Journal of Craniovertebral Junction and Spine最新文献

{"title":"Frailty index as predictors of loss of cervical lordosis following laminoplasty in patients with cervical spondylotic myelopathy.","authors":"Michael Ryan Kann, Miguel A Ruiz-Cardozo, Karma Barot, Karan Joseph, Tim Bui, Salim Yakdan, Samuel Brehm, Gabriel Trevino, Abigail Carey-Ewend, Michael Olufawo, Alexander Thomas Yahanda, Brenton Pennicooke, Camilo A Molina","doi":"10.4103/jcvjs.jcvjs_204_24","DOIUrl":"10.4103/jcvjs.jcvjs_204_24","url":null,"abstract":"<p><strong>Background: </strong>Postlaminoplasty kyphotic deformity (PKD) is a complication affecting roughly 20% of patients undergoing cervical laminoplasty. Identification of preoperative risk factors for PKD could allow surgeons to adapt treatment plans to reduce PKD.</p><p><strong>Objective: </strong>The aim of this study was to investigate the ability of the Charlson Comorbidity Index (CCI), 5-item Modified Frailty Index (5i-mFi), and Administrative Risk Analysis Index (RAI-A) to predict for the development of PKD in patients with cervical spondylotic myelopathy (CSM) undergoing laminoplasty.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed CSM patients who underwent laminoplasty at an academic tertiary care center between January 1, 2016, and January 30, 2022, and had a complete set of anterolateral cervical X-rays at 1-year follow-up. Angular kyphosis was defined as the loss of cervical lordosis by more than - 10° after surgery when measuring the difference between pre- and post-operative C2-7 Cobb angles. Regression and receiver operating characteristic (ROC) curve analysis were used to assess the ability of the frailty assessments to predict for PKD.</p><p><strong>Results: </strong>Seventy-six CMS patients were eligible, 11.8% of which developed PKD. The cohort consisted of 54 males and 22 females with a mean age of 59.5 years and body mass index of 29.2 kg/m². No CCI, 59-mFi, or RAI-A frailty subgroup was associated with kyphotic development and ROC curve analysis showed that neither CCI (P = 0.81), 5i-mFi (P = 0.59), nor RAI-A (P = 0.63) predicted for PKD. None of these assessments were a superior prognosticator of PKD.</p><p><strong>Conclusion: </strong>CCI, 5i-mFi, and RAI-A frailty assessments were not associated with the development of PKD in CSM patients.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"148-156"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are we defining preoperative anemia? A comparison of various anemia thresholds among patients undergoing short-construct lumbar spinal fusion.","authors":"Tariq Z Issa, Omar H Tarawneh, Teeto Ezeonu, Mark J Lambrechts, Mark F Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.4103/jcvjs.jcvjs_69_25","DOIUrl":"10.4103/jcvjs.jcvjs_69_25","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a risk factor for increased transfusions. However, various definitions of anemia have been described in scientific literature and a consensus on how to appropriately diagnose anemia or who to preoperatively optimize is lacking. We aimed to compare multiple anemia definitions and evaluate if any threshold best predicts transfusion requirements and surgical outcomes following spinal fusion.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 1-2 level posterior spinal fusions. Preoperative hemoglobin was defined based on preoperative laboratories within 28 days of surgery. Anemia was diagnosed using the World Health Organization (WHO), the American Society of Hematology (ASH), and the Cleveland Clinic (CC) thresholds. Youden's index and multivariable regressions were utilized to analyze associations of anemia with postoperative outcomes.</p><p><strong>Results: </strong>A total of 2257 patients were included. Patients who received a transfusion were more likely anemic regardless of definition (WHO: 60.0% vs. 14.0%, <i>P</i> < 0.001; ASH: 61.0% vs. 17.8%; CC: 70.0% vs. 26.6%; all, <i>P</i> < 0.001). On multivariable regression, all anemia definitions were independently associated with transfusions and nonhome discharge. WHO anemia was associated with the highest odds of transfusion (odds ratio [OR]: 7.48, <i>P</i> < 0.001), followed by ASH anemia (OR: 6.63, <i>P</i> < 0.001), ASH preoperative anemia (OR: 6.45, <i>P</i> < 0.001), and CC anemia (OR: 5.92, <i>P</i> < 0.001). Only WHO anemia was associated with complications (OR: 1.55, <i>P</i> = 0.045). Receiver operating characteristic curves suggest that every anemia threshold was acceptable (area under the curve [AUC] >0.70) for identifying patients needing a postoperative transfusion: ASH preoperative demonstrated the greatest AUC (AUC: 0.746), followed by WHO anemia (AUC: 0.730). All performed poorly in predicting complications (AUC: 0.541-0.553), readmissions (AUC: 0.525-0.535), and nonhome discharge (AUC: 0.561-0.596).