Outcomes Of Anterior And Posterior Surgical Treatment And Optimal Surgical Treatment For Odontoid Fractures

Objective: To analyze the outcomes of anterior and posterior approach surgery forodontoid fractures of39cases of our hospital, explore the optimal indications andsurgical strategy for odontoid fractures.Methods: Restrospective srudy the thirty-nine patients with odontoid fracturesunderwent anterior or posterior approach surgery. All the patients are followed up.Patients were divided into two groups based on the surgical approach: anteriorgroup(with14cases received anterior odontoid screw fixation) and posterior group(with25cases received posterior atlantoaxial or occioitalcervical junction fusion and fixation).Analyze the outcomes of the two approachs through comparing with operative time,bleeding volume, fusion rates, complications, cervical range of motion, cervical JOAscores, VAS scores, and ASIA spinal ingury grading.Results:1.Operative time was115.71±25.63mins in anterior group, and204.80±78.59minsin posterior group. Bleeding volume was27.86±13.11ml in anterior group, and240.00±122.47ml in posterior group. There were significant differences between twogroups on operative time, bleeding volume.2.Cervical range of motions in axial rotation were104.4±15.09°in anterior group,and66.00±16.35°in posterior group. Cervical range of motions inflexion-extension was95.56±11.30°in anterior group, and83.00±13.02°in posterior group. There wassignificant difference between two groups on cervical range of motion.3.Preoperative cervical JOA scores of two groups were16.64±0.50and15.60±1.19.Postoperative cervical JOA scores were17.00±0.00and16.52±0.82. althoughpostoperative cervical JOA scores increased, there were no significant differencebetween two groups or intergroups.4.The preoperative cervical VAS scores of the two groups were2.36±1.08and 2.24±1.05. Postoperative cervical VAS scores were0.50±0.65and1.24±1.13.Postoperative cervical VAS scores of the two groups were decreased, there wassignificant difference between two groups.5.Complication incidence3cases in anterior group and8cases in posterior groupsuffered from the pharyngalgia and dysphagia.6.All the patients were received bone union. There were no serious complicationssuch as spinal cord injury and vertebral artery injury.7.In anterior group, preoperatively9cases were classified as ASIA spinal injurygrading E, and5were D, postoperatively13were E and1were D; in posterior group,preoperatively16cases were classified as ASIA spinal injury grading E,6were D,and3were C, postoperatively19were E and6were D.Conclusion:1.Anterior odontoid screw fixation and posterior atlantoaxial or occipitalcervicaljunction fusion and fixation can be safely used with good outcomes.2.Anterior odontoid screw fixation can be used for fresh fracture or old fracturewithin3months. the fracture need to be replaced preoperation. Single screw can getgood result for odontoid fracture.3.Posterior atlantoaxial or occipitalcervical junction fusion and fixation can beused for odontoid fractures with contraindications to anterior odontoid screw fixation.But the cervical range of motions will be decreased a lot after the posterior surgery.