Comparative study between percutaneous anterior screw fixation and open surgery for treatment of odontoid process fracture

Objective:To compare the clinical results of percutaneous anterior screw fixation with conventional open surgery for the treatment of odontoid process fractures,and to assess the clinical value of the minimally invasive technique.Method:From March 2003 to June 2007,22 patients with type Ⅱ and shallow type Ⅲ odontoid process fractures were treated by anterior screw fixation.Mean age was 41.9 years old(range,25-65).10 patients who underwent percutaneous anterior screw fixation were set as the percutaneous fixation group and the other 12 patients who underwent open anterior screw fixation were set as the open fixation group.Clinical results of patients were compared in two groups.Result:The average operative time was 41minutes(range,36-55 minutes) for the percutaneous fixation group,with an average blood loss of 3ml(range,0.5-5ml).At follow-up of average 7.2 months(range,4-15 months),bony union was found in 9 cases,nonunion in one case without clinical symptom. No other complication occurred. The average operative time was 75 minutes(range,56-110 minutes) for the open fixation group,with a average blood loss of 36ml(range,20-65ml).At follow-up of average 28.9 months(range,5-47 months),bony union was found in 11 cases,nonunion in one case without clinical symptom. The transient hoarseness occurred in one patient.Conclusion:Percutaneous anterior screw fixation may obtain the same clinical result as open surgery in treating type Ⅱ and shallow type Ⅲ odontoid process fractures,but it has shorter operative time and less trauma.