Outcomes of Odontoid Process Fracture Surgery

BACKGROUND

Odontoid fractures are found in two age groups. In younger patients, they occur following traffic accidents, falls from a height and during sports. In older patients with poor bone quality, they are usually caused by falls from one's own height. Most fractures are stable and do not require surgical treatment. Unstable, severely displaced fractures with neurological deficits require surgical treatment. The aim of the study was to evaluate the surgical and functional outcomes of treatment of odontoid fractures with a cannulated screw.

MATERIALS AND METHODS

The study enrolled 20 patients that underwent surgery in the years 2020-2022. The patients were divided into two groups: below 60 (group A) and over 60 years of age (group B). Patients were assessed at one day pre-op, one day post-op, 6 weeks following surgery and 3 months following surgery. Imaging studies were performed to assess the angulation and degree of displacement of bone fragments. After the fracture was surgically fixed with a cannulated screw, bone union and the stability of fracture fixation were assessed. Preoperative and postoperative pain intensity as per a VAS, functional status assessed with the NDI questionnaire, quality of life (EQ-VAS) and neurological status (ASIA scale) were compared.

RESULTS

Good functional and surgical results were obtained in both groups of patients. Performance and quality of life improved, while pain intensity decreased in all patients. In 3 patients with post-traumatic paresis, the dysfunctions gradually subsided. No general medical or perioperative complications were observed. Bone union of the fracture was achieved in 40% of patients in group B and in 80% in group A. Achieving union did not determine the functional status of patients. On functional radiographs, all places of fixation were stable.

CONCLUSIONS

1. Odontoid fracture fixation with a single cannulated screw is a safe method of treatment. It provided a high union rate and good stability of the fracture. 2. Fracture non-union was noted more often in the group of older patients, but it did not negatively impact quality of life and performance.

Functional and Surgical Outcomes of Corpectomy in Patients with Unstable Spinal Fractures

BACKGROUND

Unstable fractures of the spine should be managed surgically. An anterior approach allows for precise decompression of the vertebral canal and reconstruction of the fractured vertebral body. The aim of the study was to evaluate the functional and surgical outcomes of anterior surgical approaches for vertebral body removal and prosthetic reconstruction.

MATERIAL AND METHODS

The objectives of this paper were accomplished by reviewing the course of treatment and treatment outcomes of patients operated on at the Orthopaedic Oncology Department in Brzozw and the Department of Orthopaedics and Traumatology in District Hospital in Stalowa Wola in the years 2020-2021. In total, the treatment of 54 patients was analyzed. The study only included patients with traumatic and pathological fractures who underwent a single-level corpectomy. A total of 18 patients with fractures of the cervical spine, 15 of the thoracic spine and 21 of lumbar spine were treated. Before and after treatment, patients' neurological status was assessed according to the Frankel classification, performance was assessed with the Karnofsky score and pain intensity was analyzed with a VAS. The vertebral wedge angle (alpha), the ratio of the anterior height of the fractured vertebral body to the anterior height of the upper adjacent vertebral body (a/c), the ratio of the anterior height to the posterior height of the fractured vertebra (a/b) and the distance between the vertebral endplates adjacent to the fractured vertebra, measured between their anterior edges (A-B) were assessed. The most common general medical and surgical complications were also evaluated.

RESULTS

After the surgery, significant pain relief measured using a VAS was noted (the median was 7 preoperatively and 4 postoperatively) and an improvement in performance according to the Karnofsky score was observed (the median was 50 preoperatively and 70 postoperatively). Out of the 14 patients with neurologic deficits 11 improved, while 5 regained the ability to walk. In four patients, the implant migrated into an adjacent vertebra and three patients suffered a fracture of the upper adjacent vertebra. The correction of the spine deteriorated in all 7 patients. There was no postoperative neurological deterioration of patients and no infectious complications. During the surgery, three patients suffered dura mater injury, which was identified intraoperatively and repaired.

CONCLUSIONS

1. Corpectomy followed by vertebral body replacement is an effective and safe method that enables the restoration of the shape of the vertebra, restoration of the physciological spinal curvature and direct neural decompression. 2. The treatment outcomes are good. Pain significantly decreases and performance improves in most patients. 3. Treatment complications are rare. The most often observed complication was migration of the implant into an adjacent vertebral endplate, fractures above the place of fixation and dura mater injury.

Outcomes of Treatment of Spinal Fractures with the SpineJack System

BACKGROUND

The use of "SpineJack" implants in patients with stable spinal fractures and without neurological deficits enables restoration of the shape of the fractured vertebra and significantly accelerates restoration of normal function. In unstable spinal fractures, additional posterior fixation is recommended. This is not recommended in patients with traumatic spinal stenosis. The aim of the study was to evaluate the surgical and functional outcomes of treatment of patients with the SpineJack implant.

MATERIAL AND METHODS

The objectives of this paper were accomplished on the basis of an evaluation of the outcomes of treatment of 39 patients operated on at the Orthopaedic Oncology Department in Brzozów and the Department of Orthopaedics and Traumatology in the District Hospital in Stalowa Wola in the years 2020-2021. 71% of patients were men; the mean age of women was 54 years and the mean age of men was 41 years. A total of 30 patients suffered traumatic fractures, while 9 patients suffered non-traumatic (pathological) fractures. Fractures were most often located in the lower parts of the thoracic and upper lumbar spine. Patient radiographs taken on the day before, the first day after and 3 months following the surgery were evaluated to assess the correction of vertebral wedging and cement leakage. Functional status was assessed using ODI, the quality of life was assessed with the EQ-VAS and the severity of pain was measured with a VAS.

RESULTS

Pain intensity, measured with a VAS scale after the surgery, significantly decreased from the mean preoperative 6.9 to 2.4 three months post-op. The mean functional status of patients (ODI) before surgery was 74.4, compared to 14.8 at 3 months post-op. Mean Quality of life (EQ-VAS) was 56.4 before the surgery and 72.4 at 3 months post-op. The vertebral wedge angle decreased after surgical treatment, from a mean value of 15.8 degrees before surgery to 8.8 degrees after surgical treatment. At three months following the surgery, the mean loss of correction was 2.2 degrees and occurred in 4 patients. The most frequent complication was cement leakage into the disc and into the spinal canal, occurring in 4 and 2 patients, respectively.

CONCLUSIONS

1. The use of "SpineJack" implants in the treatment of stable vertebral fractures enables the restoration of the shape and reduction of the vertebral wedge angle. 2. The quality of life of patients after vertebral fracture treatment with "SpineJack" implants assessed using the EQ-VAS improved significantly. The severity of pain assessed on a VAS scale decreased significantly and the patients' functional status improved according to the ODI. 3.Complications observed during treatment with "SpineJack" implants include fractures of the vertebral endplate and cement leakage, mostly asymptomatic.