</p><p><strong>Conclusions: </strong>Small variations in anemia definitions do not significantly impact the identification of patients necessitating a transfusion. However, the more discriminative WHO definition may best predict postoperative complications for lumbar fusions.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"188-194"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and outcomes of posterior circulation stroke following traumatic vertebral artery injury: A 6-year single-center retrospective cohort study.","authors":"Jonathan Sterne, Greg McLorinan","doi":"10.4103/jcvjs.jcvjs_7_25","DOIUrl":"10.4103/jcvjs.jcvjs_7_25","url":null,"abstract":"<p><strong>Objectives: </strong>Vertebral artery injury (VAI) is an uncommon, but potentially devastating, complication following cervical spine trauma. Posterior circulation ischemia (POCS) can result from a disruption to the vertebral arteries and potentially lead to long-term morbidity and mortality for these patients. This study aimed to describe the outcomes for patients with POCS as a result of VAI.</p><p><strong>Methods: </strong>Six hundred and twenty patients who sustained a cervical spine fracture with or without dislocation were identified from the years 2011 to 2017. Demographic data, injury details, and imaging results were collected with inpatient and outpatient records on the regional electronic care record. Patients with VAI were identified (n = 20) and screened for subsequent POCS. Their outcome was recorded from inpatient and outpatient records.</p><p><strong>Results: </strong>POCS was identified in 6 patients who had sustained a VAI (30%). Of those 6 patients, 5 had long-term neurological deficits following their injury and POCS. Two patients died within 30 days and 3 patients had died by 60 days following injury.</p><p><strong>Conclusions: </strong>POCS occurred in 30% of patients who sustained a VAI in this study. It carried significant morbidity and mortality for the patients who suffered this potentially devastating complication. Clinicians involved in the care of patients with cervical spine trauma should be aware of the risk factors for VAI and ensure to be suspicious of POCS in patients who have proven VAI.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"176-179"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin dependence predicts adverse outcomes following lumbar spine surgery.","authors":"Haseeb E Goheer, Alden H Newcomb, Zachary M Johnson, Christopher G Hendrix, Alexander R Garcia, Brian Q Truong, Jonathan J Carmouche","doi":"10.4103/jcvjs.jcvjs_59_25","DOIUrl":"10.4103/jcvjs.jcvjs_59_25","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spine surgery procedures have been increasing amid a growing population with diabetes mellitus (DM) with limited studies available focusing exclusively on insulin dependence as a risk factor. The objective of this study was to evaluate the differential impact of insulin dependence on perioperative outcomes following lumbar spine surgery.</p><p><strong>Materials and methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried to retrospectively identify patients who had undergone lumbar spine surgery between 2011 and 2022. The study population was divided into three distinct groups based on diabetic status: insulin-dependent DM (IDDM), insulin-independent DM (NIDDM), and no DM (non-DM). One-way analysis of variance for continuous variables and Chi-square tests for categorical variables were used to identify differences in perioperative variables between the three groups. Multivariable logistic regression analysis assessed the effect of DM status on postoperative surgical outcomes.