Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis: a meta-analysis

  • Li Baogui
  • Chen JuwenEmail author
Orthopaedic Surgery



For odontoid fractures, surgical treatment approaches including anterior odontoid screw fixation approach and the posterior C1–C2 arthrodesis approach are generally adopted in practice. However, the choice of different surgical procedures remains controversial. In addition to surgical technique, the fusion rate is an important factor contributing to the clinical efficacy. Therefore, this study was aimed to investigate the discrepancy in fusion rate between these two surgical approaches through synthesizing the currently available evidence on the topic.


A computerized search of Ovid, Medline, Embase, and the Cochrane library up to December 2017 for literature on the complication rate during odontoid fracture treatment was conducted. Risk ratio (RR) with its 95% confidence interval (CI) was pooled to assess fusion rates after surgical treatments, including anterior odontoid screw fixation approach or posterior C1–2 arthrodesis procedure, for patients with odontoid fractures.


Thirteen studies were enrolled in the meta-analysis. Results show that no significant difference was found in the overall fusion rate (RR = 0.96, 95% CI 0.90–1.01). There was no significant heterogeneity among the studies (p value = 0.60). As to age- and economic-level subgroups, there was no statistical evidence to suggest an association of the patient age and economy development level with the choice of surgical approach. However, it is shown that better fusion rates of patients (≥ 60 years) in developed countries received a better fusion rates after posterior fixation compared with anterior group using the fixed-effect model (RR = 0.88, 95% CI 0.79–0.98).


Elderly patients (≥ 60 years) underwent posterior C1–2 arthrodesis fixation shows higher fusion rates in developed countries comparing with patients who underwent anterior odontoid screw fixation. Overall, there is no significant discrepancy between these two surgical approaches. However, the conclusion should be verified by further study enrolling larger sample size.


Odontoid fractures Anterior odontoid screw Posterior C1–2 arthrodesis Complication rate Meta-analysis 



We thank the research team in the Orthopedics Department of Tian Jin 4th Center Hospital for their assistance with the study.

Author contributions

LB and CJ contribute equally to the paper. They together designed the research. LB analysed the data and prepared the typescript. CJ revised the manuscript. The other authors provided the subject data. Both two authors read and approved the final manuscript.


The authors declare that there is no funding support for this study.

Compliance with ethical standards

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work; there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis:A meta-analysis”.

Ethical approval

The study was approved by the Medical Ethics Committee of Tian Jin 4th Center Hospital, Tianjin, China.

Consent to publish

All authors Li Baogui and Chen Juwen of this paper “Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1–C2 arthrodesis:A meta-analysis” consent to publish on BMC Musculoskeletal Disorders once it is accepted.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopedics DepartmentTian Jin 4th Center HospitalTianjinChina

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