Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study

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  • 1 UO di Neurochirurgia, Ospedale Cardinal G. Panico, Tricase;
  • 2 UOC di Neurochirurgia, Azienda Ospedaliera Sant’Andrea, Sapienza, Rome;
  • 3 Dipartimento di Neurochirurgia, Azienda Ospedaliero, Universitaria S. Anna, Ferrara;
  • 4 UOC di Neurochirurgia, Ospedale San Bortolo, Vicenza;
  • 5 UOC di Neurochirurgia, Ospedale M. Bufalini, Cesena, Italy; and
  • 6 Hôpital Pierre Wertheimer, Lyon, France
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OBJECTIVE

Anderson type II odontoid fractures are severe conditions, mostly affecting elderly people (≥ 70 years old). Surgery can be performed as a primary treatment or in cases of failed conservative management. This study aimed to investigate how duration from injury to surgery, as well as clinical, radiological, and surgical risk factors, may influence the union rate after anterior odontoid screw placement for Anderson type II odontoid fractures.

METHODS

The authors conducted a retrospective multicenter study. Demographic, clinical, surgical, and radiological data of patients who underwent anterior odontoid screw placement for Anderson type II fractures were retrieved from institutional databases. Study exclusion criteria were prolonged corticosteroid drug therapy (> 4 weeks), polytraumatic injuries, oncological diagnosis, and prior cervical spine trauma.

RESULTS

Eighty-five patients were included in the present investigation. The union rate was 76.5%, and 73 patients (85.9%) did not report residual instability. Age ≥ 70 years (p < 0.001, OR 6), female gender (p = 0.016, OR 3.61), osteoporosis (p = 0.009, OR 4.02), diabetes (p = 0.056, OR 3.35), fracture diastasis > 1 mm (p < 0.001, OR 8.5), and duration from injury to surgery > 7 days (p = 0.002, OR 48) independently influenced union rate, whereas smoking status (p = 0.677, OR 1.24) and odontoid process angulation > 10° (p = 0.885, OR 0.92) did not.

CONCLUSIONS

Although many factors have been reported as influencing the union rate after anterior odontoid screw placement for Anderson type II fractures, duration from injury to surgery > 7 days appears to be the most relevant, resulting in a 48 times higher risk for nonunion. Early surgery appears to be associated with better radiological outcomes, as reported by orthopedic surgeons in other districts. Prospective comparative clinical trials are needed to confirm these results.

ABBREVIATIONS CVJ = craniovertebral junction.

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Contributor Notes

Correspondence Luca Ricciardi: UO di Neurochirurgia, Tricase, Lecce, Italy. ricciardi.lu@gmail.com.

INCLUDE WHEN CITING Published online October 2, 2020; DOI: 10.3171/2020.6.SPINE20318.

Disclosures Dr. Barrey reports being a consultant to Medicrea, Noraker, Global’S, and Implanet, and having a nonfinancial relationship to academic competition of the European Spine Journal Advisory Board.

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