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Predisposing Components of Fracture Nonunion After Posterior C1 Lateral Mass Screws Mixed with C2 Pedicle/Laminar Screw Fixation for Sort II Odontoid Fracture.

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Predisposing Components of Fracture Nonunion After Posterior C1 Lateral Mass Screws Mixed with C2 Pedicle/Laminar Screw Fixation for Sort II Odontoid Fracture.

World Neurosurg. 2018 Jan;109:e417-e425

Authors: Wang H, Wang Q, Ma L, Yang D, Ding W

Summary
INTRODUCTION: The intention of this examine was to discover the predisposing components for fracture nonunion after a lateral screw was mixed with C2 pedicle/laminar screw for a kind II odontoid fracture and hopefully present references in determination making and surgical planning for spinal surgeons.
METHODS: This can be a retrospective examine. By retrieving the medical data from January 2010 to July 2015 in our hospital, 117 sort II odontoid fracture sufferers had been reviewed. In line with the incidence of fracture union on the last follow-up, sufferers had been divided into 2 teams: union and nonunion. To analyze the predisposing components for fracture nonunion, three categorized components had been analyzed statistically: affected person characteristics-age, intercourse, physique mass index, preoperative Japanese Orthopaedic Affiliation (JOA) scores, length, comorbidity, and sophisticated accidents; surgical variables-surgery time, blood loss, C2 fixation method, vertebral artery harm, bone supply for fusion between the posterior arch of C1 and the laminae and spinous technique of C2; radiographic parameters-preoperative and speedy postoperative knowledge of C0-2 curvature, C2-7 curvature, C2-7 sagittal vertical axis, C7 slope, fracture classification, congenital hypoplastic vertebral artery, and the separation and displacement of the odontoid fracture. Different variables together with JOA and visible analog scale scores for neck ache, neck stiffness, and affected person satisfaction at last follow-up had been recorded and in contrast between the two teams.
RESULTS: Postoperative fracture nonunion was detected in 76 of 117 sufferers (65%) at last follow-up. There was no statistically vital distinction between the two teams in affected person traits of intercourse, physique mass index, JOA rating, comorbidity, and sophisticated accidents. The imply age at operation was youthful within the union group than within the nonunion group, and the imply length was shorter within the union group than within the nonunion group. There was no distinction in surgical variables of surgical procedure time, blood loss, C2 fixation method, vertebral artery harm, bone supply for fusion between the posterior arch of C1 and the laminae and spinous technique of C2. There was no distinction in radiographic parameters of fracture classification, congenital hypoplastic vertebral artery, preoperative and speedy postoperative C0-2 curvature, C2-7 curvature, C2-7 SVA, and C7 slope. No distinction was present in preoperative and speedy postoperative displacement of the odontoid fracture or speedy postoperative separation of the odontoid fracture, whereas the preoperative separation of the odontoid fracture was shorter within the union group than within the nonunion group. The logistic regression evaluation revealed that superior age (>45 years), lengthy length (>2 months), and preoperative separation of the odontoid fracture (>four mm) had been independently related to the postoperative fracture nonunion. There have been no variations between the two teams in JOA, neck ache, neck stiffness, and affected person satisfaction at last follow-up.
CONCLUSIONS: Superior age, lengthy length, and preoperative separation of odontoid fracture >four mm are predisposing components for fracture nonunion after posterior C1 lateral screw mixed with C2 pedicle/laminar screw fixation for sort II odontoid fracture. Our findings didn’t exhibit any proof of decrease practical final result and sufferers satisfaction for these sufferers who had odontoid nonunion.

PMID: 29017980 [PubMed – indexed for MEDLINE]

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