</p><p><strong>Results: </strong>A total of 349,520 lumbar spine patients were identified, of whom 20,159 were IDDM, 43,402 were NIDDM, and 285,959 were non-DM. Both IDDM (odds ratio [OR]: OR: 1.134, 95% CI [1.059-1.214]) independently increased the risk for surgical complications, whereas only IDDM increased the risk for medical (OR: 1.256, 95% CI [1.194-1.320] complications following a multivariate logistic regression analysis.</p><p><strong>Conclusions: </strong>This study highlights the increased risk of surgical and medical complications in patients with IDDM undergoing lumbar spine surgery. Both NIDDM and IDDM are independent risk factors for postoperative medical and surgical complications. These findings can be used to improve preoperative management and risk stratification for insulin dependent DM patients.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"237-242"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Minor\" trauma to cervical spine with \"major\" neurological deficits in elderly-analyzing the role of spinal stabilization.","authors":"Atul Goel, Nasser M F El-Ghandour","doi":"10.4103/jcvjs.jcvjs_130_25","DOIUrl":"10.4103/jcvjs.jcvjs_130_25","url":null,"abstract":"","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"123-125"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contiguous versus skip discectomy and fusion in cervical disc herniation: Do we need to fuse the normal intermediate segment?","authors":"Shrinath Shah, Souvik Singha, Madhusudhan Nagesh, Ninad Sawant, Mohammed Nadeem, T S Lingaraju, Harsh Deora, Abhinith Shashidhar, Subhash Kanti Konar, Arivazhagan Arimappamagan, Srinivas Dwarakanath","doi":"10.4103/jcvjs.jcvjs_28_25","DOIUrl":"10.4103/jcvjs.jcvjs_28_25","url":null,"abstract":"<p><strong>Aims and objectives: </strong>Noncontiguous degenerative cervical disc disease (NCDDD) is characterized by cervical disc prolapse involving nonadjacent segments. This study aims to determine if skip discectomy and fusion technique compared to contiguous discectomy and fusion while preserving adjacent segment disease in uninvolved intermediate segments leads to equivalent or better clinical and radiological outcomes.</p><p><strong>Methods: </strong>Fifty-two patients who underwent management of NCDDD and two-level contigious disc disease (CDD) over 6 years from 2014 to 2020 were included in the study. There were 44 male and 8 female patients with a mean age of 46.75 years. These patients were divided into two groups: Those who underwent contiguous discectomy and those who underwent skip discectomy with either anterior cervical discectomy (ACD) alone, ACD and fusion (ACDF), or ACDF with plating based on individual pathology and surgeon preference. Outcomes were assessed using clinical parameters such as modified Japanese Orthopaedic Association Score (mJOAS) and Nurick grade and radiological parameters such as disc height improvement, spinal alignment change, and fusion rates.</p><p><strong>Results: </strong>The overall mean duration of follow-up was 15.23 ± 23.69 months, with a clinical follow-up period of 23.87 ± 21.51 months and a radiological follow-up period of 7.57 ± 5.91 months, with follow-up in Group 1 being 24.67 ± 23.17 months and in Group 2 being 20.03 ± 10.53 months. The mean blood loss in Group 1 was 200.47 mL; in Group 2, it was 172 mL. The preoperative mJOAS was 10.19 ± 3.16, and the postoperative mJOAS was 12.73 ± 2.92 (<i>P</i> = 0.001). Nurick grade showed improvement from a preoperative mean score of 4.23 ± 1.02-3.65 ± 0.88 postoperatively (<i>P</i> < 0.001). Statistically significant improvement in intervertebral height at superior and inferior levels was observed. Outcomes for Skip discectomy regarding mJOAS, Nurick grade, radiological parameters, fusion, and complication rates were noninferior to contiguous discectomy and fusion.</p><p><strong>Conclusion: </strong>Skip discectomy has a similar benefit and risk profile and is noninferior compared to contiguous discectomy in addition to the preservation of intermediate disc integrity.