Outcomes of Odontoid Process Fracture Surgery

Abstract

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.