Purpose

The primary goal of this study was to conduct a systematic review and meta-analysis of articles focused on odontoid screw fixation (OSF) and screw-related complications or non-union rates.

Methods

We conducted a systematic review of the PubMed and Crossref databases between January 1982 and December 2019. Inclusion criteria comprised detailed descriptions of the surgical technique and screw-related complications (screw cut-out, loosening, breakage, malposition) or fusion rates.

Results

The initial selection consisted of 683 abstracts. A total of 150 full texts were chosen for detailed study, and 83 articles were included in the analysis. The point estimates for screw-related complications were as follows: 1. screw malposition frequency—4.8%; 2. screw cut-out rate—5.0%; 3. screw loosening/pull-out—3.8%; and 4. screw fracture rate—3.1%. The point estimate for the non-union rate was 9.7%. Statistical analysis of the screw-related complications rate based on surgical technique details was also performed

Conclusions

Double-screw OSF performance in elder patients resulted in a higher risk of post-operative screw cut-out. In other cases, the development of screw-related complications did not depend on the method of intraoperative head fixation, selection of the implant entry point for OSF, type of the used screws, or cannulated instruments application. The outcomes of single-screw fixation through the anterior lip of the C2 vertebra were comparable to other techniques of OSF. Further, statistically reliable studies should be carried out to identify the optimal technique of OSF.

中文翻译：

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齿状突螺钉固定技术对螺钉相关并发症和融合率的影响：系统评价和荟萃分析。

目的

这项研究的主要目的是对侧重于齿状突螺钉固定（OSF）和螺钉相关并发症或不愈合率的文章进行系统的回顾和荟萃分析。

方法

我们在1982年1月至2019年12月之间对PubMed和Crossref数据库进行了系统评价。纳入标准包括对手术技术和螺钉相关并发症（螺钉切开，松动，断裂，错位）或融合率的详细描述。

结果

最初的选择包括683个摘要。总共选择了150篇全文进行详细研究，分析中包括83篇文章。螺钉相关并发症的要点估计如下：1.螺钉位置不正确的频率为4.8％；2.螺丝开孔率：5.0％；3.螺钉松动/拉出— 3.8％；4.螺钉断裂率-3.1％。不工会率的点估计为9.7％。还根据手术技术细节对螺钉相关并发症发生率进行了统计分析

结论

老年患者的双螺杆OSF表现导致术后螺丝切除的风险更高。在其他情况下，与螺钉相关的并发症的发生并不取决于术中头部固定的方法，OSF植入物进入点的选择，所用螺钉的类型或空心器械的应用。通过C2椎骨前唇进行单螺钉固定的结果与其他OSF技术相当。此外，应进行统计学上可靠的研究，以确定OSF的最佳技术。