Anterior odontoid screw fixation extrusion as reason for oesophagus perforation
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Abstract
Background. Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation. Purpose. The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment.
Methods. This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases ‘odontoid fracture perforation’ and ‘anterior cervical spine perforation’. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration.
Result. The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary.
Conclusion. Patients with oesophageal perforation should be treated with special care.
Keywords: anterior odontoid screw fixationoesophagus perforationodontoid fracture
References
- Tian NF, Hu XQ, Wu LJ, et al. Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation. PLoS One. 2014; 9(7): e103065.
- Kau RL, Kim N, Hinni ML, et al. Repair of esophageal perforation due to anterior cervical spine instrumentation. Laryngoscope. 2010; 120(4): 739–742.
- Nourbakhsh A, Shi R, Vannemreddy P, et al. Operative versus nonoperative management of acute odontoid Type II fractures: a meta-analysis. J Neurosurg Spine. 2009; 11(6): 651–658.
- Bohlman HH. Complications of treatment of fracture dislocations of the cervical spine. In: Complications in orthopedic surgery, ed. CH Epps, JB Lippincott. 1978; 2: 622–623.
- Lee JS, Kang DH, Hwang SH, et al. Oral extrusion of screw after anterior cervical interbody fusion. J Korean Neurosurg Soc. 2008; 44(4): 259–261.
- Lee EJ, Jang JW, Choi SHo, et al. Delayed pharyngeal extrusion of an anterior odontoid screw. Korean J Spine. 2012; 9(3): 289–292.
- Chun HJ, Bak KH, Kang TH, et al. Rod migration into the posterior fossa after harms operation : case report and review of literatures. J Korean Neurosurg Soc. 2010; 47(3): 221–223.
- Kim SJ, Ju CIl, Kim DM, et al. Delayed esophageal perforation after cervical spine plating. Korean J Spine. 2013; 10(3): 174–176.
- Anderson LD, D'Alonzo RT, Anderson LD, et al. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974; 56(8): 1663–1674.
- Osti M, Philipp H, Meusburger B, et al. Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J. 2011; 20(11): 1915–1920.
- Cho DC, Sung JK. Analysis of risk factors associated with fusion failure after anterior odontoid screw fixation. Spine (Phila Pa 1976). 2012; 37(1): 30–34.
- Koivikko MP, Kiuru MJ, Koskinen SK, et al. Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process. J Bone Joint Surg Br. 2004; 86(8): 1146–1151.
