A Modified Posterior C1/C2 Fusion Technique for the Management of Traumatic Odontoid Type II Fractures by Using Intraoperative Spinal Navigation: Midterm Results.

OBJECTIVES

To assess midterm safety and efficacy of a modified Goel-Harms technique for the treatment of odontoid instabilities.

DESIGN

Longitudinal prospective cohort study.

SETTING

Urban Level 1 Trauma Center in Southwest Germany.

PATIENTS/

PARTICIPANTS

Orthopaedic and neurosurgical trauma patients older than 18 years admitted for ≤24 hours.

MAIN OUTCOME MEASUREMENTS: The outcome was evaluated with respect to neurological outcome, radiological outcome and surgical complications. For the functional assessment, the EQ-5D questionnaire was used. Furthermore, the Neck Disability Index and visual analog scale for neck pain were determined. A median follow-up of 39 months (range: 6-97 months) was given.

RESULTS

Of the total sample (n = 56), 26 patients with an acute traumatic odontoid fracture type II underwent posterior atlantoaxial instrumentation using spinal navigation. Neck pain evaluated with visual analog scale and Neck Disability Index showed a significant decrease at final follow-up compared to preoperative values (P < 0.05). According to the EQ-5D, the valuation of quality of life after C1/C2 fusion showed an excellent outcome with complete recovery in most cases (0.7-1).

CONCLUSIONS

Our results demonstrate satisfactory and maintained midterm clinical and radiological results after a median follow-up of 39 months. With the use of intraoperative spinal navigation, we demonstrate a modified C1/C2 posterior fusion technique, rendering accuracy, feasibility, and overall safety.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.