Literature DB >> 23125500

Posterior transodontoid fixation (Kotli technique): Not for all odontoid fractures.

S Meena1.   

Abstract

Entities:  

Year:  2011        PMID: 23125500      PMCID: PMC3485996          DOI: 10.4103/0974-8237.100076

Source DB:  PubMed          Journal:  J Craniovertebr Junction Spine        ISSN: 0974-8237


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Sir, I read with great interest the manuscript by Kotli et al. “Posterior transodontoid fixation: A new fixation (Kotli) technique”.[1] I must congratulate the authors for the case report. However, I would like to draw attention of authors and readers to the following: Transverse fractures or oblique fractures in which fracture line runs from anterosuperior to posteroinferior cannot be stabilized with the technique described by the authors. As emphasized by the authors in their manuscript, the most important fact in the treatment of odontoid fractures is placing the screw in compression. In a fracture that runs from anterosuperior to posteroinferior, interfragmentary compression may not be possible with Kotli technique and it may worsen fracture displacement. These types of fractures can be best managed by anterior odontoid screw. Transarticular screw placement across C1–C2 may be contraindicated in up to 20% of specimens on at least one side because of anatomical variations or other pathological processes.[2] If there is anatomical variation on the side (nondominant VA side) where one has to use the transarticular screw then this method cannot be used. The authors did not use any collar postoperatively. In my opinion unilateral transarticular fixation does not confer adequate stability. All the studies which the authors have quoted in support of unilateral transarticular fixation have used rigid collar for 6-8 weeks postoperatively.[2] Moreover they also used concomitant posterior wiring.[23] Although the technique showed good result in the case report but it cannot be generalized to all cases of odontoid fractures. Warm regards and once again congratulations for the research. In first paragraph of discussion the word instable should be unstable.
  3 in total

1.  A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation.

Authors:  Lois Ann Nichols; Debi P Mukherjee; Alan L Ogden; Kalia K Sadasivan; James A Albright
Journal:  J Long Term Eff Med Implants       Date:  2005

2.  Unilateral posterior atlantoaxial transarticular screw fixation.

Authors:  G S Song; N Theodore; C A Dickman; V K Sonntag
Journal:  J Neurosurg       Date:  1997-12       Impact factor: 5.115

3.  Posterior transodontoid fixation: A new fixation (Kotil) technique.

Authors:  Kadır Kotil; Neslihan Sütpideler Köksal; Selim Kayacı
Journal:  J Craniovertebr Junction Spine       Date:  2011-01
  3 in total

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