Advantages of Direct Insertion of a Straight Probe Without a Guide Tube During Anterior Odontoid Screw Fixation of Odontoid Fractures. Issue 9 (May 2016)

• Record Type: Journal Article
• Authors: Park, Jin Hoon; Kang, Dong-Ho; Lee, Moon Kyu; Yoo, Byoungwoo; Jung, Sang Ku; Hwang, Soo-Hyun; Kim, Jeoung Hee; Oh, Sunkyu; Lee, Eun Jung; Jeon, Sang Ryong; Roh, Sung Woo; Rhim, Seung Chul
• Is Part Of: Spine. Volume 41:Issue 9(2016)
• Page Start: E541
• Page End: E547
• Publication Date: 2016-05
• Subjects: anterior odontoid screw -- direction angle -- guide tube -- non-union -- odontoid fracture -- pull out -- rimming -- shallow type III odontoid fracture -- straight probe -- type 2; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001311
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective cohort study. Objective: The aim of this study was to compare the anterior odontoid screw fixation (AOSF) with a guide tube or with a straight probe. Summary of Background Data: AOSF associates with several complications, including malpositioning, fixation loss, and screw breakage. Screw pull-out from the C2 body is the most common complication. Methods: All consecutive patients with type II or rostral shallow type III odontoid fractures who underwent AOSFs during the study period were enrolled retrospectively. The guide-tube AOSF method followed the standard published method except C3 body and C2-3 disc annulus rimming was omitted to prevent disc injury; instead, the guide tube was anchored at the anterior inferior C2 vertebra corner. After 2 screw pull-outs, the guide-tube cohort was analyzed to identify the cause of instrument failure. Thereafter, the straight-probe method was developed. A guide tube was not used. A small pilot hole was made on the most anterior side of the inferior endplate, followed by insertion of a 2.5 mm straight probe through the C2 body. Non-union and instrument failure rates and screw-direction angles of the guide-tube and straight-probe groups were recorded. Results: The guide-tube group (n = 13) had 2 screw pull-outs and 1 non-union. The straight-probe group (n = 8) had no complications and significantly larger screw-direction angles than the guide-tube group (60.5 ± 4.63 vs. 54.8 ± 3.82 degrees; P = 0.047). Conclusion: Straight-probe AOSF yielded larger direction angles without injuring bone and disc. Complications were absent. The procedure was easier than guide-tube AOSF and assured sufficient engagement, even in horizontal fracture orientation cases. Level of Evidence: 3