Subaxial subluxation injuries alone were treated more often with surgical fusion (2.2% vs. 1.2%, p < .001). CONCLUSION Optimal treatment of patients with cervical injury may vary by location of injury. Our findings warrant further investigation into the difference in clinical outcomes between surgical and non-surgical management of atlantoaxial and subaxial injury.
Collapse
Affiliation(s)
- Taylor E Purvis
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael De la Garza-Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Mari L Groves
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Tian NF, Hu XQ, Wu LJ, Wu XL, Wu YS, Zhang XL, Wang XY, Chi YL, Mao FM. Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation. PLoS One 2014; 9:e103065. [PMID: 25058011 PMCID: PMC4109995 DOI: 10.1371/journal.pone.0103065] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/25/2014] [Indexed: 02/06/2023] Open
Abstract
Background Anterior odontoid screw fixation (AOSF) has been one of the most popular treatments for odontoid fractures. However, the true efficacy of AOSF remains unclear. In this study, we aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures. Methods We searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and potential sources of heterogeneity were explored by meta-regression analysis. Results Of 972 references initially identified, 63 were eligible for inclusion. 54 studies provided data regarding non-union. The pooled non-union rate was 10% (95% CI: 7%–3%). 48 citations provided re-operation information with a pooled proportion of 5% (95% CI: 3%–7%). Infection was described in 20 studies with an overall rate of 0.2% (95% CI: 0%–1.2%). The main approach related complication is postoperative dysphagia with a pooled rate of 10% (95% CI: 4%–17%). Proportions for the other approach related complications such as postoperative hoarseness (1.2%, 95% CI: 0%–3.7%), esophageal/retropharyngeal injury (0%, 95% CI: 0%–1.1%), wound hematomas (0.2%, 95% CI: 0%–1.8%), and spinal cord injury (0%, 95% CI: 0%–0.2%) were very low. Significant heterogeneities were detected when we combined the rates of non-union, re-operation, and dysphagia. Multivariate meta-regression analysis showed that old age was significantly predictive of non-union. Subgroup comparisons showed significant higher non-union rates in age ≥70 than that in age ≤40 and in age 40 to <50. Meta-regression analysis did not reveal any examined variables influencing the re-operation rate. Meta-regression analysis showed age had a significant effect on the dysphagia rate. Conclusions/Significances This study summarized the rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid factures. Elderly patients were more likely to experience non-union and dysphagia.
Collapse
Affiliation(s)
- Nai-Feng Tian
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (NFT); (FMM)
| | - Xu-Qi Hu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li-Jun Wu
- Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin-Lei Wu
- Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao-Sen Wu
- Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao-Lei Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Center for Stem Cells and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiang-Yang Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yong-Long Chi
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang-Min Mao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (NFT); (FMM)
| |
Collapse
|
7
|
Joaquim AF, Patel AA. Craniocervical traumatic injuries: evaluation and surgical decision making. Global Spine J 2011; 1:37-42. [PMID: 24353936 PMCID: PMC3864441 DOI: 10.1055/s-0031-1296055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/17/2011] [Indexed: 11/29/2022] Open
Abstract
We present a literature review of current approaches to craniocervical traumatic injuries. In an attempt to categorize the injuries that involve the upper cervical spine, we divide the injuries into two groups: (1) injuries affecting mainly bone structures and (2) predominantly ligamentous injury. This division is based on the principle that bone injuries have the potential to heal with conservative treatment whereas ligamentous injury would not heal properly, leading to an unstable spine. An accurate diagnosis and treatment are necessary to improve patient's outcome and avoid complications. As a general rule, ligamentous injuries are unstable lesions, requiring surgical treatment. Bony injuries can be conservatively treated, with surgery reserved for more unstable patterns (unstable C1 ring, displaced odontoid or C2 pars fractures).
Collapse
Affiliation(s)
- Andrei F. Joaquim
- Department of Neurology, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University, Chicago, Illinois
| |
Collapse
|