Journal of Neurosurgical Sciences 2020 Feb 10

DOI: 10.23736/S0390-5616.20.04886-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Minimally invasive percutaneous anterior odontoid screw fixation: institutional experience with a simple and effective technique

Giuseppe E. UMANA ¹ ✉, Massimiliano VISOCCHI ², Gianluca SCALIA ³, Maurizio PASSANISI ¹, Marco FRICIA ¹, Saverio FAGONE ¹, Giovanni NICOLETTI ⁴, Salvatore CICERO ¹

¹ Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy; ² Craniovertebral Junction Operative Unit and Master CVJ Surgical Approach Research Center, Institute of Neurosurgery, Policlinic “A. Gemelli”, Catholic University, Rome, Italy; ³ Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy; ⁴ Department of Neurosurgery, ARNAS Garibaldi, Catania, Italy

BACKGROUND: To show a novel modified technique to perform minimally invasive anterior odontoid screw fixation.
METHODS: Twenty-nine patients with a mean age of 45 years were treated with a modified percutaneous anterior odontoid screw fixation. All patients were affected by Type II or rostral shallow Type III odontoid fractures. A modified guide tube was used in all these patients, with reduction of soft tissue dissection for percutaneous approach.
RESULTS: There were no complications related to the modified technique. Good results and optimal screw placement were achieved in 28 out of 29 patients. Only in 1 patient we observed, after mobilization, screw displacement, probably due to severe osteoporosis.
CONCLUSIONS: In our opinion, this modified percutaneous minimally invasive technique for anterior odontoid screw fixation, along with the use of a soft tissue dilator not fixed to the spine, has not yet been reported in literature and is strongly recommended to reduce invasiveness of odontoid screw placement.

KEY WORDS: Vertebral fractures; Craniovertebral junction; Odontoid; Kirschner wire; Lag screw