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Advantages of Direct Insertion of a Straight Probe Without a Guide Tube During Anterior Odontoid Screw Fixation of Odontoid Fractures.

Spine 2016 May
STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: The aim of this study was to compare the anterior odontoid screw fixation (AOSF) with a guide tube or with a straight probe.

SUMMARY OF BACKGROUND DATA: AOSF associates with several complications, including malpositioning, fixation loss, and screw breakage. Screw pull-out from the C2 body is the most common complication.

METHODS: All consecutive patients with type II or rostral shallow type III odontoid fractures who underwent AOSFs during the study period were enrolled retrospectively. The guide-tube AOSF method followed the standard published method except C3 body and C2-3 disc annulus rimming was omitted to prevent disc injury; instead, the guide tube was anchored at the anterior inferior C2 vertebra corner. After 2 screw pull-outs, the guide-tube cohort was analyzed to identify the cause of instrument failure. Thereafter, the straight-probe method was developed. A guide tube was not used. A small pilot hole was made on the most anterior side of the inferior endplate, followed by insertion of a 2.5 mm straight probe through the C2 body. Non-union and instrument failure rates and screw-direction angles of the guide-tube and straight-probe groups were recorded.

RESULTS: The guide-tube group (n = 13) had 2 screw pull-outs and 1 non-union. The straight-probe group (n = 8) had no complications and significantly larger screw-direction angles than the guide-tube group (60.5 ± 4.63 vs. 54.8 ± 3.82 degrees; P = 0.047).

CONCLUSION: Straight-probe AOSF yielded larger direction angles without injuring bone and disc. Complications were absent. The procedure was easier than guide-tube AOSF and assured sufficient engagement, even in horizontal fracture orientation cases.

LEVEL OF EVIDENCE: 3.

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