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Review
. 2023 Dec 26;19(4):409-421.
doi: 10.13004/kjnt.2023.19.e64. eCollection 2023 Dec.

Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review

Woong Rae Jo  1 , Chang-Young Lee  1 , Sae Min Kwon  1 , Chang-Hyun Kim  1 , Min-Yong Kwon  1 , Jae Hyun Kim  1 , Young San Ko  1
Affiliations
Review

Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review

Woong Rae Jo et al. Korean J Neurotrauma. .

Abstract

Objective: Odontoid fractures are treated surgically through the anterior or posterior approach. Each surgical approach has its advantages and disadvantages, so the preferred approach remains debatable. There are few meta-analyses or systemic reviews on the mechanical complications of surgical treatment for odontoid fractures. This meta-analysis aimed to compare the operation-related morbidity, including mechanical complications, and mortality of patients with odontoid fractures, treated via the anterior or posterior approach.

Methods: A systematic search was performed on PubMed/Medline, Embase, and the Cochrane Library for the studies up to October 2023 on the complication rate of the surgical treatment of odontoid fractures, related to the surgical approach. The risk ratios (RR) with the 95% confidence intervals (CIs) were pooled to assess the mechanical complication rates, other complications, revision surgery, and mortality, depending on the surgical approach.

Results: A total of 1,519 studies were retrieved using the search strategy, and 782 patients from 15 articles were included in this meta-analysis. Mechanical complications were significantly more frequent in the anterior surgical group with low heterogeneity. The incidences of fracture nonunion and revision surgery were also higher in the anterior surgery group. However, there was no significant difference in systemic complications and mortality rates between the two groups.

Conclusion: The posterior approach was more advantageous than the anterior approach in terms of mechanical complications, fusion rates, and incidence of revision surgery. However, further studies, should be performed to strengthen these results.

Keywords: Arthrodesis; Complications; Fracture fixation; Meta-analysis; Odontoid process; Spinal fractures.

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Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Figures

FIGURE 1
FIGURE 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart detailing the search strategy and studies selection.
FIGURE 2
FIGURE 2. Forest plot comparing mechanical complication of anterior and posterior approach.
CI: confidence interval.
FIGURE 3
FIGURE 3. (A) Forest plot comparing systemic complication of anterior and posterior approach. (B) Forest plot comparing mortality of anterior and posterior approach. (C) Forest plot comparing non-union of anterior and posterior approach. (D) Forest plot comparing revision surgery of anterior and posterior approach.
CI: confidence interval.
See this image and copyright information in PMC

References

    1. Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56:1663–1674. - PubMed
    1. Andersson S, Rodrigues M, Olerud C. Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J. 2000;9:56–59. - PMC - PubMed
    1. Apfelbaum RI, Lonser RR, Veres R, Casey A. Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg. 2000;93(Suppl):227–236. - PubMed
    1. Bao X, Chen Y, Guo C, Xu S. Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review. Front Surg. 2023;10:1125665. - PMC - PubMed
    1. Barrey CY, di Bartolomeo A, Barresi L, Bronsard N, Allia J, Blondel B, et al. C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing. Eur Spine J. 2021;30:1574–1584. - PubMed

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