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"243-249"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parameter algorithm-driven optimization of surgical approaches: An investigation based on T1 slope minus C2-7 cervical lordosis in patients with cervical degenerative diseases.","authors":"Tao Liu, Zhongzheng Zhi, Shuiqiang Qiu, Jian Kang, Jinhao Miao, Zhimin He, Zude Liu","doi":"10.4103/jcvjs.jcvjs_65_25","DOIUrl":"10.4103/jcvjs.jcvjs_65_25","url":null,"abstract":"<p><strong>Background: </strong>The parameter of T1 slope (T1S) minus C2-7 cervical lordosis (CL) is relevant to the surgical management of cervical degenerative diseases (CDD), but whether it contributes to cervical approaches decision-making has not been reported in the literature prior.</p><p><strong>Purpose: </strong>The purpose of this study was to investigate surgical approach optimization based on T1S minus C2-7 CL in the perioperative management of CDD.</p><p><strong>Materials and methods: </strong>Three hundred sixty-six patients diagnosed with CDD were enrolled from 2018 to 2023. Grouped based on T1S-CL, a value of T1S-CL <20° defined as a matching group, and a value of T1S-CL >20° comprised a matching group. All patients underwent only cervical anterior or posterior approach surgery. Clinical indexes of the Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) and neck disability index (NDI), and radiologic parameters of T1S, CL, and sagittal vertical axis (C2-7 SVA) were recorded and analyzed.</p><p><strong>Results: </strong>Before surgery, there were significant differences in factors between the two groups for CL, T1S, and T1S-CL (<i>P</i> < 0.05). Postoperatively, clinical indexes and radiological parameters changed significantly (<i>P</i> < 0.001) in each group. There are significant correlations indicated between T1S and CL (<i>P</i> < 0.05) except for one in a mismatching group of posterior approach (<i>P</i> > 0.05) postoperatively. There are significant correlations indicated between T1S-CL and T1S, CL (<i>P</i> < 0.05) in two groups of anterior approaches except for posterior approaches (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>T1S-CL-based surgical approaches indicate that cervical anterior approaches are superior to posterior paths in improving and optimizing sagittal alignment. Posterior approaches may impair alignment in situations of T1S-CL <20°, and deteriorate malalignment established with conditions of T1S-CL >20°.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"180-187"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of atlantoaxial stabilization on juvenile idiopathic scoliosis involving Chiari malformation and syrinx.","authors":"Sen Harun Emre, Simsek Serkan, Kaptanoglu Erkan","doi":"10.4103/jcvjs.jcvjs_43_25","DOIUrl":"10.4103/jcvjs.jcvjs_43_25","url":null,"abstract":"<p><p>Idiopathic scoliosis (IS) is frequently associated with Chiari malformation (CM) and syringomyelia, conditions thought to share a common underlying cause: Atlantoaxial instability. Atlantoaxial stabilization has recently emerged as a novel treatment option. A 4-year-old girl presented with progressive scoliosis (Cobb angle of 28.6°), neck pain, CM, and syringomyelia. The patient was diagnosed with central or axial atlantoaxial instability and underwent C1-C2 fixation. Postoperatively, she experienced significant relief from neck pain. Follow-ups demonstrated progressive syrinx reduction, while X-rays revealed a Cobb angle decrease to 21° in 18 months. This case highlights the potential of atlantoaxial stabilization to halt scoliosis progression in IS patients with CM and syringomyelia. Unlike traditional multisegmental stabilization, C1-C2 fixation offers a minimally invasive approach and preserves spinal mobility in growth-age patients. Atlantoaxial instability should be considered in IS cases with CM and syringomyelia. Atlantoaxial stabilization alone may provide effective treatment with favorable clinical and radiological outcomes.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"250-253"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometric analysis of some important parameters for the transoral approach to the occipito-atlanto-axial region: MDCT study.","authors":"Musa Acar, Serdar Karaköse, Elif Iyiduran","doi":"10.4103/jcvjs.jcvjs_64_25","DOIUrl":"10.4103/jcvjs.jcvjs_64_25","url":null,"abstract":"<p><strong>Context: </strong>Transoral approach is a frequently preferred method for the craniocervical region. Interventions in this area are performed for decompression purposes or to provide craniocervical fixation. To get a good result, knowing the anatomy of the region in detail will make the entrepreneur's job much easier.