Journal of Craniovertebral Junction and Spine

LETTER TO EDITOR
Year
: 2011  |  Volume : 2  |  Issue : 2  |  Page : 102-

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


S Meena 
 Department of Orthopaedics, JPN Apex trauma centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Correspondence Address:
S Meena
Department of Orthopaedics, JPN Apex trauma centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029
India




How to cite this article:
Meena S. Posterior transodontoid fixation (Kotli technique): Not for all odontoid fractures.J Craniovert Jun Spine 2011;2:102-102


How to cite this URL:
Meena S. Posterior transodontoid fixation (Kotli technique): Not for all odontoid fractures. J Craniovert Jun Spine [serial online] 2011 [cited 2020 Sep 28 ];2:102-102
Available from: http://www.jcvjs.com/text.asp?2011/2/2/102/100076


Full Text

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. [2],[3]

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.

References

1Kotil K, Köksal NS, Kayaci S. Posterior transodontoid fixation: A new fixation (Kotil) technique. J Craniovertebr Junction Spine 2011;2:41-5.
2Song GS, Theodore N, Dickman CA, Sonntag VK. Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg 1997;87:851-5.
3Nichols LA, Mukherjee DP, Ogden AL, Sadasivan KK, Albright JA. A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation. J Long Term Eff Med Implants 2005;15:33-8.