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Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We h...

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Autores principales: Munakomi, Sunil, Tamrakar, Karuna, Chaudhary, Pramod Kumar, Bhattarai, Binod
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000Research 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133680/
https://www.ncbi.nlm.nih.gov/pubmed/27990259
http://dx.doi.org/10.12688/f1000research.9131.2
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author Munakomi, Sunil
Tamrakar, Karuna
Chaudhary, Pramod Kumar
Bhattarai, Binod
author_facet Munakomi, Sunil
Tamrakar, Karuna
Chaudhary, Pramod Kumar
Bhattarai, Binod
author_sort Munakomi, Sunil
collection PubMed
description Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail  our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous  in clinical set ups lacking state of the art facilities.  Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study. Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing  patients in developing nations having rudimentary neurosurgical set up.
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spelling pubmed-51336802016-12-16 Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients Munakomi, Sunil Tamrakar, Karuna Chaudhary, Pramod Kumar Bhattarai, Binod F1000Res Clinical Practice Article Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail  our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous  in clinical set ups lacking state of the art facilities.  Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study. Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing  patients in developing nations having rudimentary neurosurgical set up. F1000Research 2016-11-21 /pmc/articles/PMC5133680/ /pubmed/27990259 http://dx.doi.org/10.12688/f1000research.9131.2 Text en Copyright: © 2016 Munakomi S et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Practice Article
Munakomi, Sunil
Tamrakar, Karuna
Chaudhary, Pramod Kumar
Bhattarai, Binod
Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title_full Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title_fullStr Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title_full_unstemmed Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title_short Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
title_sort anterior single odontoid screw placement for type ii odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients
topic Clinical Practice Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133680/
https://www.ncbi.nlm.nih.gov/pubmed/27990259
http://dx.doi.org/10.12688/f1000research.9131.2
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