</p><p><strong>Aims: </strong>The aim of the study is to contribute to the surgeons' perspective during the intervention by creating reference values in transoral approaches to the cervical region.</p><p><strong>Settings and design: </strong>This study is a retrospective descriptive file screening study.</p><p><strong>Methods: </strong>The study was performed using cranial computed tomography images of 200 patients. These patients consisted of 100 men and 100 women. The age range of the individuals included in the study varies between 20 and 80. In our study, the parameters measured and recorded in the coronal, sagittal, and axial plane.</p><p><strong>Statistical analysis used: </strong>SPSS 22 was used for statistical analysis.</p><p><strong>Results: </strong>In our study, seven different parameters were measured and recorded. Our results were evaluated between genders and in terms of lateralization. The obtained averages were tested statistically.</p><p><strong>Conclusions: </strong>To plan and conclude a successful surgical intervention, it is necessary to have a good command of the area to be operated on. The data we present in our study will help surgeons dealing with the region in this sense. In addition, our study will contribute to the creation of a database on healthy individuals in Turkish society.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"232-236"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of different posterior arthrodesis techniques versus anterior dens screw for odontoid fractures: A systematic review and meta-analysis.","authors":"Pavlos Texakalidis, Stavros Matsoukas, Michael Cloney, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler Koski, Nader S Dahdaleh","doi":"10.4103/jcvjs.jcvjs_42_25","DOIUrl":"10.4103/jcvjs.jcvjs_42_25","url":null,"abstract":"<p><strong>Background and objectives: </strong>Odontoid fractures are often managed surgically. The most common approaches are anterior dens screw (ADS) and posterior arthrodesis (PA), with the latter being associated with significantly higher fusion rates. PA techniques can include wiring, C1-C2 transarticular (TA) screws, and C1 lateral mass (LM)-C2 pars/pedicle screws. Most comparative studies group multiple PA techniques together when comparing PA versus ADS. Our objective was to systematically review the literature and identify studies that separately provide fusion rates of each different posterior C1-C2 arthrodesis (PA) technique utilized compared to ADS.</p><p><strong>Methods: </strong>A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effects meta-analysis was performed, and the <i>I²</i> statistic was used to assess heterogeneity.</p><p><strong>Results: </strong>In total, 15 studies comprising 685 patients (ADS: 377; wiring: 58; TA: 150; C1 LM-C2 pars/pedicle screws: 100). The average age of the patients ranged across the included studies between 22 and 82.4 years old. The mean last follow-up was >12 months in eight studies. Only two studies reported a follow-up period of <6 months. Most of the odontoid fractures were type II based on the Anderson-D'Alonzo classification. Use of C1 LM-C2 pars/pedicle screws was associated with significantly higher odds of fusion compared to ADS (C1 LM-C2 pars/pedicle: 97%; ADS: 87.2%; odds ratio [OR]: 3.89; 95% confidence interval [CI]: 1.34-11.29; <i>I^2:</i> 0%). TA screws were associated with significantly higher odds of fusion compared to ADS (TA: 98%; ADS: 87%; OR: 4.19; 95% CI: 1.67-10.47; <i>I^2:</i> 0%). There was no difference in the rate of fusion between wiring and ADS (wiring: 84.4%; ADS: 92.6%; OR: 0.34; 95% CI: 0.08-1.40; <i>I^2:</i> 48.8%).</p><p><strong>Conclusions: </strong>C1-C2 TA screws and C1 LM-C2 pars/pedicle screws are both associated with statistically significant higher rates of fusion compared to ADS for odontoid fractures. ADS showed higher rates of fusion compared to wiring, although this did not reach statistical significance.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"126-132"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}