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Rhinology/Allergy

(470) Systematic Review and Meta-Analysis of Fixation in Relation to Odontoidectomy

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Paavali A. Hannikainen, BS: No relevant relationships to disclose.
Jeremy T. Zack, BS: No relevant relationships to disclose.
Patrick D. Kelly, MD, MSCI: No relevant relationships to disclose.
Marc R. Rosen, MD: No relevant relationships to disclose.


Introduction: Various pathologies necessitate resection of the odontoid process resulting in instability at the craniovertebral junction. Although odontoidectomy and fusion of cervical spine has been described in the literature, discussion on separate, staged, multi-day surgeries for these two procedures has not been explicitly explored.

Methods: A systematic review of articles was performed by searching MEDLINE, CINAHL, Cochrane, and ProQuest databases with the search terms “odontoidectomy” and (“fixation” or “fusion” or “arthrodesis”) for all date ranges. Results were uploaded to Covidence software for analysis by two reviewers. Articles that identified at which point fixation is done in relation to odontoidectomy were included in the study. Data on the number of articles and patients, dates of publication, age of patients, and indications for surgery were extracted.

Results: The review found 226 unique articles for screening as of December 2022. 132 articles were selected for full-text analysis with inclusion of 70 articles. 397 patients (81.2%) from 39 articles (55.7%) had odontoidectomy and fixation during the same anesthesia period (O+F), 30 patients (6.1%) from 14 articles (20.0%) had fixation after odontoidectomy as separate anesthesia periods (O,F), 29 patients (5.9%) from 11 articles (15.7%) had no fixation (N), and 23 patients (4.7%) from 6 articles (8.6%) had fixation before odontoidectomy (F,O). Articles for all approaches included pediatric and adult patients. 42.0% of patients undergoing O+F had atlantoaxial dislocation as the indication for surgery compared to 13.8% for F,O and 7.0% for O,F.

Conclusions: O+F is the most common method of approach to cervical spine instability after odontoidectomy in literature. A greater proportion of O+F articles were large case series, meanwhile, a greater proportion of O,F and F,O approaches were case reports. Both pediatric and adult patients have been reported to undergo F,O, O+F, and O,F approaches. Atlantoaxial dislocation in literature is more commonly operated with O+F approach, rather than F,O and O,F approaches.