Posttraumatic axis dens pseudoarthrosis: report of 12 cases managed via modified craniocervical fusion and anterior screw fixation

  • А. М. Киселев Department of Neurosurgery Moscow Regional Scientific Research Clinical Institute, Moscow, Russia
  • П. В. Кротенков Department of Neurosurgery Moscow Regional Scientific Research Clinical Institute, Moscow, Russia
Keywords: axis dens pseudoarthrosis, craniocervical fusion, odontoid screw fixation, osteogenesis, spinal fixation, surgical technique

Abstract

Objectives: surgical management of the axis dens pseudoarthrosis remains controversial due to the complex anatomy and biomechanics of this region. The current management strategy for this pathology is posterior atlanto-axial fusion or combined anterior and posterior fusion utilizing various bone and metallic constructs. Anterior fusion or direct screw fixation alone, showed unacceptably high rate offailure and are not currently recommended. Methods: in this paper we report experience of the 12 patients with the axis dens pseudoarthrosis managed utilizing alternative strategy: modified posterior occipitocervical fusion to stabilize the craniovertebral junction, followed by direct odontoid screw fixation to fix the mobile fracture fragment, to perform the destruction of the false joint and permit the refilling of the defect with new fibrocartilaginous callus, drawing osteogenesis from the periosteum across the fracture gap. Results: we were able to achieve excellent clinical results in all patients. Follow-up examinations showed successful bone union at both sides and no hardware-related or infection complications. Conclusions: in axis dens pseudoarthrosis posterior craniocervical fusion must resist movement in eight degrees offreedom, with inclusion to the fixation of the occiput, atlant and the axis and supplemented by odontoid screw fixation to provide proliferative reaction on the bone ends.

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Posttraumatic axis dens pseudoarthrosis: report of 12 cases managed via modified craniocervical fusion and anterior screw fixation
Published
2007-05-31
How to Cite
Киселев, А., & Кротенков, П. (2007). Posttraumatic axis dens pseudoarthrosis: report of 12 cases managed via modified craniocervical fusion and anterior screw fixation. Bulletin of the International Scientific Surgical Association, 2(2-3), 27-31. Retrieved from http://surgjournal.ru/index.php/BISSA/article/view/193
Section
Original Articles