Dataset Information

Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation.

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 fractures. Elderly patients were more likely to experience non-union and dysphagia.

SUBMITTER: Tian NF

PROVIDER: S-EPMC4109995 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation.

Tian Nai-Feng NF Hu Xu-Qi XQ Wu Li-Jun LJ Wu Xin-Lei XL Wu Yao-Sen YS Zhang Xiao-Lei XL Wang Xiang-Yang XY Chi Yong-Long YL Mao Fang-Min FM

PloS one 20140724 7

<h4>Background</h4>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.<h4>Methods</h4>We searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and po ...[more]

PMID: 25058011

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Project description:BackgroundPercutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation.MethodsTwenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery.ResultsThere were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group.ConclusionsThe top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.

Project description:BackgroundThe posterior screw fixation in atlas via posterior arch and lateral mass, also called C1 "pedicle" screw, combined with C2 pedicle screw fixiation has shown better biomechanical stability in unstable atlantoaxial fractures. However, its popularization has to fulfill the limitation imposed by anatomical characteristics. The aim of this study was to explore the manipulation, effect, and safety of the atlantoaxial transpedicular screw fixation under "direct vision" for the treatment of unstable atlantoaxial fracture.MethodsAll the patients diagnosed with unstable atlantoaxial fracture, who received surgery treatment of C1,C2 internal fixation from January 2012 to December 2014 were reviewed. Only these patients that were diagnosed with atlantoaxial unstability secondary to trauma and were treated with atlantoaxial transpedicular screw fixation under "direct vision" and iliac autograft were included. The safety of transpedicular screw placement, postoperative outcome, atlantoaxial stability, autograft fusion, and complications was observed and analyzed retrospectively. The pain visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) score were used as surgical curative effect evaluation standards.ResultsWe reviewed a total of 92 patients diagnosed with unstable atlantoaxial fracture, who received surgery treatment of C1,C2 internal fixation from January 2012 to December 2014, and 87 patients were treated with atlantoaxial transpedicular screw fixation under "direct vision" and were included this analysis. A total of 306 transpedicular screws in atlas and axis were placed successfully. All cases were followed-up >12 months. The overall breach rate was 11.36%. None of the breaches resulted in new-onset neurological sequela. The neurological status in cases with bilateral upper extremities numbness and lower extremities weakness had improved after surgery. At the latest follow-up, the neck VAS and JOA scores were significantly improved (P < .01) than those preoperatively. No cases demonstrated implantation failure and bone graft absorption on the postoperative x-ray films and CT scans.ConclusionAtlantoaxial transpedicular screw fixation under "direct vision" and iliac autograft for the treatment of unstable atlantoaxial fracture has shown simple manipulation and efficient performance. Thus, the technique of C1-C2 fixation is feasible in treating unstable atlantoaxial fracture.

Project description:BackgroundThe anterior pedicle screw (APS) technique for L5 and S1 is crucial for proper anterior lumbar interbody fusion (ALIF). This study aimed to determine the projection, screw trajectory angle, and bone screw passageway length (BSPL), as well as the screw insertion regularity and the operating area within which it is safe to perform insertion.MethodsForty patients with low back pain, all of whom had lumbar computed tomography scans available, was included in this retrospective analysis. Radiographic parameters were measured, including: the distances from the projection to the upper endplate, lower endplate, and midline; the transverse and sagittal screw angles; and the BSPL. In addition, 10 fresh adult cadaveric lumbosacral spine segments were selected to determine the safe anatomic area in which to operate. Finally, APSs were inserted in L5 and S1 to determine the regularity of APS insertion.ResultsWe measured the anterior projection parameters, including: the distances to the upper endplate (L5: 12.5±1.3 mm; S1: 4.54±0.87 mm), lower endplate (L5: 17.3±1.6 mm), and midline (L5: 6.6±0.7 mm; S1: 6.6±0.6 mm); the screw trajectory angle, including the transverse screw angle (L5: 25.3±2.8°; S1: 25.7±2.6°), sagittal screw angle (L5: 17.1±1.7°; S1: 22.4±1.1°); and the BSPL (L5: 48.6±3.5 mm; S1: 48.0±3.5 mm). The regularity of APS insertion in L5 and S1 was determined. Upon the needle reaching a point in the lateral view, it reached the corresponding point in the anteroposterior (AP) view. The anatomic parameters of the safe operating area were as follows: the distance from the abdominal aortic bifurcation to the L5 lower edge (40.50±9.40 mm); the distance from the common iliac vein confluence to the L5 lower edge (27.80±8.60 mm); and the horizontal distance from the inner edge of the common iliac vein to the L5 lower edge (37.50±1.30 mm). We also determined the distance between S1 holes (29.30±1.30 mm), the L5/S1 intervertebral height (17.20±1.50 mm), and the safe operating area (2,058.20±84.30 mm2).ConclusionsThis study has determined the projection, screw trajectory angle, and BSPL of APSs in L5 and S1, their insertion regularity, and the area in which the operation can be safely performed.

