Comparison of Atlantoaxial Rotation and Functional Outcomes of Two Nonfusion Techniques in the Treatment of Anderson-D’Alonzo Type II Odontoid Fractures

Study Design. A retrospective comparative study. Objective. The aim of this study was to compare the outcomes of anterior screw fixation and posterior temporary-fixation in the treatment of Anderson-D’Alonzo type II odontoid fractures. Summary of Background Data. Posterior C1-C2 temporary-fixation can spare the motion of C1-C2 in the treatment of odontoid fractures. However, it is unknown whether it can achieve the same outcomes as anterior screw fixation. Methods. Data of 20 patients who underwent posterior temporary-fixation due to Anderson-D’Alonzo type II odontoid fractures with intact transverse ligament were retrospectively reviewed. Another 20 patients undergoing anterior screw fixation were randomly selected as the control group. The range of motion (ROM) in rotation of C1-C2 measured on functional computed tomography (CT) scan and outcomes evaluated by the visual analog scale (VAS) for neck pain, neck stiffness, patient satisfaction, and neck disability index (NDI) were compared between two groups at the final follow-up. Results. At the final follow-up, 19 cases in each groups achieved facture healing. Total C1-C2 ROM in rotation on both sides in the posterior temporary-fixation group was 32.4 ± 12.5°, smaller than 40.0 ± 13.0 in the anterior fixation group. However, there was no statistical difference between two groups. And there was no significant difference between two groups in functional outcomes evaluated by VAS for neck pain, neck stiffness, patient satisfaction, and NDI. Conclusion. Posterior temporary-fixation can spare the motion of C1-C2 and achieve same good clinical outcomes as anterior screw fixation in the treatment of Anderson-D’Alonzo type II odontoid fractures. It was an ideal alternative strategy to anterior screw fixation. Level of Evidence: 3

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