Project description:Reconstruction after multilevel decompression of the cervical spine, especially in the weakened osteoporotic, neoplastic or infectious spine often requires circumferential stabilization and fusion. To avoid the additional posterior surgery in these cases while increasing rigidity of anterior-only screw-plate constructs, the authors introduce the concept of anterior transpedicular screw (ATPS) fixation. We demonstrated its morphological feasibility as well as its indications in a previous study in Part I of our project. Consequently, the objectives of the current study were to assess the ex vivo accuracy of placing ATPS into the cervical vertebra as well as the biomechanical performance of ATPS in comparison to traditional vertebral body screws (VBS) in terms of pull-out strength (POS). Twenty-three ATPS were inserted alternately to two screws into the pedicles and vertebral bodies, respectively, of six cadaveric specimens from C3-T1. For insertion of ATPS, a manual fluoroscopically assisted technique was used. Pre- and post insertional CT-scans were used to assess accuracy of ATPS insertion in the axial and sagittal planes. A newly designed grading system and accuracy score were used to delineate accuracy of ATPS insertion. Following insertion of screws, 23 ATPS and 22 VBS were subjected to pull-out testing (POT). The bone mineral density (BMD) of each specimen was assessed prior to POT. Statistical analysis showed that the incidence of correctly placed screws and non-critical pedicles breaches in axial plane was 78.3%, and 95.7% in sagittal plane. Hence, according to our definition of "critical" pedicle breach that exposes neurovascular structures at risk, 21.7% (n = 5) of all ATPS inserted showed a critical pedicle breach in axial plane. Notably, no critical pedicle perforation occurred at the C6 to T1 levels. Pull-out testing of ATPS and VBS revealed that pull-out resistance of ATPS was 2.5-fold that of VBS. Mean POS of 23 ATPS with a mean BMD of 0.566 g/cm(2) and a mean osseus screw purchase of 27.2 mm was 467.8 N. In comparison, POS of 22 VBS screws with a mean BMD of 0.533 g/cm(2) and a mean osseus screw purchase of 16.0 mm was 181.6 N. The difference in ultimate pull-out strength between the ATPS and VBS group was significant (p < 0.000001). Also, accuracy of ATPS placement in axial plane was shown to be significantly correlated with POS. In contrast, there was no correlation between screw-length, BMD, or level of insertion and the POS of ATPS or VBS. The study demonstrated that the use of ATPS might be a new technique worthy of further investigation. The use of ATPS shows the potential to increase construct rigidity in terms of screw-plate pull-out resistance. It might diminish construct failures during anterior-only reconstructions of the highly unstable decompressed cervical spine.

Project description:BACKGROUND:It is still unknown whether bioabsorbable magnesium (Mg) screws provide an advantage over titanium screws in the treatment of medial malleolar (MM) fractures. The purpose of this retrospective study is to compare the clinical and radiological outcomes of MM fractures fixed with either bioabsorbable Mg screws or conventional titanium screws. MATERIALS AND METHODS:A cohort of 48 patients with MM fractures who underwent compression screw fixation was retrospectively reviewed. Twenty-three patients (16 male, 7 female; mean age: 37.9?±?17.7 years) were treated with bioabsorbable Mg screws, and 25 patients (14 male, 11 female; mean age: 45.0?±?15.7 years) were treated with conventional titanium screw fixation. All patients were followed up for at least 1 year, with a mean time of 24.6?±?10.5 months (12-53 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale was used to evaluate the clinical results. The Kellgren-Lawrence (KL) osteoarthritis grading was used to evaluate posttraumatic osteoarthritis on final ankle radiographs. Fracture union, rate of implant removal, and complications were recorded. Comparative analysis of two independent groups was performed using the chi-squared test and the Mann-Whitney U-test. RESULTS:The two groups were comparable concerning demographic and clinical characteristics. Age (p?=?0.146), sex (p?=?0.252), side (p?=?0.190), MM fracture type (p?=?0.500), associated fractures (p?=?0.470), and follow-up period (p?=?0.903) were similar between the groups. At final follow-up examination, AOFAS score (p?=?0.191) was similar between groups. Fracture union was achieved in all cases. Grade of posttraumatic osteoarthritis, according to KL, was equally distributed in both groups (p?=?0.074). No deep infection or osteomyelitis was seen. Five patients in the titanium screw group underwent implant removal, due to pain in three of them and difficulty in wearing shoes in the other two (p?=?0.031). Implant removal was performed after a mean of 14.2?±?3.1 months (12-19 months). CONCLUSIONS:Bioabsorbable Mg and titanium screws had similar therapeutic efficacy in MM fracture fixation regarding functional and radiological outcomes. However, the rate of implant removal was higher with titanium screws. Bioabsorbable Mg screws may be a favorable fixation option since secondary implant removal procedures can be prevented. LEVEL OF EVIDENCE:Level IV, Retrospective case series.

Dataset Information

Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation.

Background

Methods

Results

Conclusions/significances

Publications

Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation.

Similar Datasets

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